Pub Date : 2023-05-15eCollection Date: 2023-01-01DOI: 10.1093/hropen/hoad017
Pedro Melo, Simon Wood, Georgios Petsas, Yealin Chung, Julija Gorodeckaja, Malcolm J Price, Arri Coomarasamy
{"title":"Reply to: 'Hiding in plain sight' and 'Caution is needed when communicating analyses based on an apple to orange comparison'.","authors":"Pedro Melo, Simon Wood, Georgios Petsas, Yealin Chung, Julija Gorodeckaja, Malcolm J Price, Arri Coomarasamy","doi":"10.1093/hropen/hoad017","DOIUrl":"10.1093/hropen/hoad017","url":null,"abstract":"","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 3","pages":"hoad017"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9576471","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}
Pub Date : 2023-04-24eCollection Date: 2023-01-01DOI: 10.1093/hropen/hoad011
Christian De Geyter, Carlos Calhaz-Jorge, Veerle Goossens, Cristina M Magli, Jesper Smeenk, Kristina Vesela, Nathalie Vermeulen, Christine Wyns
More than 20 years ago, the survey of activities in medically assisted reproduction (MAR) was initiated in Europe and resulted in cross-sectional annual reports, as issued by the European IVF Monitoring (EIM) consortium of ESHRE. Over time, these reports mirror the continuous development of the technologies and contribute to increased transparency and surveillance of reproductive care. Meanwhile, progressive changes of existing treatment modalities and the introduction of new technologies resulted in the need of a cumulative approach in the assessment of treatment outcomes, which warrants a prospective cycle-by-cycle data registry on MAR activities, including fertility preservation. This change in the paradigm of data collection in Europe towards the construction of cumulative outcome results is expected to generate additional insights into cross-institutional but also cross-border movements of patients and reproductive material. This is essential to improve vigilance and surveillance. The European monitoring of Medically Assisted Reproduction (EuMAR) project, co-funded by the European Union, will establish a registry for the transnational collection of prospective cycle-by-cycle MAR and fertility preservation data on the basis of an individual reproductive care code (IRCC). The rationale for the project and the objectives are presented here.
{"title":"EuMAR: a roadmap towards a prospective, cycle-by-cycle registry of medically assisted reproduction in Europe.","authors":"Christian De Geyter, Carlos Calhaz-Jorge, Veerle Goossens, Cristina M Magli, Jesper Smeenk, Kristina Vesela, Nathalie Vermeulen, Christine Wyns","doi":"10.1093/hropen/hoad011","DOIUrl":"10.1093/hropen/hoad011","url":null,"abstract":"<p><p>More than 20 years ago, the survey of activities in medically assisted reproduction (MAR) was initiated in Europe and resulted in cross-sectional annual reports, as issued by the European IVF Monitoring (EIM) consortium of ESHRE. Over time, these reports mirror the continuous development of the technologies and contribute to increased transparency and surveillance of reproductive care. Meanwhile, progressive changes of existing treatment modalities and the introduction of new technologies resulted in the need of a cumulative approach in the assessment of treatment outcomes, which warrants a prospective cycle-by-cycle data registry on MAR activities, including fertility preservation. This change in the paradigm of data collection in Europe towards the construction of cumulative outcome results is expected to generate additional insights into cross-institutional but also cross-border movements of patients and reproductive material. This is essential to improve vigilance and surveillance. The European monitoring of Medically Assisted Reproduction (EuMAR) project, co-funded by the European Union, will establish a registry for the transnational collection of prospective cycle-by-cycle MAR and fertility preservation data on the basis of an individual reproductive care code (IRCC). The rationale for the project and the objectives are presented here.</p>","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 2","pages":"hoad011"},"PeriodicalIF":8.3,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f7/b4/hoad011.PMC10126319.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299156","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}
Pub Date : 2023-04-20eCollection Date: 2023-01-01DOI: 10.1093/hropen/hoad014
Tong Wu, Ke-Cheng Huang, Jin-Feng Yan, Jin-Jin Zhang, Shi-Xuan Wang
<p><strong>Study question: </strong>What is the current state-of-the-art methodology assessing decellularized extracellular matrix (dECM)-based artificial ovaries for treating ovarian failure?</p><p><strong>Summary answer: </strong>Preclinical studies have demonstrated that decellularized scaffolds support the growth of ovarian somatic cells and follicles both <i>in vitro</i> and <i>in vivo</i>.</p><p><strong>What is known already: </strong>Artificial ovaries are a promising approach for rescuing ovarian function. Decellularization has been applied in bioengineering female reproductive tract tissues. However, decellularization targeting the ovary lacks a comprehensive and in-depth understanding.</p><p><strong>Study design size duration: </strong>PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception until 20 October 2022 to systematically review all studies in which artificial ovaries were constructed using decellularized extracellular matrix scaffolds. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.</p><p><strong>Participants/materials setting methods: </strong>Two authors selected studies independently based on the eligibility criteria. Studies were included if decellularized scaffolds, regardless of their species origin, were seeded with ovarian cells or follicles. Review articles and meeting papers were removed from the search results, as were articles without decellularized scaffolds or recellularization or decellularization protocols, or control groups or ovarian cells.</p><p><strong>Main results and the role of chance: </strong>The search returned a total of 754 publications, and 12 papers were eligible for final analysis. The papers were published between 2015 and 2022 and were most frequently reported as coming from Iran. Detailed information on the decellularization procedure, evaluation method, and preclinical study design was extracted. In particular, we concentrated on the type and duration of detergent reagent, DNA and extracellular matrix detection methods, and the main findings on ovarian function. Decellularized tissues derived from humans and experimental animals were reported. Scaffolds loaded with ovarian cells have produced estrogen and progesterone, though with high variability, and have supported the growth of various follicles. Serious complications have not been reported.</p><p><strong>Limitations reasons for caution: </strong>A meta-analysis could not be performed. Therefore, only data pooling was conducted. Additionally, the quality of some studies was limited mainly due to incomplete description of methods, which impeded specific data extraction and quality analysis. Several studies that used dECM scaffolds were performed or authored by the same research group with a few modifications, which might have biased our evaluation.</p><p><strong>Wider implications of the findings: </stro
