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Reply: Double vitrification and warming does not compromise the chance of live birth—a potential invalid conclusion 答复:双重玻璃化和升温不会影响活产机会--一个潜在的无效结论
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-01-04 DOI: 10.1093/hropen/hoad050
S. Makieva, M. Sachs, Min Xie, Ana Velasco, Samia El-Hadad, D. R. Kalaitzopoulos, Ioannis Dedes, R. Stiller, B. Leeners
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引用次数: 0
Influence of ovarian stromal cells on human ovarian follicle growth in a 3D environment 三维环境中卵巢基质细胞对人类卵泡生长的影响
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-21 DOI: 10.1093/hropen/hoad052
M. Grubliauskaitė, H. Vlieghe, S. Moghassemi, A. Dadashzadeh, A. Camboni, Ž. Gudlevičienė, C. Amorim
Do ovarian stromal cells (OSCs) influence the viability and growth of human pre-antral follicles in vitro? A feeder layer of oSCs promotes the growth and transition of low developmental stage follicles to the primary/secondary stage while maintaining a high proportion of viable follicles. In the ovary, follicles rely on the support of ovarian cells, which secrete essential factors for their survival and development. This phenomenon has also been demonstrated in vitro through the 3D culture of isolated mouse primary and secondary follicles on a feeder layer of ovarian stromal cells. This co-culture notably enhances follicle survival and growth. Pre-antral follicles were isolated from human frozen-thawed ovarian tissue (OT) biopsies and then encapsulated in 1% alginate scaffolds. These embedded pre-antral follicles were either placed directly on the OSCs feeder layer or at the bottom of a culture dish for a 7-day in vitro culture (control). The study compared follicle viability, growth and hormone production between the different groups. Primordial/intermediate and primary follicles were isolated from frozen-thawed OT of cancer patients (n = 6). Ovarian stromal cells were then isolated from OT of post-menopausal women and cultured as a feeder layer. Follicle diameter was measured on days 0 and 7 using an inverted microscope to assess their development based on the increase in diameter. Viability was evaluated by staining a subset of follicles (n = 87) with calcein AM and ethidium homodimer-I, followed by classification into healthy/minimally damaged and damaged/dead follicles using confocal fluorescence microscopy. Additionally, estradiol levels were measured using ELISA. A total of 382 human preantral follicles (370 primordial/intermediate and 12 primary) with a mean diameter of 40.8 ± 9.9 µm (mean±SD) were isolated, embedded in 1% alginate hydrogel, and placed either on a monolayer of oSCs or directly on the plastic. By Day 7, the preantral follicles showed a significant size increase under both culture conditions (p < 0.0001 for D0 vs D7). The mean diameter of follicles (quiescent and growing) cultured on the feeder layer was 80.6 ± 11.0 μm compared to 67.3 ± 7.2 μm without it (p = 0.07). During the 7-day in vitro culture, the viability of the follicles significantly decreased only in the group without an OSCs monolayer compared to the D0 viability (p < 0.05). Additionally, more follicles transitioned to a higher developmental stage in the presence of OSCs (D0 primordial/intermediate: 184, primary: 7 vs D7 primordial/intermediate: 51, primary/secondary: 93) compared to those cultured without OSCs (D0 primordial/intermediate: 186, primary: 5 vs D7 primordial/intermediate: 84, primary/secondary: 65; p < 0.001). Specifically, 66 and 44 follicles reached the secondary stage (75 < x < 200 μm) in the presence and absence of OSCs, respectively. Moreover, the estradiol level was significantly higher (p = 0.006) i
卵巢基质细胞(OSCs)会影响体外人类前青春期卵泡的活力和生长吗? 卵巢基质细胞哺育层可促进低发育阶段卵泡的生长和向初级/次级阶段的过渡,同时保持高比例的存活卵泡。 在卵巢中,卵泡依赖卵巢细胞的支持,而卵巢细胞会分泌卵泡生存和发育所必需的因子。通过在卵巢基质细胞供养层上对分离的小鼠初级和次级卵泡进行三维培养,这一现象在体外也得到了证实。这种共培养显著提高了卵泡的存活和生长。 从冷冻解冻的人类卵巢组织(OT)活检组织中分离出前青春期卵泡,然后将其包裹在 1%的海藻酸盐支架中。将这些包埋的前前卵巢卵泡直接放置在卵母细胞养料层上,或放置在培养皿底部进行为期 7 天的体外培养(对照组)。研究比较了不同组别的卵泡活力、生长和激素分泌情况。 研究人员从冷冻解冻的癌症患者(6 人)OT 中分离出原始/中期卵泡和初级卵泡。然后从绝经后妇女的卵巢组织中分离出卵巢基质细胞,并将其作为供养层进行培养。在第 0 天和第 7 天使用倒置显微镜测量卵泡直径,根据直径的增加情况评估卵泡的发育情况。用钙黄绿素 AM 和乙二胺同二聚体-I 对一部分卵泡(n = 87)进行染色,然后用共聚焦荧光显微镜将卵泡分为健康/轻度受损卵泡和受损/死亡卵泡,从而评估卵泡的存活率。此外,还使用酶联免疫吸附法测定了雌二醇水平。 共分离出 382 个平均直径为 40.8 ± 9.9 µm(平均值±SD)的人类前胚乳卵泡(370 个原始/中期卵泡和 12 个初级卵泡),将其包埋在 1%的藻酸盐水凝胶中,然后放在单层 oSCs 上或直接放在塑料上。到第 7 天时,在两种培养条件下,前胚乳卵泡的大小都有显著增加(D0 与 D7 比较,p < 0.0001)。在饲养层上培养的卵泡(静止和生长)的平均直径为 80.6 ± 11.0 μm,而不在饲养层上培养的卵泡的平均直径为 67.3 ± 7.2 μm(p = 0.07)。在为期7天的体外培养过程中,与D0的存活率相比,只有无OSCs单层组的卵泡存活率显著下降(p < 0.05)。此外,在有 OSCs 存在的情况下,更多的卵泡过渡到了更高的发育阶段(D0 初级/中级:184 个,初级:7 个 vs D7 个):184, primary: 7 vs D7 primordial/intermediate:51,初级/中级:93)相比(D0 初级/中级:186,初级:5 vs D7 初级/中级:51,初级/中级:93):186, primary: 5 vs D7 primordial/intermediate:84,初级/中级:65;p <0.001)。具体来说,在有 OSCs 和没有 OSCs 的情况下,分别有 66 个和 44 个卵泡达到二级阶段(75 < x < 200 μm)。此外,与不使用 OSCs 培养的卵泡(29.9 ± 4.0 pg/ml)相比,使用 OSCs 培养的含有原始卵泡和生长卵泡的藻酸盐珠中的雌二醇水平(54.1 ± 14.2 pg/ml)明显更高(p = 0.006)。 不适用 该研究采用的是短期培养法,原始/中期/初级卵泡均未达到前列期。需要进行进一步的体外研究,以调查藻酸盐支架与人类卵巢基质细胞的卵泡发育能力、生理学和类固醇生成情况。 长期以来,在体外短期培养中激活人类原始/中期卵泡并使其生长到二级阶段一直是一项挑战。然而,与人类卵巢基质细胞共同培养显示出克服这一限制的潜力。 本研究得到了比利时国家科学研究基金会(FNRS-PDR Convention grant number T.0004.20,授予 C.A.A.;博士奖学金授予 H.V.)、卢万基金会(Fondation Louvain,授予 C.A.A.;博士奖学金授予 S.M.)的资助、作为 Frans Heyes 先生遗产的一部分,以及作为 Ilse Schirmer 夫人遗产的一部分,授予 A.D. 的博士奖学金)、抗癌基金会(授予 A.C. 2018-042 号补助金)以及欧洲共同体结构基金和立陶宛研究理事会(协议注册号:D-19-0874)。作者无利益冲突需要声明。
