Therapeutic advances in reproductive health最新文献

Background: Infertility affects around 17.5% of reproductive-aged individuals worldwide, posing significant personal and public health challenges. Although Medically Assisted Reproduction and Assisted Reproductive Technology (ART; e.g., in vitro fertilization) have advanced outcomes, many couples fail to conceive due to unaddressed pelvic, uterine, or systemic factors.

Objectives: We aim to (1) define the current usage of Restorative Reproduction Medicine (RRM) in clinical practice, (2) compare RRM outcomes with conventional ART, and (3) propose an integrated model of RRM plus ART for optimal fertility care.

Design: A systematic review following PRISMA guidelines was conducted (INPLASY registration no. INPLASY2024110069).

Data sources and methods: We searched PubMed, Scopus, and Web of Science (January 1995-October 2024), combining terms such as "restorative reproductive medicine," "intrauterine adhesions," "myomas," "polyps," "hydrosalpinx," "endometritis," "BMI," "thyroid dysfunction," "microbiome," and "assisted reproductive technology." Inclusion criteria: studies on uterine/systemic factors affecting infertility, focusing on surgical/pharmacological RRM interventions and ART limitations. Exclusion criteria: male-only infertility, case reports, narrative reviews, non-English publications. Quality assessment employed the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. We also briefly noted potential publication bias due to language and study-type restrictions.

Results: From >25,000 initial titles, 3 sequential screenings yielded 145 key articles addressing uterine (septum, myomas, polyps, adhesions) and systemic (body mass index (BMI) extremes, thyroid dysfunction, microbiome imbalance) factors. Surgical corrections (e.g., hysteroscopic removal of polyps/myomas, salpingectomy for hydrosalpinx) significantly improved natural conception and ART success (⩾20%-40% increase in clinical pregnancy). Chronic endometritis treatment, endometrial microbiome modulation, and BMI/thyroid optimization further improved pregnancy rates by 15%-20%. Comparisons of RRM versus ART alone indicated that RRM often lowers overall cost and may reduce miscarriage, while ART offers immediate embryo transfer. Combining RRM to correct pathologies prior to ART can boost implantation and live birth rates (⩾40%-70% improvement in some studies).

Conclusion: Restorative Reproductive Medicine comprehensively addresses pelvic and systemic abnormalities, thereby enhancing fertility outcomes and complementing ART. A proposed integrated model-RRM diagnostics/interventions followed by ART if needed-maximizes success, reduces time/cost, and emphasizes holistic reproductive health. Further multicenter trials are warranted to standardize protocols and fully realize RRM's potential in modern fertility care.

Background: Adverse birth outcomes associated with grand multiparity are more ambiguous than those linked to multiparity. The primary literature on this issue reveals inconsistent findings across various studies. A paucity of data is evident in systematic reviews and meta-analyses that assess adverse birth outcomes specifically for African grand multiparas.

Objectives: To address the pooled adverse birth outcomes and their associated factors among African grand multiparas.

Design: Systematic review and meta-analysis.

Data sources and methods: Studies were systematically searched from April 20, 2024, to June 15, 2024, using Scopus, Web of Science, PubMed, Science Direct, African Journal Online, and the Wiley Online Library. The Joanna Briggs Institute tool was used for a quality assessment of each primary study. Data were extracted using Excel and analyzed with Stata 11 software. A random-effects model was employed to calculate the pooled estimates. The paper employs appropriate statistical techniques to assess publication bias and heterogeneity, such as the symmetry of the funnel plot, Egger's test, and Cochran's Q test. The study addresses a critical public health issue in Africa, contributing valuable data that could inform policy and healthcare practices aimed at reducing adverse birth outcomes among grand multiparas. A subgroup analysis was performed based on the publication years.

Results: The pooled prevalence of adverse birth outcomes among African grand multiparas was 24.97%; 95% CI: 19.97-31.99. Pregnancy-related complications (AOR: 3.17; 95% CI: 2.35-4.28), a history of home births (AOR: 3.30; 95% CI: 1.70-6.40), and rural residence (AOR: 4.12; 95% CI: 3.12-5.44) were significantly associated with adverse birth outcomes among African grand multiparas.