研究问题:目前评估基于脱细胞细胞外基质(dECM)的人工卵巢治疗卵巢功能衰竭的最先进方法是什么?临床前研究表明,脱细胞支架可在体外和体内支持卵巢体细胞和卵泡的生长:人工卵巢是拯救卵巢功能的一种有前途的方法。脱细胞技术已被应用于女性生殖道组织的生物工程。然而,针对卵巢的脱细胞技术还缺乏全面深入的了解:对PubMed、Embase、Web of Science和Cochrane Central Register of Controlled Trials进行了检索,系统回顾了从开始到2022年10月20日使用脱细胞细胞外基质支架构建人工卵巢的所有研究。综述按照系统综述和元分析首选报告项目(PRISMA)协议进行:两位作者根据资格标准独立选择研究。如果脱细胞支架(无论其物种来源)播种了卵巢细胞或卵泡,则纳入研究。检索结果中删除了综述文章和会议论文,也删除了没有脱细胞支架或再细胞化或脱细胞化方案、对照组或卵巢细胞的文章:搜索共检索到 754 篇论文,其中 12 篇符合最终分析条件。这些论文发表于 2015 年至 2022 年之间,其中来自伊朗的论文最多。我们提取了脱细胞程序、评估方法和临床前研究设计的详细信息。我们特别关注了去污试剂的类型和持续时间、DNA 和细胞外基质检测方法以及关于卵巢功能的主要发现。报告了来自人类和实验动物的脱细胞组织。装有卵巢细胞的支架可产生雌激素和孕激素,但差异很大,并支持各种卵泡的生长。尚未有关于严重并发症的报道:无法进行荟萃分析。谨慎原因:无法进行荟萃分析,因此只进行了数据汇总。此外,一些研究的质量有限,主要原因是方法描述不完整,妨碍了具体的数据提取和质量分析。有几项使用脱细胞模塑支架的研究是由同一个研究小组完成或撰写的,只做了一些修改,这可能会使我们的评估结果产生偏差:总的来说,基于脱细胞技术的人工卵巢是替代不足卵巢的一种很有前景的实验性选择。应为脱细胞方案、质量实施和细胞毒性控制制定通用的可比标准。目前,脱细胞材料还远未应用于人工卵巢的临床研究:本研究由国家自然科学基金资助(编号:82001498 和 81701438)。作者无利益冲突需要声明:本系统综述已在国际系统综述前瞻性注册中心(PROSPERO,ID CRD42022338449)注册。
{"title":"Extracellular matrix-derived scaffolds in constructing artificial ovaries for ovarian failure: a systematic methodological review.","authors":"Tong Wu, Ke-Cheng Huang, Jin-Feng Yan, Jin-Jin Zhang, Shi-Xuan Wang","doi":"10.1093/hropen/hoad014","DOIUrl":"10.1093/hropen/hoad014","url":null,"abstract":"<p><strong>Study question: </strong>What is the current state-of-the-art methodology assessing decellularized extracellular matrix (dECM)-based artificial ovaries for treating ovarian failure?</p><p><strong>Summary answer: </strong>Preclinical studies have demonstrated that decellularized scaffolds support the growth of ovarian somatic cells and follicles both <i>in vitro</i> and <i>in vivo</i>.</p><p><strong>What is known already: </strong>Artificial ovaries are a promising approach for rescuing ovarian function. Decellularization has been applied in bioengineering female reproductive tract tissues. However, decellularization targeting the ovary lacks a comprehensive and in-depth understanding.</p><p><strong>Study design size duration: </strong>PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception until 20 October 2022 to systematically review all studies in which artificial ovaries were constructed using decellularized extracellular matrix scaffolds. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.</p><p><strong>Participants/materials setting methods: </strong>Two authors selected studies independently based on the eligibility criteria. Studies were included if decellularized scaffolds, regardless of their species origin, were seeded with ovarian cells or follicles. Review articles and meeting papers were removed from the search results, as were articles without decellularized scaffolds or recellularization or decellularization protocols, or control groups or ovarian cells.</p><p><strong>Main results and the role of chance: </strong>The search returned a total of 754 publications, and 12 papers were eligible for final analysis. The papers were published between 2015 and 2022 and were most frequently reported as coming from Iran. Detailed information on the decellularization procedure, evaluation method, and preclinical study design was extracted. In particular, we concentrated on the type and duration of detergent reagent, DNA and extracellular matrix detection methods, and the main findings on ovarian function. Decellularized tissues derived from humans and experimental animals were reported. Scaffolds loaded with ovarian cells have produced estrogen and progesterone, though with high variability, and have supported the growth of various follicles. Serious complications have not been reported.</p><p><strong>Limitations reasons for caution: </strong>A meta-analysis could not be performed. Therefore, only data pooling was conducted. Additionally, the quality of some studies was limited mainly due to incomplete description of methods, which impeded specific data extraction and quality analysis. Several studies that used dECM scaffolds were performed or authored by the same research group with a few modifications, which might have biased our evaluation.</p><p><strong>Wider implications of the findings: </stro","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 2","pages":"hoad014"},"PeriodicalIF":8.3,"publicationDate":"2023-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9822308","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}
Pub Date : 2023-01-13eCollection Date: 2023-01-01DOI: 10.1093/hropen/hoac062
Álvaro Martínez-Moro, Ismael Lamas-Toranzo, Leopoldo González-Brusi, Alba Pérez-Gómez, Ester Padilla-Ruiz, Javier García-Blanco, Pablo Bermejo-Álvarez
{"title":"Reply to: Technical specificities of the study of the mitochondrial genome.","authors":"Álvaro Martínez-Moro, Ismael Lamas-Toranzo, Leopoldo González-Brusi, Alba Pérez-Gómez, Ester Padilla-Ruiz, Javier García-Blanco, Pablo Bermejo-Álvarez","doi":"10.1093/hropen/hoac062","DOIUrl":"10.1093/hropen/hoac062","url":null,"abstract":"","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 1","pages":"hoac062"},"PeriodicalIF":8.3,"publicationDate":"2023-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/b8/hoac062.PMC9838313.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10604156","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}
Edwin-Amalraj Raja, Siladitya Bhattacharya, Abha Maheshwari, David J McLernon
<p><strong>Study question: </strong>Are perinatal outcomes following fresh blastocyst versus fresh cleavage stage embryo transfer (ET) different in singletons, twins, and between singleton siblings?</p><p><strong>Summary answer: </strong>Singleton babies conceived following fresh blastocyst, versus cleavage stage, ET are less likely to be small for gestational age (SGA) or to have a congenital anomaly (a result confirmed by comparing singleton siblings), while singletons born following fresh blastocyst ET were at a higher risk of being large for gestational age (LGA) than their sibling born following fresh cleavage stage ET.</p><p><strong>What is known already: </strong>Blastocyst stage transfer is now the preferred strategy in most IVF units. Previous studies have suggested that babies conceived through blastocyst transfer are at increased risk of preterm birth and LGA.</p><p><strong>Study design size duration: </strong>A national population-based retrospective cohort study was performed using linked Human Fertilisation and Embryology Authority (HFEA) data on 130 516 IVF and ICSI livebirths occurring from 103 062 women between 2000 and 2017.</p><p><strong>Participants/materials setting methods: </strong>We included women who had at least one singleton livebirth resulting from IVF/ICSI fresh embryo treatment, using their own eggs and partner's sperm. A linked HFEA dataset was analysed using a multilevel framework, which accommodated repeated IVF cycles resulting in livebirths in the same woman. A population-averaged robust Poisson model was used for binary outcomes and a multinomial logistic regression model was used for categorical outcomes. Unadjusted and adjusted risk ratios (aRRs) (95% CI) were calculated.