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引用次数: 0
The cumulative live birth rates of 18,593 women with progestin-primed ovarian stimulation-related protocols and frozen–thawed transfer cycles 采用孕激素刺激卵巢相关方案和冻融移植周期的 18 593 名妇女的累计活产率
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-21 DOI: 10.1093/hropen/hoad051
Yunhan Nie, Wenya Guo, Xi Shen, Yating Xie, Yuqi Zeng, Hongyuan Gao, Yali Liu, Li Wang
What are the odds of achieving pregnancy when adopting progestin-primed ovarian stimulation (PPOS)-related protocols combined with repetitive frozen–thawed transfer (FET) cycles in patients with different clinical characteristics? The cumulative live birth rates (CLBRs) of women undergoing different PPOS-related protocols can be significantly and consistently enhanced within six FET cycles when the female age is < 40 years (or even <45 years) and when >5 oocytes are retrieved, regardless of antral follicle count (AFC). There have been numerous studies on the live birth rate of the first FET cycle in patients with PPOS-related protocols. These studies have focused mainly on comparing pregnancy outcomes with those of other stimulation protocols. However, owing to the unique features of the PPOS-related strategy, such as its flexible timing of oocyte retrieval and repeated transfer of frozen embryos, studies using the CLBR as an overall indicator of success and investigating which types of patients would benefit from this protocol are lacking. This retrospective cohort study included 18,593 women who underwent PPOS-related protocols (dydrogesterone + hMG, medroxyprogesterone acetate + hMG, micronized progesterone + hMG treatment, and luteal-phase ovarian stimulation protocol) from 1 March 2011 to 31 September 2022 in our centre. The population was categorized by female age, number of oocytes retrieved, and AFC in the analysis of CLBR within six FET cycles. The age groups (groups 1-5, respectively) were <30, 30-34, 35-39, 40-44, and ≥45 years. The number of oocytes retrieved was grouped as 1-5, 6-10, 11-15, 16-20, and >20. AFC was grouped as < 5, 5-10, 11-15, and >15. The Kaplan–Meier analysis (optimistic method), which hypothesized that patients who did not continue treatment had the same chance of achieving a live birth as those who continued, and the competing risk method (conservative method) which hypothesized they had no chance of achieving a live birth, were applied. In further analyses, the Cox model and Fine–Gray model were adopted: the former corresponds to the optimistic scenario, and the latter corresponds to the pessimistic scenario. CLBR had a declining trend with female age over six FET cycles (groups 1-5, respectively: optimistic: 96.9%, 96.6%, 91.4%, 67.3%, and 11.7%; conservative: 87.3%, 85.0%, 74.0%, 41.3%, and 7.5%), requiring more FET cycles to achieve a success rate of at least 50% (groups 1-5, respectively: optimistic: 2, 2, 2, 4 and >6 cycles; conservative: 2, 2, 2, > 6 and > 6 cycles). CLBR showed an increasing trend with the number of oocytes retrieved (groups 1-5, respectively: optimistic: 93.8%, 94.3%, 95.8%, 96.0%, and 95.6%; conservative: 66.2%, 78.3%, 85.6%, 88.9%, and 91.0%). All groups needed the same number of FET cycles to achieve a success rate of at least 50% (groups 1-5, respectively: optimistic: 2, 2, 2, 2 and 2 cycles; conservative: 2, 2, 2, 2 and 2 cycles). Furthermore,
不同临床特征的患者在采用孕激素促排卵(PPOS)相关方案结合重复冻融移植(FET)周期时,怀孕的几率有多大? 当女性年龄达到 5 个卵母细胞时,无论前卵泡数(AFC)如何,接受不同 PPOS 相关方案的女性在 6 个 FET 周期内的累积活产率(CLBR)均可显著且持续地提高。 关于采用 PPOS 相关方案的患者在第一个 FET 周期的活产率,已有许多研究。这些研究主要集中于比较与其他刺激方案的妊娠结果。然而,由于 PPOS 相关策略的独特性,如取回卵母细胞的时间灵活、重复移植冷冻胚胎等,将 CLBR 作为成功率的总体指标,并调查哪些类型的患者可从该方案中获益的研究还很缺乏。 这项回顾性队列研究纳入了本中心2011年3月1日至2022年9月31日期间接受PPOS相关方案(地屈孕酮+hMG、醋酸甲羟孕酮+hMG、微粒化孕酮+hMG治疗和黄体期卵巢刺激方案)的18593名女性。 研究对象按女性年龄、取卵数量和六个 FET 周期内 CLBR 分析中的 AFC 进行分类。年龄组(1-5 组)分别为 20 人。AFC分为15组。采用卡普兰-梅耶分析法(乐观法)和竞争风险法(保守法)进行分析,前者假设不继续治疗的患者与继续治疗的患者获得活产的机会相同,后者假设他们没有机会获得活产。在进一步分析中,采用了 Cox 模型和 Fine-Gray 模型:前者对应于乐观方案,后者对应于悲观方案。 在六个 FET 周期中,CLBR 随女性年龄呈下降趋势(1-5 组分别为:乐观组:96.9%、96.6%、91.4%、67.3% 和 11.7%;保守组:87.3%、85.0%、74.0%、41.3% 和 7.5%),需要更多的 FET 周期才能达到至少 50%的成功率(1-5 组分别为:乐观组:2、2、2、4 和 >6 个周期;保守组:2、2、2、>6 和 >6 个周期)。CLBR 随取回卵母细胞数量的增加而呈上升趋势(1-5 组分别为:乐观组:93.8%、94.3%、95.8%、96.0% 和 95.6%;保守组:66.2%、78.3%、85.6%、88.9% 和 91.0%)。所有组别都需要相同数量的 FET 周期才能达到至少 50%的成功率(1-5 组分别为:乐观组:2、2、2、2 和 2 个周期;保守组:2、2、2、2 和 2 个周期)。此外,6 个 FET 周期内的 CLBR 随 AFC 数量的增加而呈上升趋势(1-4 组分别为:乐观组:89.2%、94.8%、95.9% 和 96.3%;保守组:67.4%、78.2%、83.9% 和 88.1%),到第二个 FET 周期时,所有 4 组的成功率均达到至少 50%。 目前的研究因其回顾性设计和单中心性质而受到限制,这可能会限制我们研究结果的推广性。 本研究介绍了两个模型(卡普兰-梅耶分析法和竞争风险法),用于评估使用 PPOS 相关方案的患者的临床结果,这两个模型对高龄患者或卵巢储备功能减退的患者尤其有用。我们的研究结果鼓励 45 岁以下的患者,尤其是 40 岁以下的患者,以及 AFC 较低和取卵较少的患者尝试这种新方案。此外,本研究还证明了不同临床特征的患者在六个 FET 周期内 CLBR 的改善程度,为决定移植失败后是否继续进行 ART 提供了有价值的参考。 本研究得到了国家自然科学基金的资助(L.W.的基金号为 82071603,刘宇的基金号为 82001502)。无利益冲突需要声明。 不适用。
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引用次数: 0
Birth outcomes in mothers with hypertensive disorders and polycystic ovary syndrome: a population-based cohort study 患有高血压和多囊卵巢综合征的母亲的分娩结局:一项基于人群的队列研究
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-04 DOI: 10.1093/hropen/hoad048