Conclusion: Overall, the pooled prevalence of adverse birth outcomes among grand multiparas was comparably high. Variables such as rural residence, previous pregnancy-related complications, and a history of home births were significantly associated with adverse birth outcomes. Strengthening institutional births, providing high-quality prenatal care, and early pregnancy follow-ups are recommended to reduce adverse birth outcomes in grand multiparous women. In addition, improving the availability of comprehensive contraceptive options for rural-residing African grand multiparous women is essential.

Prospero registration: CRD42024569768.

Fertility preservation (FP) includes all the methods to preserve germ cells, reproductive tissues, or embryos for the future reproduction of patients at risk of infertility. Cryopreservation is an essential step of FP, storing the specimens in subzero temperatures to suppress cellular metabolism and restore cryopreserved specimens for future use. Although oocyte cryopreservation (OC) and embryo cryopreservation (EC) are two accepted methods of FP in women, ovarian tissue cryopreservation (OTC) is a novel method that is favorable in patients who are not appropriate candidates for OC and EC, and those who suffer from irritating menopause symptoms caused by estradiol deficiency. OTC has shown promising results in restoring fertility and the endocrine function of ovaries. Slow freezing and vitrification are two well-established methods for cryopreservation of biological specimens. Despite recent developments in the vitrification of ovarian tissue and comparable results to slow freezing, we lack a standard protocol for ovarian tissue vitrification, and slow freezing is still the preferred method in most centers. Under an acceptable medical condition and desirability, transplantation of cryopreserved tissue is performed either in orthotopic sites (orthotopic transplantation, OT) such as the original site of the ovaries and uterus, or heterotopic sites (heterotopic transplantation, HT) like abdominal wall, forearm, and peritoneal lining. Although both sites of transplantation are associated with endocrine function recovery, OT better restores fertility. This review will focus on OTC and its types, ovarian tissue transplantation, and efficacy in clinical practice.

Background: The rising rate of cesarean sections (CSs) has become a global concern due to its implications for maternal and neonatal health. The World Health Organization recommends that CS rates should not exceed 10-15% at the population level. However, many countries report rates well above this threshold.

Objectives: To evaluate CS rates using the Robson Ten Group Classification System (TGCS) and identify the major contributing groups to develop targeted strategies for reducing unnecessary cesarean deliveries.

Design: A retrospective clinical audit based on standardized classification and descriptive analysis.

Methods: This retrospective audit was conducted using hospital delivery records from January 1st to December 31st, 2022, at the Department of Obstetrics and Gynecology, Holy Family Hospital, Karachi, Pakistan. All CSs were categorized into 10 groups using the Robson classification system. Descriptive statistics were used to determine group size, CS rate within each group, relative contribution to the overall CS rate, and absolute group contribution.

Results: A total of 1464 deliveries occurred during the study period, including 507 CSs. Of these, 48.8% were elective and 51.2% were emergency CS. The major contributors to the CS rate were group 5 (51.9%), group 2 (18.5%), and group 10 (14.4%). The leading indications for cesarean delivery were previous CS (32.3%), non-progress of labor (21.15%), and cephalopelvic disproportion (16.92%).

Conclusion: Targeted strategies such as promoting vaginal birth after cesarean, implementing standardized labor monitoring protocols, and strengthening antenatal counseling can help reduce unnecessary CS while maintaining maternal and neonatal safety.

Background: Preeclampsia is a leading cause of maternal morbidity and mortality. Various predictive methods exist, but none are without flaws. Risk factors vary in different women and at different gestational ages; hence, investigating non-modifiable factors, such as ABO and Rhesus blood groups, may aid prediction and early detection of preeclampsia.

Objectives: This study aimed to evaluate the association between maternal ABO blood groups and preeclampsia.

Design: This was a prospective cohort study.

Methods: This study included singleton, normotensive, Rhesus-positive primigravidae with different ABO blood groups at <20 weeks of gestation. The primary outcome was the incidence of preeclampsia in mothers with Rhesus (D)-positive ABO blood groups (O, A, B and AB), while the secondary outcomes were the overall preeclampsia incidence and the odds ratio for preeclampsia between blood group O and non-O (A, B and AB) participants.