</p><p><strong>Main results and the role of chance: </strong>There were 130 516 livebirths in 103 062 women, including 86 630 singletons, 43 886 twin births, and 5384 pairs of singleton siblings. In comparison with fresh cleavage stage ET, fresh blastocyst stage transfer in singletons was associated with a lower risk of low birthweight (aRR = 0.92; 95% CI 0.86, 0.99), lower risk of being SGA (0.83; 0.78, 0.89), and lower risk of congenital anomaly (0.79; 0.71, 0.89). This analysis did not show an increase in risk associated with preterm birth (1.00; 0.94, 1.06), high birthweight (0.99; 0.93, 1.06), LGA (0.99; 0.93, 1.05), and the chance of healthy singleton baby (1.00; 1.00, 1.02). Twins resulting from fresh blastocyst stage ET were at slightly higher risk of preterm birth (1.05; 1.02, 1.10) compared with twins conceived following fresh cleavage stage ET. There was insufficient evidence for an association with the other perinatal outcomes. Singleton siblings born following fresh blastocyst stage ET were at a higher risk of being LGA (1.57; 1.01, 2.46) and at lower risk of having a congenital anomaly (0.52; 0.28, 0.97) compared to their singleton siblings born following cleavage stage ET. There was some evidence of excess risk of preterm birt
{"title":"A comparison of perinatal outcomes following fresh blastocyst or cleavage stage embryo transfer in singletons and twins and between singleton siblings.","authors":"Edwin-Amalraj Raja, Siladitya Bhattacharya, Abha Maheshwari, David J McLernon","doi":"10.1093/hropen/hoad003","DOIUrl":"https://doi.org/10.1093/hropen/hoad003","url":null,"abstract":"<p><strong>Study question: </strong>Are perinatal outcomes following fresh blastocyst versus fresh cleavage stage embryo transfer (ET) different in singletons, twins, and between singleton siblings?</p><p><strong>Summary answer: </strong>Singleton babies conceived following fresh blastocyst, versus cleavage stage, ET are less likely to be small for gestational age (SGA) or to have a congenital anomaly (a result confirmed by comparing singleton siblings), while singletons born following fresh blastocyst ET were at a higher risk of being large for gestational age (LGA) than their sibling born following fresh cleavage stage ET.</p><p><strong>What is known already: </strong>Blastocyst stage transfer is now the preferred strategy in most IVF units. Previous studies have suggested that babies conceived through blastocyst transfer are at increased risk of preterm birth and LGA.</p><p><strong>Study design size duration: </strong>A national population-based retrospective cohort study was performed using linked Human Fertilisation and Embryology Authority (HFEA) data on 130 516 IVF and ICSI livebirths occurring from 103 062 women between 2000 and 2017.</p><p><strong>Participants/materials setting methods: </strong>We included women who had at least one singleton livebirth resulting from IVF/ICSI fresh embryo treatment, using their own eggs and partner's sperm. A linked HFEA dataset was analysed using a multilevel framework, which accommodated repeated IVF cycles resulting in livebirths in the same woman. A population-averaged robust Poisson model was used for binary outcomes and a multinomial logistic regression model was used for categorical outcomes. Unadjusted and adjusted risk ratios (aRRs) (95% CI) were calculated.</p><p><strong>Main results and the role of chance: </strong>There were 130 516 livebirths in 103 062 women, including 86 630 singletons, 43 886 twin births, and 5384 pairs of singleton siblings. In comparison with fresh cleavage stage ET, fresh blastocyst stage transfer in singletons was associated with a lower risk of low birthweight (aRR = 0.92; 95% CI 0.86, 0.99), lower risk of being SGA (0.83; 0.78, 0.89), and lower risk of congenital anomaly (0.79; 0.71, 0.89). This analysis did not show an increase in risk associated with preterm birth (1.00; 0.94, 1.06), high birthweight (0.99; 0.93, 1.06), LGA (0.99; 0.93, 1.05), and the chance of healthy singleton baby (1.00; 1.00, 1.02). Twins resulting from fresh blastocyst stage ET were at slightly higher risk of preterm birth (1.05; 1.02, 1.10) compared with twins conceived following fresh cleavage stage ET. There was insufficient evidence for an association with the other perinatal outcomes. Singleton siblings born following fresh blastocyst stage ET were at a higher risk of being LGA (1.57; 1.01, 2.46) and at lower risk of having a congenital anomaly (0.52; 0.28, 0.97) compared to their singleton siblings born following cleavage stage ET. There was some evidence of excess risk of preterm birt","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 2","pages":"hoad003"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9096003","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}
Pre-conception counselling and management of expectations about chance of success of IVF/ICSI treatments is an integral part of fertility care. Registry data are usually used to inform patients about expected success rates of IVF/ICSI treatment, as these data should best represent real-world populations and clinical practice. In registries, the success rate of IVF/ICSI treatments is conventionally reported per treatment cycle or per embryo transfer and estimated from data for which several treatment attempts per subject have been pooled (e.g. repetitive IVF/ICSI attempts or repetitive attempts of cryotransfer). This, however, may underestimate the true mean chance of success per treatment attempt, because treatment attempts of women with a poor prognosis will usually be over-represented in a pool of treatment cycle data compared to treatment events of women with a good prognosis. Of note, this phenomenon is also a source of potential bias when comparing outcomes between fresh transfers and cryotransfers, since women can undergo a maximum of only one fresh transfer after each IVF/ICSI treatment, but potentially several cryotransfers. Herein, we use a trial dataset from 619 women, who underwent one cycle of ovarian stimulation and ICSI, a Day 5 fresh transfer and/or subsequent cryotransfers (follow-up of all cryotransfers up to 1 year after the start of stimulation), to exemplify the underestimation of the live birth rate, when not accounting for repeated transfers in the same woman. Using mixed-effect logistic regression modelling, we show that the mean live birth rate per transfer per woman in cryocycles is underestimated by the factor 0.69 (e.g. live birth rate per cryotransfer of 36% after adjustment versus 25% unadjusted). We conclude that the average chance of success of treatment cycles of women of a given age, treated in a given centre, etc., when conventionally calculated per cycle or per embryo transfer from a pool of treatment events, do not apply to an individual woman. We suggest that patients are, especially at the outset of treatment, systematically confronted with mean estimates of success per attempt that are too low. Live birth rates per transfer from datasets encompassing multiple transfers from single individuals could be more accurately reported using statistical models accounting for the correlation between cycle outcomes within women.