Xinxia Chen, Mika Gissler, C. Lavebratt
Is PCOS associated with higher risks of extreme birth size and/or preterm birth in mothers with different hypertension types? PCOS was associated with additional risks of preterm birth in mothers with chronic hypertension and in singleton pregnancies of mothers with pre-eclampsia, and with increased risks of offspring being large for gestational age (LGA) in mothers with gestational hypertension. Women with PCOS are more likely to develop gestational hypertension, preeclampsia, and chronic hypertension. Although adverse birth outcomes have been frequently reported in mothers with PCOS, such associations in the setting of a hypertensive disorder remain unknown. This is a population-based cohort study including all live births 2004-2014 in Finland (n = 652 732), excluding mothers with diagnoses that could cause signs and symptoms like PCOS to ensure diagnosis specificity. Maternal diagnoses of PCOS, gestational hypertension, chronic hypertension, and pre-eclampsia were identified from the Finnish national registries. Generalized estimating equation and multivariable logistic regression were used to assess the adjusted odds ratio (aOR) and 95% CIs of preterm birth, very preterm birth and offspring being small (SGA) or large (LGA) for gestational age in hypertensive mothers with or without PCOS, using normotensive mothers without PCOS as reference. Of 43 902 (6.7%) mothers with hypertensive disorders, 1709 (3.9%) had PCOS. Significant interactions were detected for PCOS with hypertension on preterm birth, very preterm birth, offspring being SGA and LGA (F = 504.1, pinteraction <0.001; F = 124.2, pinteraction <0.001; F = 99.5, pinteraction <0.001; F = 2.7, pinteraction =0.012, respectively). Using mothers with no hypertensive disorder and no PCOS as reference, the risks of preterm and very preterm birth were overrepresented in mothers with chronic hypertension and pre-eclampsia without PCOS. PCOS was associated with higher risks of preterm birth (aOR PCOS 4.02, 3.14–5.15 vs. aOR non-PCOS 2.51, 2.32–2.71) in mothers with chronic hypertension, with significant interaction between the exposures (F = 32.7, pinteraction <0.001). Comorbid PCOS was also associated with a higher risk of preterm birth in singleton pregnancies of mothers with pre-eclampsia (aOR PCOS 7.33, 5.92–9.06 vs. aOR non-PCOS 5.72, 5.43–6.03; F = 50.0, pinteraction<0.001). Furthermore, the combined associations of PCOS with chronic hypertension or pre-eclampsia persisted for spontaneous births. Moreover, the risk of offspring LGA was increased in mothers with PCOS and gestational hypertension although decreased in those with gestational hypertension alone (aOR PCOS 2.04, 1.48–2.80 vs. aOR non-PCOS 0.80, 0.72–0.89; F = 9.7, pinteraction=0.002), whereas for offspring SGA the risks were comparable between hypertensive mothers with and those without PCOS. Information on medication treatment, gestational weeks of onset for pre-eclampsia and gesta
多囊卵巢综合征与不同高血压类型母亲的极端出生尺寸和/或早产风险是否相关?多囊卵巢综合征与慢性高血压母亲的早产风险增加有关,与子痫前期母亲的单胎妊娠有关,与妊娠高血压母亲的后代大胎龄(LGA)风险增加有关。患有多囊卵巢综合征的妇女更容易发生妊娠期高血压、先兆子痫和慢性高血压。尽管PCOS母亲的不良分娩结果经常被报道,但在高血压疾病的背景下,这种关联仍然未知。这是一项基于人群的队列研究,包括2004-2014年在芬兰出生的所有活产婴儿(n = 652 732),排除了诊断可能导致多囊卵巢综合征等体征和症状的母亲,以确保诊断的特异性。从芬兰国家登记处确定了多囊卵巢综合征、妊娠期高血压、慢性高血压和先兆子痫的母亲诊断。采用广义估计方程和多变量logistic回归方法,以无PCOS的正常血压母亲为参照,评估有PCOS或无PCOS的高血压母亲早产、极早产和胎龄小(SGA)或大(LGA)的调整优势比(aOR)和95% ci。43 902例(6.7%)患有高血压疾病的母亲中,1709例(3.9%)患有多囊卵巢综合征。PCOS合并高血压与早产、非常早产、子代SGA和LGA存在显著相互作用(F = 504.1, p相互作用<0.001;F = 124.2, p交互作用<0.001;F = 99.5, p交互作用<0.001;F = 2.7, p - interaction =0.012)。以无高血压疾病和无PCOS的母亲为对照,慢性高血压和先兆子痫无PCOS的母亲早产和非常早产的风险过高。PCOS与慢性高血压母亲的早产风险较高相关(aOR PCOS为4.02,3.14-5.15,aOR非PCOS为2.51,2.32-2.71),暴露之间存在显著交互作用(F = 32.7, p交互作用<0.001)。合并多囊卵巢综合征(PCOS)与子痫前期母亲的单胎妊娠早产风险较高相关(aOR PCOS为7.33,5.92-9.06,aOR非PCOS为5.72,5.43-6.03;F = 50.0, p交互作用<0.001)。此外,PCOS与慢性高血压或先兆子痫的联合关联在自然分娩中持续存在。此外,PCOS合并妊娠高血压的母亲的后代LGA风险增加,而单独妊娠高血压的母亲的后代LGA风险降低(aOR PCOS为2.04,1.48-2.80,aOR非PCOS为0.80,0.72-0.89;F = 9.7, p相互作用=0.002),而对于后代SGA的风险,高血压母亲与未患PCOS的母亲之间是相当的。没有关于药物治疗、子痫前期和妊娠期高血压发病的妊娠周数、孕期体重增加和多囊卵巢综合征表型的信息。所有诊断都是从登记处检索的,仅代表那些因其症状而寻求医疗护理的人。众所周知,1996年以前用于识别多囊卵巢综合征的ICD-9代码低估了多囊卵巢综合征的患病率,而将无排卵性不孕症纳入多囊卵巢综合征可能会引入过度代表偏差,尽管多囊卵巢综合征占无排卵性不孕症的80%。由于样本量有限,应谨慎解释与母体多囊卵巢综合征和高血压疾病相关的极早产风险。母体多囊卵巢综合征的多胎妊娠太少,无法进行亚组分析。此外,ART仅包括IVF/ICSI。其他治疗的潜在影响,如促排卵,没有被检查。多囊卵巢综合征与高血压母亲早产或后代LGA的额外风险相关,高血压类型之间存在差异。这些加剧的风险突出了妊娠咨询和高血压疾病妇女管理中多囊卵巢综合征的考虑。本研究得到山东省自然科学基金[ZR2020MH064 to X.C],山东大学和卡罗林斯卡研究所联合研究基金[SDU-KI-2019-08 to X.C and c.l],芬兰卫生与福利研究所:药物与妊娠项目[M.G.]、瑞典研究理事会[2022-01188 to C.L.]、斯德哥尔摩郡议会和卡罗林斯卡研究所之间的医学培训和临床研究区域协议(ALF)斯德哥尔摩郡议会[SLL20190589 to C.L.]、瑞典大脑基金会[FO2021-0412 to C.L.]。资助者在研究设计、数据收集、分析和解释、撰写报告或决定是否提交发表方面没有任何作用。作者报告没有利益冲突。不适用。
{"title":"Birth outcomes in mothers with hypertensive disorders and polycystic ovary syndrome: a population-based cohort study","authors":"Xinxia Chen, Mika Gissler, C. Lavebratt","doi":"10.1093/hropen/hoad048","DOIUrl":"https://doi.org/10.1093/hropen/hoad048","url":null,"abstract":"\u0000 \u0000 \u0000 Is PCOS associated with higher risks of extreme birth size and/or preterm birth in mothers with different hypertension types?\u0000 \u0000 \u0000 \u0000 PCOS was associated with additional risks of preterm birth in mothers with chronic hypertension and in singleton pregnancies of mothers with pre-eclampsia, and with increased risks of offspring being large for gestational age (LGA) in mothers with gestational hypertension.\u0000 \u0000 \u0000 \u0000 Women with PCOS are more likely to develop gestational hypertension, preeclampsia, and chronic hypertension. Although adverse birth outcomes have been frequently reported in mothers with PCOS, such associations in the setting of a hypertensive disorder remain unknown.\u0000 \u0000 \u0000 \u0000 This is a population-based cohort study including all live births 2004-2014 in Finland (n = 652 732), excluding mothers with diagnoses that could cause signs and symptoms like PCOS to ensure diagnosis specificity.\u0000 \u0000 \u0000 \u0000 Maternal diagnoses of PCOS, gestational hypertension, chronic hypertension, and pre-eclampsia were identified from the Finnish national registries. Generalized estimating equation and multivariable logistic regression were used to assess the adjusted odds ratio (aOR) and 95% CIs of preterm birth, very preterm birth and offspring being small (SGA) or large (LGA) for gestational age in hypertensive mothers with or without PCOS, using normotensive mothers without PCOS as reference.\u0000 \u0000 \u0000 \u0000 Of 43 902 (6.7%) mothers with hypertensive disorders, 1709 (3.9%) had PCOS. Significant interactions were detected for PCOS with hypertension on preterm birth, very preterm birth, offspring being SGA and LGA (F = 504.1, pinteraction &lt;0.001; F = 124.2, pinteraction &lt;0.001; F = 99.5, pinteraction &lt;0.001; F = 2.7, pinteraction =0.012, respectively). Using mothers with no hypertensive disorder and no PCOS as reference, the risks of preterm and very preterm birth were overrepresented in mothers with chronic hypertension and pre-eclampsia without PCOS. PCOS was associated with higher risks of preterm birth (aOR PCOS 4.02, 3.14–5.15 vs. aOR non-PCOS 2.51, 2.32–2.71) in mothers with chronic hypertension, with significant interaction between the exposures (F = 32.7, pinteraction &lt;0.001). Comorbid PCOS was also associated with a higher risk of preterm birth in singleton pregnancies of mothers with pre-eclampsia (aOR PCOS 7.33, 5.92–9.06 vs. aOR non-PCOS 5.72, 5.43–6.03; F = 50.0, pinteraction&lt;0.001). Furthermore, the combined associations of PCOS with chronic hypertension or pre-eclampsia persisted for spontaneous births. Moreover, the risk of offspring LGA was increased in mothers with PCOS and gestational hypertension although decreased in those with gestational hypertension alone (aOR PCOS 2.04, 1.48–2.80 vs. aOR non-PCOS 0.80, 0.72–0.89; F = 9.7, pinteraction=0.002), whereas for offspring SGA the risks were comparable between hypertensive mothers with and those without PCOS.\u0000 \u0000 \u0000 \u0000 Information on medication treatment, gestational weeks of onset for pre-eclampsia and gesta","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"58 13","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138604961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Etiology, histology and long-term outcome of bilateral testicular regression: a large Belgian series 双侧睾丸退化的病因、组织学和长期结果:比利时大型系列研究
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-12-01 DOI: 10.1093/hropen/hoad047
L. J. W. Tack, C. Brachet, V. Beauloye, C. Heinrichs, E. Boros, K. De Waele, S. van der Straaten, S. Van Aken, M. Craen, A. Lemay, A. Rochtus, K. Casteels, D. Beckers, T. Mouraux, K. Logghe, M. Van Loocke, G. Massa, K. Van de Vijver, H. Syryn, J. Van de Velde, E. De Baere, H. Verdin, M. Cools
What is the long-term outcome of individuals born with bilateral testicular regression (BTR) in relation to its underlying etiology? Statural growth and pubertal development are adequate with incremental doses of testosterone replacement therapy, however penile growth is often suboptimal, especially in those with a suspected genetic etiology (i.e. heterozygous DHX37 variants) or a micropenis at birth. BTR is a rare and poorly understood condition. Although a vascular origin has been postulated, heterozygous missense variants in DHX37 have been attributed to the phenotype as well. How these various etiologies impact the clinical phenotype, gonadal histology and outcome of BTR remains unclear. For this cross-sectional study, individuals with BTR were recruited in eight Belgian pediatric endocrinology departments, between December 2019 and December 2022. A physical exam was performed cross-sectionally in all 17 end-pubertal participants and a quality of care questionnaire was completed by 11 of them. Exome-based panel testing of 241 genes involved in gonadal development and spermatogenesis was performed along with a retrospective analysis of presentation and management. A centralized histological review of gonadal rests was done for 10 participants. A total of 35 participants (33 with male, one with female and one with non-binary gender identity), were recruited at a mean age of 15.0±5.7 years. The median age at presentation was 1.2 years [0-14 years]. Maternal gestational complications were common (38.2%), with a notably high incidence of monozygotic twin pregnancies (8.8%). Heterozygous (likely) pathogenic missense variants in DHX37 (p.Arg334Trp and p.Arg308Gln) were found