{"title":"Conventional outcome reporting per IVF cycle/embryo transfer may systematically underestimate chances of success for women undergoing ART: relevant biases in registries, epidemiological studies, and guidelines.","authors":"Georg Griesinger, Per Larsson","doi":"10.1093/hropen/hoad018","DOIUrl":"https://doi.org/10.1093/hropen/hoad018","url":null,"abstract":"<p><p>Pre-conception counselling and management of expectations about chance of success of IVF/ICSI treatments is an integral part of fertility care. Registry data are usually used to inform patients about expected success rates of IVF/ICSI treatment, as these data should best represent real-world populations and clinical practice. In registries, the success rate of IVF/ICSI treatments is conventionally reported per treatment cycle or per embryo transfer and estimated from data for which several treatment attempts per subject have been pooled (e.g. repetitive IVF/ICSI attempts or repetitive attempts of cryotransfer). This, however, may underestimate the true mean chance of success per treatment attempt, because treatment attempts of women with a poor prognosis will usually be over-represented in a pool of treatment cycle data compared to treatment events of women with a good prognosis. Of note, this phenomenon is also a source of potential bias when comparing outcomes between fresh transfers and cryotransfers, since women can undergo a maximum of only one fresh transfer after each IVF/ICSI treatment, but potentially several cryotransfers. Herein, we use a trial dataset from 619 women, who underwent one cycle of ovarian stimulation and ICSI, a Day 5 fresh transfer and/or subsequent cryotransfers (follow-up of all cryotransfers up to 1 year after the start of stimulation), to exemplify the underestimation of the live birth rate, when not accounting for repeated transfers in the same woman. Using mixed-effect logistic regression modelling, we show that the mean live birth rate per transfer per woman in cryocycles is underestimated by the factor 0.69 (e.g. live birth rate per cryotransfer of 36% after adjustment versus 25% unadjusted). We conclude that the average chance of success of treatment cycles of women of a given age, treated in a given centre, etc., when conventionally calculated per cycle or per embryo transfer from a pool of treatment events, do not apply to an individual woman. We suggest that patients are, especially at the outset of treatment, systematically confronted with mean estimates of success per attempt that are too low. Live birth rates per transfer from datasets encompassing multiple transfers from single individuals could be more accurately reported using statistical models accounting for the correlation between cycle outcomes within women.</p>","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 2","pages":"hoad018"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/37/hoad018.PMC10214861.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9545715","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}
<p><strong>Study question: </strong>Are dietary fat and fatty acid (FA) intakes related to the odds of asthenozoospermia?</p><p><strong>Summary answer: </strong>Plant-based fat consumption was associated with decreased asthenozoospermia odds, while the consumption of animal-based monounsaturated fatty acid (MUFA) was positively related to asthenozoospermia odds.</p><p><strong>What is known already: </strong>Dietary fat and FA are significant ingredients of a daily diet, which have been demonstrated to be correlated to the reproductive health of men. However, to date, evidence on fat and FA associations with the odds of asthenozoospermia is unclear.</p><p><strong>Study design size duration: </strong>The hospital-based case-control study was performed in an infertility clinic from June 2020 to December 2020. Briefly, 549 asthenozoospermia cases and 581 controls with normozoospermia were available for final analyses.</p><p><strong>Participants/materials setting methods: </strong>We collected dietary data through a verified food frequency questionnaire of 110 food items. Asthenozoospermia cases were ascertained according to the World Health Organization guidelines. To investigate the correlations of dietary fat and FA consumptions with the odds of asthenozoospermia, we calculated the odds ratios (ORs) and corresponding 95% CIs through unconditional logistic regression models.</p><p><strong>Main results and the role of chance: </strong>Relative to the lowest tertile of consumption, the highest tertile of plant-based fat intake was inversely correlated to the odds of asthenozoospermia (OR = 0.68, 95% CI = 0.50-0.91), with a significant dose-response relation (OR = 0.85, 95% CI = 0.75-0.97, per standard deviation increment). Inversely, animal-based MUFA intake (OR = 1.49, 95% CI = 1.04-2.14) was significantly correlated to increased odds of asthenozoospermia, and an evident dose-response relation was also detected (OR = 1.24, 95% CI = 1.05-1.45, per standard deviation increment). Subgroup analyses showed similar patterns of associations to those of the primary results. Moreover, we observed significant interactions on both multiplicative and additive scales between animal-based MUFA and cigarette smoking.</p><p><strong>Limitations reasons for caution: </strong>Selection bias and recall bias were unavoidable in any of the observational studies. As we failed to obtain the information of trans-fatty acid (TFA) consumption, the relation of TFA intake and asthenozoospermia odds was unclear.</p><p><strong>Wider implications of the findings: </strong>This study indicated that different sources of fat and FAs might exert different effects on the etiology of asthenozoospermia, and cigarette smoking could exacerbate the adverse effect of high animal-based MUFA intake on asthenozoospermia. Our findings provide novel evidence pertaining to the fields of prevention of asthenozoospermia through decreasing animal-derived fat and FA consumptions and smoking cessation.<