in three participants. No other (likely) pathogenic variants were found. All three participants with a DHX37 variant had a microphallus at birth (leading to female sex assignment in one), while only six of the remaining 31 participants without a DHX37 variant (19.4%) had a microphallus at birth (information regarding one participant was missing). Testosterone therapy during infancy to increase penile growth was more effective in those without versus those with a DHX37 variant. The three participants with a DHX37 variant developed a male, female and non-binary gender identity, respectively; all other participants identified as males. Testosterone replacement therapy (TRT) in incremental doses had been initiated in 25 participants (median age at start 12.4 years). Final height was within the target height range in all end-pubertal participants, however, five out of 11 participants (45.5%), for whom stretched penile length (SPL) was measured, had a micropenis (mean adult SPL: 9.6 ± 2.5). Of the 11 participants who completed the questionnaire, five (45.5%) reported suboptimal understanding of the goals and effects of TRT at the time of puberty induction. Furthermore, only six (54.5%) and five (45.5%) of these 11 participants indicated they we
先天性双侧睾丸退化(BTR)患者的长期预后与其潜在病因有何关系?随着睾酮替代治疗剂量的增加,生理生长和青春期发育是足够的,但是阴茎生长往往不是最佳的,特别是那些疑似遗传病因(即杂合DHX37变异)或出生时小阴茎的人。BTR是一种罕见且鲜为人知的疾病。尽管血管起源已被假设,DHX37的杂合错义变异也归因于表型。这些不同的病因如何影响BTR的临床表型、性腺组织学和结果尚不清楚。在这项横断面研究中,在2019年12月至2022年12月期间,在比利时的八个儿科内分泌科招募了BTR患者。对所有17名青春期末期参与者进行了横断面体检,其中11人完成了护理质量问卷。对涉及性腺发育和精子发生的241个基因进行了基于外显子组的面板检测,并对表现和管理进行了回顾性分析。对10名参与者进行了性腺休息的集中组织学检查。共招募35名参与者(男性33名,女性1名,非二元性别认同1名),平均年龄15.0±5.7岁。发病时的中位年龄为1.2岁[0-14岁]。妊娠并发症发生率较高(38.2%),其中单卵双胎发生率较高(8.8%)。在3名参与者中发现了DHX37的杂合(可能)致病性错义变异(p.a g334trp和p.a g308gln)。未发现其他(可能的)致病变异。所有三个DHX37变异的参与者在出生时都有一个小阴茎(导致其中一个性别分配为女性),而其余31个没有DHX37变异的参与者中只有6个(19.4%)在出生时有一个小阴茎(关于一个参与者的信息缺失)。婴儿期睾酮治疗促进阴茎生长对没有DHX37变异的人比携带DHX37变异的人更有效。携带DHX37变异的3名参与者分别形成了男性、女性和非二元性别认同;其他参与者均为男性。25名参与者(开始时中位年龄12.4岁)开始了增量剂量的睾酮替代疗法(TRT)。所有被试的最终身高均在目标身高范围内,但11名被试中有5名(45.5%)的被试阴茎拉伸长度(SPL)为小阴茎(平均SPL: 9.6±2.5)。在完成问卷调查的11名参与者中,有5名(45.5%)报告在青春期诱导时对TRT的目标和效果的理解不够理想。此外,在这11名参与者中,分别只有6名(54.5%)和5名(45.5%)表示他们充分了解TRT的风险和潜在副作用。对两名DHX37变异参与者的组织学分析表明,由于在两个和一个未分化的性腺组织中存在勒氏杆菌残留物,性腺发育早期中断。在其他8名被分析的参与者中,没有发现性腺残留,与BTR诊断一致。本研究的局限性包括样本量相对较小(n = 35)和携带DHX37变异的个体较少(n = 3)。此外,由于没有记录或被参与者拒绝,关于SPL的数据经常缺失。TRT提供了足够的身体发育,即使在青春期后期开始,从而为医生提供了时间来探索患者的性别认同,如果需要。然而,在这些患者的整个治疗过程中,需要充分和可理解的关于TRT的作用和副作用的信息。拉伸的阴茎长度在许多个体中仍然是次优的,可以通过婴儿期的睾酮替代疗法来改善,以模仿生理上的迷你青春期。在一些参与者中,高发生率的妊娠并发症(38.2%)和三个单卵双胞胎妊娠与BTR表型不一致支持环境起源。具有杂合DHX37变异的个体具有更严重的表型,直到成年期阴茎生长受到严重限制。组织学分析证实DHX37是性腺发育基因,而不是btr相关基因。资金由比利时儿科内分泌和糖尿病学会(BESPEED)和根特大学医院在NucleUZ赠款(EDB)下提供。MC和EDB由两名高级临床研究员资助(分别为1801018N和1802220N)。作者报告没有利益冲突。N/A。
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引用次数: 0
Reply: Artificial intelligence as a door opener for a new era of human reproduction. 回复:人工智能开启人类繁衍新时代的大门。
IF 8.3 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-25 eCollection Date: 2023-01-01 DOI: 10.1093/hropen/hoad045
F Horta, M Salih, C Austin, R Warty, V Smith, D L Rolnik, S Reddy, H Rezatofighi, B Vollenhoven
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引用次数: 0
Artificial intelligence as a door opener for a new era of human reproduction. 人工智能开启了人类繁衍的新时代。
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-25 eCollection Date: 2023-01-01 DOI: 10.1093/hropen/hoad043
Markus Hengstschläger
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引用次数: 1
Cumulative live birth rate and neonatal outcomes after early rescue ICSI: a propensity score matching analysis. 早期抢救性卵胞浆内单精子显微注射后的累积活产率和新生儿预后:倾向得分匹配分析。
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-23 eCollection Date: 2023-01-01 DOI: 10.1093/hropen/hoad046
Yaping Jiang, Lei Jin, Bo Huang, Li Wu, Xinling Ren, Hui He
<p><strong>Study question: </strong>Is early rescue ICSI (E-RICSI) an effective and safe technique compared to conventional ICSI?</p><p><strong>Summary answer: </strong>Despite the higher multi-pronucleus (PN) rate compared to conventional ICSI, E-RICSI did not add extra risks to clinical and neonatal outcomes.</p><p><strong>What is known already: </strong>Based on the finding that the second polar body was released in 80% of fertilized oocytes by 4 h after exposure to spermatozoa and in ∼90% of fertilized oocytes by 6 h, E-RICSI brings forward the timing of rescue ICSI to 6 h after initial insemination, and effectively prevents oocyte aging and embryo-uterus asynchrony. However, some researchers still voice concerns about the efficacy and safety of E-RICSI, and comparative studies are limited.</p><p><strong>Study design size duration: </strong>A retrospective cohort study was conducted on patients who underwent conventional ICSI or E-RICSI treatment between January 2015 and December 2020 at a university-affiliated hospital. Using 1:1 propensity score matching, 1496 cases entered each group.</p><p><strong>Participants/materials setting methods: </strong>In total, 1496 couples undergoing conventional ICSI oocyte retrieval cycles and 1496 undergoing E-RICSI oocyte retrieval cycles were enrolled in this study, and basic clinical characteristics, embryologic data, clinical outcomes and neonatal data were compared between groups. The embryos in the E-RICSI group were divided into two subgroups: those fertilized by iIVF (IVF subgroup) and those fertilized by E-RICSI (E-RICSI subgroup); the embryologic data, clinical outcomes, and neonatal data for these subgroups were also compared with the conventional ICSI group. Logistic regression was used for statistical analysis with potential confounder adjustment.