研究问题:膳食脂肪和脂肪酸(FA)的摄入量与弱精子症的几率有关吗?概要回答:植物性脂肪摄入与弱精子症几率降低有关,而动物性单不饱和脂肪酸(MUFA)的摄入与弱精子症几率呈正相关。已知情况:膳食脂肪和FA是日常饮食的重要组成部分,已被证明与男性生殖健康有关。然而,到目前为止,关于脂肪和FA与弱精子症发病率之间关系的证据尚不清楚。研究设计规模持续时间:该基于医院的病例对照研究于2020年6月至2020年12月在一家不孕症诊所进行。总之,549例弱精子症病例和581例正常精子症对照可供最终分析。参与者/材料设置方法:我们通过经过验证的110种食物的食物频率问卷收集饮食数据。根据世界卫生组织指南确定无精子症病例。为了研究膳食脂肪和FA摄入量与弱精子症几率的相关性,我们通过无条件logistic回归模型计算了优势比(or)和相应的95% ci。主要结果和偶然性的作用:相对于摄入的最低分位数,植物性脂肪摄入的最高分位数与弱精子症的几率呈负相关(OR = 0.68, 95% CI = 0.50-0.91),具有显著的剂量-反应关系(OR = 0.85, 95% CI = 0.75-0.97,每标准差增量)。相反,基于动物的MUFA摄入量(OR = 1.49, 95% CI = 1.04-2.14)与弱精子症的发生率增加显著相关,并且还检测到明显的剂量-反应关系(OR = 1.24, 95% CI = 1.05-1.45,每标准差增量)。亚组分析显示了与主要结果相似的关联模式。此外,我们观察到在基于动物的MUFA和吸烟之间的乘法和加法尺度上显著的相互作用。局限性:选择偏倚和回忆偏倚在任何观察性研究中都是不可避免的。由于我们未能获得反式脂肪酸(TFA)摄入量的信息,因此TFA摄入量与弱精子症发病率的关系尚不清楚。研究结果的更广泛意义:该研究表明,不同来源的脂肪和FAs可能对弱精子症的病因产生不同的影响,吸烟可能加剧动物性多游离脂肪酸的高摄入量对弱精子症的不利影响。我们的研究结果为通过减少动物源性脂肪和FA的摄入以及戒烟来预防弱精子症提供了新的证据。研究经费/利益竞争:本工作由辽宁省揭邦瓜槐项目、辽宁省自然科学基金、盛京医院临床研究培养项目、盛京医院优秀科学基金资助。所有作者无利益冲突需要声明。试验注册号:无。
{"title":"Dietary fat and fatty acid consumptions and the odds of asthenozoospermia: a case-control study in China.","authors":"Jun-Qi Zhao, Xiao-Bin Wang, Xu Leng, Yi-Fan Wei, Dong-Hui Huang, Jia-Le Lv, Qiang Du, Ren-Hao Guo, Bo-Chen Pan, Qi-Jun Wu, Yu-Hong Zhao","doi":"10.1093/hropen/hoad030","DOIUrl":"https://doi.org/10.1093/hropen/hoad030","url":null,"abstract":"<p><strong>Study question: </strong>Are dietary fat and fatty acid (FA) intakes related to the odds of asthenozoospermia?</p><p><strong>Summary answer: </strong>Plant-based fat consumption was associated with decreased asthenozoospermia odds, while the consumption of animal-based monounsaturated fatty acid (MUFA) was positively related to asthenozoospermia odds.</p><p><strong>What is known already: </strong>Dietary fat and FA are significant ingredients of a daily diet, which have been demonstrated to be correlated to the reproductive health of men. However, to date, evidence on fat and FA associations with the odds of asthenozoospermia is unclear.</p><p><strong>Study design size duration: </strong>The hospital-based case-control study was performed in an infertility clinic from June 2020 to December 2020. Briefly, 549 asthenozoospermia cases and 581 controls with normozoospermia were available for final analyses.</p><p><strong>Participants/materials setting methods: </strong>We collected dietary data through a verified food frequency questionnaire of 110 food items. Asthenozoospermia cases were ascertained according to the World Health Organization guidelines. To investigate the correlations of dietary fat and FA consumptions with the odds of asthenozoospermia, we calculated the odds ratios (ORs) and corresponding 95% CIs through unconditional logistic regression models.</p><p><strong>Main results and the role of chance: </strong>Relative to the lowest tertile of consumption, the highest tertile of plant-based fat intake was inversely correlated to the odds of asthenozoospermia (OR = 0.68, 95% CI = 0.50-0.91), with a significant dose-response relation (OR = 0.85, 95% CI = 0.75-0.97, per standard deviation increment). Inversely, animal-based MUFA intake (OR = 1.49, 95% CI = 1.04-2.14) was significantly correlated to increased odds of asthenozoospermia, and an evident dose-response relation was also detected (OR = 1.24, 95% CI = 1.05-1.45, per standard deviation increment). Subgroup analyses showed similar patterns of associations to those of the primary results. Moreover, we observed significant interactions on both multiplicative and additive scales between animal-based MUFA and cigarette smoking.</p><p><strong>Limitations reasons for caution: </strong>Selection bias and recall bias were unavoidable in any of the observational studies. As we failed to obtain the information of trans-fatty acid (TFA) consumption, the relation of TFA intake and asthenozoospermia odds was unclear.</p><p><strong>Wider implications of the findings: </strong>This study indicated that different sources of fat and FAs might exert different effects on the etiology of asthenozoospermia, and cigarette smoking could exacerbate the adverse effect of high animal-based MUFA intake on asthenozoospermia. Our findings provide novel evidence pertaining to the fields of prevention of asthenozoospermia through decreasing animal-derived fat and FA consumptions and smoking cessation.<","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 3","pages":"hoad030"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9950617","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}
F Spinella, F Bronet, F Carvalho, E Coonen, M De Rycke, C Rubio, V Goossens, A Van Montfoort
<p><strong>Study question: </strong>What are the trends and developments in preimplantation genetic testing (PGT) in 2018 as compared to previous years?</p><p><strong>Summary answer: </strong>The main trends observed in this 21st dataset on PGT are that the implementation of trophectoderm biopsy with comprehensive whole-genome testing is most often applied for PGT-A and concurrent PGT-M/SR/A, while for PGT-M and PGT-SR, single-cell testing with PCR and FISH still prevail.</p><p><strong>What is known already: </strong>Since it was established in 1997, the ESHRE PGT Consortium has been collecting and analysing data from mainly European PGT centres. To date, 20 datasets and an overview of the first 10 years of data collections have been published.</p><p><strong>Study design size duration: </strong>The data for PGT analyses performed between 1 January 2018 and 31 December 2018 with a 2-year follow-up after analysis were provided by participating centres on a voluntary basis. Data were collected using an online platform, which is based on genetic analysis and has been in use since 2016.</p><p><strong>Participants/materials setting methods: </strong>Data on biopsy method, diagnostic technology, and clinical outcome were submitted by 44 centres. Records with analyses for more than one PGT for monogenic disorders (PGT-M) and/or PGT for chromosomal structural rearrangements (PGT-SR), or with inconsistent data regarding the PGT modality, were excluded. All transfers performed within 2 years after the analysis were included, enabling the calculation of cumulative pregnancy rates. Data analysis, calculations, and preparation of figures and tables were carried out by expert co-authors.</p><p><strong>Main results and the role of chance: </strong>The current data collection from 2018 covers a total of 1388 analyses for PGT-M, 462 analyses for PGT-SR, 3003 analyses for PGT for aneuploidies (PGT-A), and 338 analyses for concurrent PGT-M/SR with PGT-A.The application of blastocyst biopsy is gradually rising for PGT-M (from 19% in 2016-2017 to 33% in 2018), is status quo for PGT-SR (from 30% in 2016-2017 to 33% in 2018) and has become the most used biopsy stage for PGT-A (from 87% in 2016-2017 to 98% in 2018) and for concurrent PGT-M/SR with PGT-A (96%). The use of comprehensive, whole-genome amplification (WGA)-based diagnostic technology showed a small decrease for PGT-M (from 15% in 2016-2017 to 12% in 2018) and for PGT-SR (from 50% in 2016-2017 to 44% in 2018). Comprehensive testing was, however, the main technology for PGT-A (from 93% in 2016-2017 to 98% in 2018). WGA-based testing was also widely used for concurrent PGT-M/SR with PGT-A, as a standalone technique (74%) or in combination with PCR or FISH (24%). Trophectoderm biopsy and comprehensive testing strategies are linked with higher diagnostic efficiencies and improved clinical outcomes per embryo transfer.</p><p><strong>Limitations reasons for caution: </strong>The findings apply to the data submitted
研究问题:与往年相比,2018年胚胎植入前基因检测(PGT)的趋势和发展是什么?总结:在第21个PGT数据集中观察到的主要趋势是,对PGT-A和同时进行的PGT- m /SR/A进行营养外胚层活检最常应用于PGT-A和PGT- m /SR/A,而对于PGT- m和PGT-SR,单细胞PCR和FISH检测仍然盛行。已知情况:自1997年成立以来,ESHRE PGT联盟一直在收集和分析主要来自欧洲PGT中心的数据。迄今为止,已发布了20个数据集和前10年数据收集的概述。研究设计规模持续时间:2018年1月1日至2018年12月31日期间进行的PGT分析数据,分析后随访2年,由参与中心自愿提供。数据是通过一个基于基因分析的在线平台收集的,该平台自2016年以来一直在使用。参与者/材料设置方法:44个中心提交了活检方法、诊断技术和临床结果的数据。单基因疾病(PGT- m)和/或染色体结构重排(PGT- sr)的PGT多于一项,或PGT模式数据不一致的记录被排除在外。所有在分析后2年内进行的移植都包括在内,从而可以计算累积妊娠率。数据分析、计算以及图表和表格的准备由专家共同作者进行。主要结果和偶然性的作用:2018年目前收集的数据共包括PGT- m分析1388项,PGT-SR分析462项,PGT非整倍体(PGT- a)分析3003项,PGT- m /SR与PGT- a并发分析338项。囊胚活检在PGT-M中的应用逐渐增加(从2016-2017年的19%增加到2018年的33%),在PGT-SR中的应用也是如此(从2016-2017年的30%增加到2018年的33%),并已成为PGT-A(从2016-2017年的87%增加到2018年的98%)和PGT-M/SR与PGT-A同时使用的活检阶段(96%)。使用基于全基因组扩增(WGA)的综合诊断技术显示,PGT-M(从2016-2017年的15%降至2018年的12%)和PGT-SR(从2016-2017年的50%降至2018年的44%)的比例略有下降。然而,综合检测是PGT-A的主要技术(从2016-2017年的93%上升到2018年的98%)。基于wga的检测也广泛用于与PGT-A同时进行的PGT-M/SR,作为单独技术(74%)或与PCR或FISH结合(24%)。滋养外胚层活检和综合检测策略与每次胚胎移植更高的诊断效率和改善的临床结果有关。注意的局限性:研究结果适用于44个参与中心提交的数据,并不代表PGT的全球趋势。这份手稿中没有提供出生婴儿健康的细节。研究结果的更广泛意义:联盟数据集为跟踪PGT实践的趋势提供了宝贵的资源。研究经费/竞争利益:该研究没有外部资金,所有费用由ESHRE承担。没有任何相互竞争的利益。试验注册号:无。
{"title":"ESHRE PGT Consortium data collection XXI: PGT analyses in 2018.","authors":"F Spinella, F Bronet, F Carvalho, E Coonen, M De Rycke, C Rubio, V Goossens, A Van Montfoort","doi":"10.1093/hropen/hoad010","DOIUrl":"https://doi.org/10.1093/hropen/hoad010","url":null,"abstract":"<p><strong>Study question: </strong>What are the trends and developments in preimplantation genetic testing (PGT) in 2018 as compared to previous years?</p><p><strong>Summary answer: </strong>The main trends observed in this 21st dataset on PGT are that the implementation of trophectoderm biopsy with comprehensive whole-genome testing is most often applied for PGT-A and concurrent PGT-M/SR/A, while for PGT-M and PGT-SR, single-cell testing with PCR and FISH still prevail.</p><p><strong>What is known already: </strong>Since it was established in 1997, the ESHRE PGT Consortium has been collecting and analysing data from mainly European PGT centres. To date, 20 datasets and an overview of the first 10 years of data collections have been published.</p><p><strong>Study design size duration: </strong>The data for PGT analyses performed between 1 January 2018 and 31 December 2018 with a 2-year follow-up after analysis were provided by participating centres on a voluntary basis. Data were collected using an online platform, which is based on genetic analysis and has been in use since 2016.</p><p><strong>Participants/materials setting methods: </strong>Data on biopsy method, diagnostic technology, and clinical outcome were submitted by 44 centres. Records with analyses for more than one PGT for monogenic disorders (PGT-M) and/or PGT for chromosomal structural rearrangements (PGT-SR), or with inconsistent data regarding the PGT modality, were excluded. All transfers performed within 2 years after the analysis were included, enabling the calculation of cumulative pregnancy rates. Data analysis, calculations, and preparation of figures and tables were carried out by expert co-authors.</p><p><strong>Main results and the role of chance: </strong>The current data collection from 2018 covers a total of 1388 analyses for PGT-M, 462 analyses for PGT-SR, 3003 analyses for PGT for aneuploidies (PGT-A), and 338 analyses for concurrent PGT-M/SR with PGT-A.The application of blastocyst biopsy is gradually rising for PGT-M (from 19% in 2016-2017 to 33% in 2018), is status quo for PGT-SR (from 30% in 2016-2017 to 33% in 2018) and has become the most used biopsy stage for PGT-A (from 87% in 2016-2017 to 98% in 2018) and for concurrent PGT-M/SR with PGT-A (96%). The use of comprehensive, whole-genome amplification (WGA)-based diagnostic technology showed a small decrease for PGT-M (from 15% in 2016-2017 to 12% in 2018) and for PGT-SR (from 50% in 2016-2017 to 44% in 2018). Comprehensive testing was, however, the main technology for PGT-A (from 93% in 2016-2017 to 98% in 2018). WGA-based testing was also widely used for concurrent PGT-M/SR with PGT-A, as a standalone technique (74%) or in combination with PCR or FISH (24%). Trophectoderm biopsy and comprehensive testing strategies are linked with higher diagnostic efficiencies and improved clinical outcomes per embryo transfer.</p><p><strong>Limitations reasons for caution: </strong>The findings apply to the data submitted ","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 2","pages":"hoad010"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/fb/hoad010.PMC10121336.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742132","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}