</p><p><strong>Main results and the role of chance: </strong>The 2PN rate, blastocyst formation rate, and viable blastocyst formation rate of the E-RICSI group were significantly lower compared to the conventional ICSI group (2PN rate: <i>P</i> < 0.001; blastocyst formation rate: <i>P</i> < 0.001; viable blastocyst formation rate: <i>P</i> = 0.004), and the multi-PN rate in the E-RICSI group was significantly higher than the conventional ICSI group (<i>P</i> < 0.001). However, the number of 2PN embryos, normal cleavage embryo rate, Day 3 high-quality cleavage embryo rate, and high-quality blastocyst rate were similar between groups. When considering the IVF embryos and E-RCSI embryos in the E-RICSI group independently, the 2PN rate of the conventional ICSI group was significantly lower than E-RICSI subgroup but higher than the IVF subgroup, whereas the blastocyst formation rate and viable blastocyst formation rate were higher than E-RICSI embryos but comparable to IVF embryos. As for the clinical and neonatal outcomes, the implantation rate of the E-RICSI subgroup was significantly lower than the IVF subgroup but comparable to the conventional ICSI gro
研究问题:与传统的ICSI相比,早期抢救性ICSI(E-RICSI)是否是一种有效而安全的技术?尽管与传统的ICSI相比,E-RICSI的多单核(PN)率较高,但它并没有增加临床和新生儿结局的额外风险:E-RICSI发现,80%的受精卵细胞在接触精子后4小时内释放出第二极体,90%的受精卵细胞在接触精子后6小时内释放出第二极体,因此,E-RICSI将抢救性ICSI的时间提前到初次授精后6小时,有效防止了卵细胞衰老和胚胎与子宫不同步。然而,仍有研究人员对 E-RICSI 的有效性和安全性表示担忧,而且对比研究也很有限:对2015年1月至2020年12月期间在某大学附属医院接受常规ICSI或E-RICSI治疗的患者进行了一项回顾性队列研究。采用1:1倾向得分匹配,每组各有1496例。参与者/材料设置方法:共有1496对夫妇接受了常规ICSI取卵周期治疗,1496对夫妇接受了E-RICSI取卵周期治疗,对两组的基本临床特征、胚胎学数据、临床结局和新生儿数据进行了比较。E-RICSI 组的胚胎被分为两个亚组:通过 iIVF 受精的胚胎(IVF 亚组)和通过 E-RICSI 受精的胚胎(E-RICSI 亚组);这些亚组的胚胎学数据、临床结果和新生儿数据也与常规 ICSI 组进行了比较。采用逻辑回归进行统计分析,并对潜在混杂因素进行调整:E-RICSI组的2PN率、囊胚形成率和存活囊胚形成率显著低于常规ICSI组(2PN率:P P = 0.004),E-RICSI组的多PN率显著高于常规ICSI组(P 局限性 需谨慎的原因:本研究因采用回顾性设计、样本量有限和随访时间较短而受到限制。然而,我们的研究表明,有必要进行大规模、多中心、长期随访的随机对照试验:短期人工授精(3小时)结合E-RICSI可能是一种安全有效的方法,可预防受精完全失败的发生,可鼓励精子正常或边缘精子的患者先尝试试管婴儿:本研究得到了国家重点研发计划(编号:2021YFC2700603)和国家自然科学基金(编号:81801443)的资助。作者声明无利益冲突:不适用。
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引用次数: 0
Bisphenol-A disturbs hormonal levels and testis mitochondrial activity, reducing male fertility. 双酚a会扰乱荷尔蒙水平和睾丸线粒体活动,降低男性生育能力。
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-15 eCollection Date: 2023-01-01 DOI: 10.1093/hropen/hoad044
Do-Yeal Ryu, Won-Ki Pang, Elikanah Olusayo Adegoke, Md Saidur Rahman, Yoo-Jin Park, Myung-Geol Pang
<p><strong>Study question: </strong>How does bisphenol-A (BPA) influence male fertility, and which mechanisms are activated following BPA exposure?</p><p><strong>Summary answer: </strong>BPA exposure causes hormonal disruption and alters mitochondrial dynamics and activity, ultimately leading to decreased male fertility.</p><p><strong>What is known already: </strong>As public health concerns following BPA exposure are rising globally, there is a need to understand the exact mechanisms of BPA on various diseases. BPA exposure causes hormonal imbalances and affects male fertility by binding the estrogen receptors (ERs), but the mechanism of how it mediates the hormonal dysregulation is yet to be studied.</p><p><strong>Study design size duration: </strong>This study consisted of a comparative study using mice that were separated into a control group and a group exposed to the lowest observed adverse effect level (LOAEL) (n = 20 mice/group) after a week of acclimatization to the environment. For this study, the LOAEL established by the US Environmental Protection Agency of 50 mg/kg body weight (BW)/day of BPA was used. The control mice were given corn oil orally. Based on the daily variations in BW, both groups were gavaged every day from 6 to 11 weeks (6-week exposure). Before sampling, mice were stabilized for a week. Then, the testes and spermatozoa of each mouse were collected to investigate the effects of BPA on male fertility. IVF was carried out using the cumulus-oocyte complexes from female hybrid B6D2F1/CrljOri mice (n = 3) between the ages of eight and twelve weeks.</p><p><strong>Participants/materials setting methods: </strong>Signaling pathways, apoptosis, and mitochondrial activity/dynamics-related proteins were evaluated by western blotting. ELISA was performed to determine the levels of sex hormones (FSH, LH, and testosterone) in serum. Hematoxylin and eosin staining was used to determine the effects of BPA on histological morphology and stage VII/VIII testicular seminiferous epithelium. Blastocyst formation and cleavage development rate were evaluated using IVF.</p><p><strong>Main results and the role of chance: </strong>BPA acted by binding to ERs and G protein-coupled receptors and activating the protein kinase A and mitogen-activated protein kinase signaling pathways, leading to aberrant hormone levels and effects on the respiratory chain complex, ATP synthase and protein-related apoptotic pathways in testis mitochondria (<i>P </i><<i> </i>0.05). Subsequently, embryo cleavage and blastocyst formation were reduced after the use of affected sperm, and abnormal morphology of seminiferous tubules and stage VII and VIII seminiferous epithelial cells (<i>P </i><<i> </i>0.05) was observed. It is noteworthy that histopathological lesions were detected in the testes at the LOAEL dose, even though the mice remained generally healthy and did not exhibit significant changes in BW following BPA exposure. These observations suggest that testicul