E Koert, T S Hartwig, G M Hviid Malling, L Schmidt, H S Nielsen
<p><strong>Study question: </strong>What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy?</p><p><strong>Summary answer: </strong>Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy.</p><p><strong>What is known already: </strong>Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time.</p><p><strong>Study design size duration: </strong>This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min).</p><p><strong>Participants/materials setting methods: </strong>Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated.</p><p><strong>Main results and the role of chance: </strong>Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme '<i>The first 20 weeks: a 'scary' gap in care</i>' there were two themes: <i>Positive pregnancy test: 'Tell them it's not the same pregnancy'</i> and <i>First trimester: 'We craved that someone was taking care of us'.</i> The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular descr
研究问题:在先前早孕流产(PL)后的后续妊娠中,夫妻对医疗保健和支持的需求是什么?在整个妊娠过程中需求是如何变化的?概要回答:夫妇在怀孕的前20周描述了未满足的孕期护理需求,并对怀孕其余时间提供的护理更满意。已知情况:尽管早期妊娠妊娠很常见(约占妊娠的25%),但缺乏研究来指导实践,以优化治疗和支持未来妊娠。研究中对这一问题的重视程度较低,人们普遍认为夫妻在经历过产后忧郁症后应该“再试一次”。与没有经历过产后忧郁症的女性相比,有产后忧郁症的女性在怀孕前三个月的焦虑程度有所增加。没有纵向研究探讨夫妻在整个怀孕期间的需求是什么,以及这些需求如何随着时间的推移而变化。研究设计规模持续时间:这是一项定性纵向双元(联合)访谈研究。总共有15对夫妇在怀孕期间接受了四次采访。这些夫妇是从哥本哈根流产队列研究项目中招募的。面试在医院或大学进行,或者在网上进行。访谈时间从20到91分钟不等(平均54分钟)。参与者/材料设置方法:纳入标准包括有一至两个早期分娩的夫妇,他们自我报告有新的怀孕,并愿意一起接受英语访谈。对夫妇进行了四次面谈:在妊娠试验呈阳性后,每三个月一次。访谈记录和数据分析使用主题分析来比较和对比夫妇在怀孕的四个时期和整个怀孕期间的需求。一对同性伴侣和14对异性伴侣参与了调查。主要结果和偶然性的作用:夫妇的需求在整个怀孕期间被分为两个主要的纵向主题,按20周的扫描进行划分。在每个纵向主题中,有两个主题代表每个时间段。在纵向主题“前20周:护理方面的“可怕”差距”中,有两个主题:妊娠测试呈阳性:“告诉他们这不是同一个怀孕”和“我们渴望有人照顾我们”。丹麦公共医疗保健系统提供的标准妊娠护理包括12周和20周的扫描。虽然所有夫妇都希望在怀孕早期对胎儿进行额外的扫描和监测,以提供保证并及早发现问题,但他们在转诊和提供的护理方面描述了相当大的差异。夫妻双方都表达了对怀孕的高度担忧和焦虑,特别是孕妇在最初的几周内描述了“从一次扫描到另一次扫描的生存”。夫妇们在任何提供扫描或付费的舒适扫描中进行扫描,但这导致了支离破碎的护理。相反,他们希望继续护理,并承认和敏感地认识到,产后怀孕与第一次怀孕是不同的。在纵向主题“第二个20周:护理系统中的安全”中,有两个主题:妊娠中期:“我认为我们得到了很好的照顾”和妊娠晚期:“与其说是“需要知道”,不如说是“很高兴知道”一切都好。”夫妇们报告说,他们的痛苦程度较低,在这段时间里,对护理的总体需求得到了满足。他们对定期或延长的产前支持表示总体满意,尽管在前20周,需要对其PL病史进行额外的确认和敏感。夫妇们表示,如果他们有任何担忧或问题,他们可以获得助产士/护士的24小时电话支持,这让他们感到更安全。注意的局限性:参与者是从一项正在进行的队列研究中自我选择的,该研究是针对在医院就诊的PL患者进行的。单身女性不包括在研究中。这项研究仅限于丹麦的数据收集;然而,其他拥有公共医疗保健系统的国家可能在提供产前保健、复发性妊娠丢失(RPL)诊所提供的护理和私人扫描方面提供类似的服务。研究结果的更广泛意义:研究结果强调,早期早产会增加对后续妊娠的监测和护理需求。本研究强调了在妊娠护理方面存在的差距,因为在获得产前护理之前,在新怀孕的最初几周,他们对监测和支持的需求很高,并且在他们有多个PLs之前,可以转到RPL单位。研究资金/竞争利益:该项目已获得欧盟地平线2020研究和创新计划的资助,根据Marie Skłodowska-Curie资助协议No . 101028172 for E.K. 哥本哈根流产队列研究由生物创新研究所基金会资助。H.S.N.获得了Freya Biosciences、Ferring Pharmaceuticals、生物创新研究所、教育部、诺和诺德基金会、Augustinus Fonden、Oda og Hans Svenningsens Fond、Demant Fonden、Ole Kirks Fond和丹麦独立研究基金的科学资助。H.S.N.收到Ferring Pharmaceuticals、Merck、Astra Zeneca、Cook Medical、Gedeon Richter和Ibsa Nordic的讲座和演讲的个人付款或酬金。所有其他作者声明没有竞争利益。
{"title":"'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy.","authors":"E Koert, T S Hartwig, G M Hviid Malling, L Schmidt, H S Nielsen","doi":"10.1093/hropen/hoad032","DOIUrl":"https://doi.org/10.1093/hropen/hoad032","url":null,"abstract":"<p><strong>Study question: </strong>What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy?</p><p><strong>Summary answer: </strong>Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy.</p><p><strong>What is known already: </strong>Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time.</p><p><strong>Study design size duration: </strong>This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min).</p><p><strong>Participants/materials setting methods: </strong>Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated.</p><p><strong>Main results and the role of chance: </strong>Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme '<i>The first 20 weeks: a 'scary' gap in care</i>' there were two themes: <i>Positive pregnancy test: 'Tell them it's not the same pregnancy'</i> and <i>First trimester: 'We craved that someone was taking care of us'.</i> The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular descr","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 3","pages":"hoad032"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10412407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10000059","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}
<p><strong>Study question: </strong>What are the roles of maternal 5,10-methylenetetrahydrofolate reductase (<i>MTHFR</i>) C677T/A1298C combination polymorphisms on the embryological and clinical outcomes of IVF/ICSI?</p><p><strong>Summary answer: </strong>Our study reveals for the first time that the oocyte maturation potential gradually decreases with a reduction of maternal MTHFR activity determined by combined C677T/A1298C polymorphisms, while embryo quality was worse in women with intermediate MTHFR activity.</p><p><strong>What is known already: </strong>Although many previous studies have explored the association between <i>MTHFR</i> polymorphisms and IVF/ICSI outcomes, the results remain contradictory due to inadequate samples, no adjustment for potential confounders and/or the study of C677T and A1298C separately. Few studies have systematically investigated the exact role of MTHFR activity determined by combined C677T/A1298C polymorphisms on the embryological and clinical outcomes of IVF/ICSI.</p><p><strong>Study design size duration: </strong>This is a retrospective cohort study investigating 1160 women who were referred for <i>MTHFR</i> genotyping and IVF/ICSI treatment at Peking University Third Hospital from May 2017 to May 2020.</p><p><strong>Participants/materials setting methods: </strong>Women who were referred for <i>MTHFR</i> genotyping and their first IVF/ICSI treatment at our hospital were included and those undergoing preimplantation genetic testing cycles were excluded. The included women were divided into different cohorts according to their C677T, A1298C and combined C677T/A1298C genotypes. The embryological outcomes, including oocytes retrieved, metaphase II oocytes, oocyte maturation rate, normal fertilization rate and transplantable embryo rate, were evaluated by generalized linear regression models. The clinical outcomes, including biochemical pregnancy rate, clinical pregnancy rate and live birth rate, were evaluated by log-binomial regression models. All outcomes were adjusted for potential confounders.</p><p><strong>Main results and the role of chance: </strong>Women with the combined 677TT/1298AA genotype (hereafter abbreviated as TT/AA, as with other combined genotypes), whose enzyme activity was the lowest, had a lower oocyte maturation rate compared with those with the wild-type genotype (<i>P </i>=<i> </i>0.007). Moreover, the oocyte maturation rate decreased linearly with the decline in MTHFR enzyme activity determined by combined C677T/A1298C genotypes (<i>P</i>-trend = 0.001). The combined CC/AC, CC/CC&CT/AA and CT/AC genotypes with intermediate enzyme activity were associated with a lower transplantable embryo rate (<i>P </i>=<i> </i>0.013, 0.030 and 0.039, respectively). The differences in clinical outcomes between women with wild-type genotype and combined C677T/A1298C variant genotypes were not significant.</p><p><strong>Limitations reasons for caution: </strong>Our study population had comparable embry
{"title":"Association between maternal <i>MTHFR</i> C677T/A1298C combination polymorphisms and IVF/ICSI outcomes: a retrospective cohort study.","authors":"Yong-Jie Lu, Qin Li, Li-Xue Chen, Tian Tian, Jia Kang, Yong-Xiu Hao, Jian-Suo Zhou, Yuan-Yuan Wang, Li-Ying Yan, Rong Li, Liang Chang, Jie Qiao","doi":"10.1093/hropen/hoac055","DOIUrl":"https://doi.org/10.1093/hropen/hoac055","url":null,"abstract":"<p><strong>Study question: </strong>What are the roles of maternal 5,10-methylenetetrahydrofolate reductase (<i>MTHFR</i>) C677T/A1298C combination polymorphisms on the embryological and clinical outcomes of IVF/ICSI?</p><p><strong>Summary answer: </strong>Our study reveals for the first time that the oocyte maturation potential gradually decreases with a reduction of maternal MTHFR activity determined by combined C677T/A1298C polymorphisms, while embryo quality was worse in women with intermediate MTHFR activity.</p><p><strong>What is known already: </strong>Although many previous studies have explored the association between <i>MTHFR</i> polymorphisms and IVF/ICSI outcomes, the results remain contradictory due to inadequate samples, no adjustment for potential confounders and/or the study of C677T and A1298C separately. Few studies have systematically investigated the exact role of MTHFR activity determined by combined C677T/A1298C polymorphisms on the embryological and clinical outcomes of IVF/ICSI.</p><p><strong>Study design size duration: </strong>This is a retrospective cohort study investigating 1160 women who were referred for <i>MTHFR</i> genotyping and IVF/ICSI treatment at Peking University Third Hospital from May 2017 to May 2020.</p><p><strong>Participants/materials setting methods: </strong>Women who were referred for <i>MTHFR</i> genotyping and their first IVF/ICSI treatment at our hospital were included and those undergoing preimplantation genetic testing cycles were excluded. The included women were divided into different cohorts according to their C677T, A1298C and combined C677T/A1298C genotypes. The embryological outcomes, including oocytes retrieved, metaphase II oocytes, oocyte maturation rate, normal fertilization rate and transplantable embryo rate, were evaluated by generalized linear regression models. The clinical outcomes, including biochemical pregnancy rate, clinical pregnancy rate and live birth rate, were evaluated by log-binomial regression models. All outcomes were adjusted for potential confounders.</p><p><strong>Main results and the role of chance: </strong>Women with the combined 677TT/1298AA genotype (hereafter abbreviated as TT/AA, as with other combined genotypes), whose enzyme activity was the lowest, had a lower oocyte maturation rate compared with those with the wild-type genotype (<i>P </i>=<i> </i>0.007). Moreover, the oocyte maturation rate decreased linearly with the decline in MTHFR enzyme activity determined by combined C677T/A1298C genotypes (<i>P</i>-trend = 0.001). The combined CC/AC, CC/CC&CT/AA and CT/AC genotypes with intermediate enzyme activity were associated with a lower transplantable embryo rate (<i>P </i>=<i> </i>0.013, 0.030 and 0.039, respectively). The differences in clinical outcomes between women with wild-type genotype and combined C677T/A1298C variant genotypes were not significant.</p><p><strong>Limitations reasons for caution: </strong>Our study population had comparable embry","PeriodicalId":73264,"journal":{"name":"Human reproduction open","volume":"2023 1","pages":"hoac055"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9749479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10392077","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}