研究问题:双酚a (BPA)如何影响男性生育能力,哪些机制在BPA暴露后被激活?概要回答:BPA暴露会导致荷尔蒙紊乱,改变线粒体动力学和活动,最终导致男性生育能力下降。已知情况:随着BPA暴露引起的公共健康问题在全球范围内不断上升,有必要了解BPA对各种疾病的确切机制。BPA暴露导致激素失衡,并通过结合雌激素受体(er)影响男性生育能力,但其介导激素失调的机制尚不清楚。研究设计规模持续时间:本研究包括一项比较研究,将小鼠分为对照组和暴露于最低观察到的不良反应水平(LOAEL)的组(n = 20只/组),经过一周的环境适应。本研究采用美国环境保护署规定的双酚a最低剂量50 mg/kg体重(BW)/天。对照组小鼠口服玉米油。根据体重的日变化情况,两组小鼠每天灌胃6 ~ 11周(6周暴露)。取样前,小鼠稳定一周。然后,收集每只小鼠的睾丸和精子,研究BPA对雄性生殖能力的影响。使用8 - 12周龄的雌性杂交B6D2F1/CrljOri小鼠(n = 3)的卵母细胞复合物进行体外受精。参与者/材料设置方法:通过western blotting检测信号通路、细胞凋亡和线粒体活性/动力学相关蛋白。ELISA法测定血清中性激素(FSH、LH和睾酮)水平。采用苏木精和伊红染色法观察双酚a对睾丸VII/VIII期精原细胞组织学形态的影响。采用体外受精技术评价囊胚形成和卵裂发育率。主要结果及作用:BPA通过与er和G蛋白偶联受体结合,激活蛋白激酶A和丝裂原激活的蛋白激酶信号通路,导致激素水平异常,影响睾丸线粒体呼吸链复合体、ATP合酶和蛋白相关凋亡通路(P < 0.05)。使用受影响精子后,胚胎分裂和囊胚形成减少,精管和VII、VIII期精管上皮细胞形态出现异常(P < 0.05)。值得注意的是,在LOAEL剂量下,在睾丸中检测到组织病理学病变,尽管小鼠总体上保持健康,并且在BPA暴露后没有表现出明显的体重变化。这些观察结果表明,睾丸毒性不仅仅是由于全身效应导致小鼠整体健康受损的次要结果。大规模数据:不适用。注意的局限性:由于睾丸中的蛋白质表达水平已被证实,因此需要对每种睾丸细胞类型(间质细胞、支持细胞和精原干细胞)进行体外研究,以进一步阐明BPA暴露的确切机制。此外,本研究中使用的BPA剂量大大超过了现实生活中典型的人类暴露水平。因此,有必要开展更符合人类日常暴露的BPA浓度影响的实验,以全面评估其对睾丸毒性和线粒体活性的影响。研究结果的更广泛意义:这些发现表明BPA暴露通过破坏睾丸中的线粒体动力学和活动来影响男性生育能力,并为后续研究BPA暴露对男性生殖功能和生育能力的影响以及这些影响的潜在机制提供了坚实的基础。此外,这些发现表明BPA的LOAEL浓度表现出特殊的毒性,特别是考虑到其对睾丸的特定影响以及通过损害线粒体活性对男性生育能力的不利后果。因此,我们有理由认为,BPA会引起不同的毒理学反应和机制终点,这取决于每个靶器官的特定浓度水平。研究经费/竞争利益:本工作由教育部资助的韩国国家研究基金(NRF)基础科学研究计划(NRF- 2018r1a6a1a03025159)资助。没有宣布竞争利益。
{"title":"Bisphenol-A disturbs hormonal levels and testis mitochondrial activity, reducing male fertility.","authors":"Do-Yeal Ryu, Won-Ki Pang, Elikanah Olusayo Adegoke, Md Saidur Rahman, Yoo-Jin Park, Myung-Geol Pang","doi":"10.1093/hropen/hoad044","DOIUrl":"https://doi.org/10.1093/hropen/hoad044","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Study question: &lt;/strong&gt;How does bisphenol-A (BPA) influence male fertility, and which mechanisms are activated following BPA exposure?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Summary answer: &lt;/strong&gt;BPA exposure causes hormonal disruption and alters mitochondrial dynamics and activity, ultimately leading to decreased male fertility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;What is known already: &lt;/strong&gt;As public health concerns following BPA exposure are rising globally, there is a need to understand the exact mechanisms of BPA on various diseases. BPA exposure causes hormonal imbalances and affects male fertility by binding the estrogen receptors (ERs), but the mechanism of how it mediates the hormonal dysregulation is yet to be studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design size duration: &lt;/strong&gt;This study consisted of a comparative study using mice that were separated into a control group and a group exposed to the lowest observed adverse effect level (LOAEL) (n = 20 mice/group) after a week of acclimatization to the environment. For this study, the LOAEL established by the US Environmental Protection Agency of 50 mg/kg body weight (BW)/day of BPA was used. The control mice were given corn oil orally. Based on the daily variations in BW, both groups were gavaged every day from 6 to 11 weeks (6-week exposure). Before sampling, mice were stabilized for a week. Then, the testes and spermatozoa of each mouse were collected to investigate the effects of BPA on male fertility. IVF was carried out using the cumulus-oocyte complexes from female hybrid B6D2F1/CrljOri mice (n = 3) between the ages of eight and twelve weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants/materials setting methods: &lt;/strong&gt;Signaling pathways, apoptosis, and mitochondrial activity/dynamics-related proteins were evaluated by western blotting. ELISA was performed to determine the levels of sex hormones (FSH, LH, and testosterone) in serum. Hematoxylin and eosin staining was used to determine the effects of BPA on histological morphology and stage VII/VIII testicular seminiferous epithelium. Blastocyst formation and cleavage development rate were evaluated using IVF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main results and the role of chance: &lt;/strong&gt;BPA acted by binding to ERs and G protein-coupled receptors and activating the protein kinase A and mitogen-activated protein kinase signaling pathways, leading to aberrant hormone levels and effects on the respiratory chain complex, ATP synthase and protein-related apoptotic pathways in testis mitochondria (&lt;i&gt;P &lt;/i&gt;&lt;&lt;i&gt; &lt;/i&gt;0.05). Subsequently, embryo cleavage and blastocyst formation were reduced after the use of affected sperm, and abnormal morphology of seminiferous tubules and stage VII and VIII seminiferous epithelial cells (&lt;i&gt;P &lt;/i&gt;&lt;&lt;i&gt; &lt;/i&gt;0.05) was observed. It is noteworthy that histopathological lesions were detected in the testes at the LOAEL dose, even though the mice remained generally healthy and did not exhibit significant changes in BW following BPA exposure. These observations suggest that testicul","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 4","pages":"hoad044"},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10681812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138464785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Building a family at advanced parental age: a systematic review on the risks and opportunities for parents and their offspring. 在父母高龄时建立家庭:对父母及其后代的风险和机会的系统回顾。
Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2023-11-15 eCollection Date: 2023-01-01 DOI: 10.1093/hropen/hoad042
Nathalie B Neeser, Andrea Martani, Eva De Clercq, Christian De Geyter, Nicolas Vulliemoz, Bernice S Elger, Tenzin Wangmo
<p><strong>Study question: </strong>What is the existing empirical literature on the psychosocial health and wellbeing of the parents and offspring born at an advanced parental age (APA), defined as 40 years onwards?</p><p><strong>Summary answer: </strong>Although the studies show discrepancies in defining who is an APA parent and an imbalance in the empirical evidence for offspring, mothers, and fathers, there is a drive towards finding psychotic disorders and (neuro-)developmental disorders among the offspring; overall, the observed advantages and disadvantages are difficult to compare.</p><p><strong>What is known already: </strong>In many societies, children are born to parents at advanced ages and there is rising attention in the literature towards the consequences of this trend.</p><p><strong>Study design size duration: </strong>The systematic search was conducted in six electronic databases (PubMed including Medline, Embase, Scopus, PsycInfo, CINAHL, and SocINDEX) and was limited to papers published between 2000 and 2021 and to English-language articles. Search terms used across all six electronic databases were: ('advanced parental age' OR 'advanced maternal age' OR 'advanced paternal age' OR 'advanced reproductive age' OR 'late parent*' OR 'late motherhood' OR 'late fatherhood') AND ('IVF' OR 'in vitro fertilization' OR 'in-vitro-fertilization' OR 'fertilization in vitro' OR 'ICSI' OR 'intracytoplasmic sperm injection' OR 'reproductive techn*' OR 'assisted reproductive technolog*' OR 'assisted reproduction' OR 'assisted conception' OR 'reproduction' OR 'conception' OR 'birth*' OR 'pregnan*') AND ('wellbeing' OR 'well-being' OR 'psycho-social' OR 'social' OR 'ethical' OR 'right to reproduce' OR 'justice' OR 'family functioning' OR 'parental competenc*' OR 'ageism' OR 'reproductive autonomy' OR 'outcome' OR 'risk*' OR 'benefit*').</p><p><strong>Participants/materials setting methods: </strong>The included papers were empirical studies in English published between 2000 and 2021, where the study either examined the wellbeing and psychosocial health of parents and/or their children, or focused on parental competences of APA parents or on the functioning of families with APA parents. A quality assessment of the identified studies was performed with the QATSDD tool. Additionally, 20% of studies were double-checked at the data extraction and quality assessment stage to avoid bias. The variables sought were: the geographical location, the year of publication, the methodological approach, the definitions of APA used, what study group was at the centre of the research, what research topic was studied, and what advantages and disadvantages of APA were found.</p><p><strong>Main results and the role of chance: </strong>A total number of 5403 articles were identified, leading to 2543 articles being included for title and abstract screening after removal of duplicates. This resulted in 98 articles included for a full-text reading by four researchers. Ult
研究问题:关于父母和在父母高龄(APA)(定义为40岁以后)出生的子女的心理社会健康和福祉,现有的实证文献是什么?摘要回答:尽管研究表明,在定义谁是APA父母方面存在差异,而且在后代、母亲和父亲的经验证据方面也存在不平衡,但在后代中发现精神障碍和(神经)发育障碍是一种驱动力;总的来说,观察到的优点和缺点很难比较。已知情况:在许多社会中,孩子都是由高龄父母所生,这一趋势的后果在文献中引起了越来越多的关注。研究设计规模持续时间:系统检索在六个电子数据库(PubMed包括Medline、Embase、Scopus、PsycInfo、CINAHL和SocINDEX)中进行,仅限于2000年至2021年间发表的论文和英语文章。在所有六个电子数据库中使用的搜索词是:(“父母高龄”或“母亲高龄”或“父亲高龄”或“生育高龄”或“父母晚育”或“母亲晚育”或“父亲晚育”)和(“IVF”或“体外受精”或“体外受精”或“ICSI”或“胞浆内精子注射”或“生殖技术”或“辅助生殖技术”或“辅助受孕”或“生殖”或“受孕”或“生育”或“怀孕”)和(“幸福”或“幸福”或“社会心理”或“社会”或“伦理”或“生育权”或“正义”或“家庭功能”或“父母能力”或“年龄歧视”或“生殖自主”或“结果”或“风险”或“利益”)。参与者/材料设置方法:纳入的论文是2000年至2021年间发表的英文实证研究,其中研究要么检查父母和/或其子女的福祉和心理社会健康,要么关注APA父母的父母能力,要么关注APA父母的家庭功能。使用QATSDD工具对已确定的研究进行质量评估。此外,20%的研究在数据提取和质量评估阶段进行了双重检查,以避免偏倚。所寻求的变量包括:地理位置、出版年份、方法方法、使用的APA定义、研究的中心是哪个研究组、研究的研究主题以及发现的APA的优缺点。主要结果及偶然性的作用:共识别5403篇文章,去除重复后纳入2543篇文章进行标题和摘要筛选。这导致了98篇文章被4名研究人员纳入了全文阅读。最终,69项研究被纳入最终样本。关键成果涉及与研究目标相关的四个方面。(i)研究显示在界定谁是APA父母方面存在差异。(ii)不同参与者群体(母亲、父亲和后代)的经验证据存在不平衡,后代是研究最多的研究对象。(三)所研究的课题强调后代患神经发育障碍和精神障碍的风险增加。(iv)观察到的优势和劣势各不相同,无法比较,特别是对于APA父母的后代。局限性:本综述只考虑上述数据库中2000年至2021年间发表的英语研究。研究结果的更广泛含义:需要更多的研究来了解在APA建立家庭对后代成年后的风险和益处。此外,探索非西方社会年长父亲和年长父母视角的研究将提供大量信息。研究经费/竞争利益:本文的写作得到了瑞士国家科学基金会(Weave/Lead Agency资助计划,批准号10001AL_197415/1,项目标题为“高龄家庭建设:跨学科方法”)的财政支持。资助者在本文的起草过程中没有任何作用,文中所表达的观点仅代表作者的观点。作者没有利益冲突。本系统综述在普洛斯彼罗注册:CRD42022304564。
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Human reproduction open
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