Results: A total of 264 participants were enrolled, with 244 followed up until delivery. Eighteen participants developed preeclampsia with an incidence of 7.4% (95% confidence interval: 3.9-10.7). Most participants had blood group O (57.0%), followed by A (29.5%), B (12.7%) and AB (0.8%). The mean gestational age at preeclampsia onset was 37.8 ± 2 weeks. Blood group AB had the highest incidence of preeclampsia (50%), followed by B (16.1%), O (5.8%) and A (5.6%). Among 105 participants with non-O blood groups, 10 developed preeclampsia (p = 0.265). The adjusted odds ratio for the non-O blood group who developed preeclampsia was 1.65.

Conclusion: Maternal ABO blood group was not significantly associated with preeclampsia incidence. However, blood group AB exhibited the highest preeclampsia incidence compared with the other blood groups.

Background: Adolescents in Africa encounter various sexual and reproductive health (SRH) challenges, such as insufficient information, societal stigma, inadequate services, and cultural obstacles. Enhancing collaboration between parents and healthcare providers can foster trust, improve communication, and provide better support, ultimately leading to improved access, quality, and utilization of SRH services (SRHS) for adolescents.

Objective: This paper offers perspectives from parents and healthcare providers on the roles of their partnerships in improving adolescent SRHS.

Design: The research employed a qualitative phenomenological study design.

Methods: The study included eight focus group discussions with parents whose adolescents attended selected youth centers and four face-to-face in-depth interviews with healthcare providers who worked there.

Results: The research revealed two prominent themes regarding the partnership between parents and healthcare professionals in adolescent SRH. The initial theme represents the perspectives of healthcare providers, emphasizing the importance of service awareness, cultural norms, geographic obstacles, and the necessity of parental consent as critical subthemes. The following theme reflects the viewpoints of parents, concentrating on the dialogue surrounding sexual health, the role of healthcare providers in promoting family conversations, and the request for support in providing sexual health information to their adolescents.

Conclusion: Collaboration between healthcare providers and parents is essential for improving adolescents' access to SRHS, which can greatly mitigate health-related risks. Nonetheless, this partnership encounters obstacles stemming from insufficient awareness of available services, sociocultural influences, and a lack of parental understanding regarding SRH topics. It is imperative to tackle these challenges through focused educational initiatives and enhanced communication strategies to create a supportive atmosphere that enables both adolescents and their parents to effectively address SRH concerns.

Background: Septate uterus is a congenital uterine malformation associated with adverse reproductive and obstetrical outcomes. Hysteroscopic septum resection (HSC) with/without balloon stent placement is a treatment option for reconstituting to a normal uterine cavity; however, procedure safety and efficacy of office-based-ultrasound guided (US) HSC in patients undergoing fertility treatment is not thoroughly studied.

Objectives: (1) To assess the safety and efficacy of office-based US-guided HSC septoplasty; (2) compare the safety and effectiveness of adjuvant intrauterine-balloon-Cook stent (IUBS) and (3) to evaluate the reproductive outcomes after each method.

Design: Retrospective cohort study.

Methods: We conducted a retrospective cohort study (n = 90) of patients undergoing HSC at the CReATe Fertility Centre, Toronto, Canada between 2011-2022. The Congenital Uterine Malformation by Experts (CUME-2018) guideline's criteria were used for diagnosis and classification of malformation/septum size as 1-arcuate uterus <10 mm (52% (47/90)), 2-septum 10-19 mm (31% (28/90)), 3-septum 20-40 mm (7% (6/90)), and 4-complete septa (10% (9/90)). The main outcomes were the rate of procedure complications and the efficacy of septum removal. Secondary outcome measures were reproductive outcomes after septoplasty and the safety and effectiveness of adjuvant IUBS placement. T-test and chi-square test, McNemar test, and Cochran-Mantel-Haenszel test were used for stratified statistical analysis.

Results: Office-HSC under US guidance was performed in 82 patients (US group) and septoplasty with laparoscopic guidance in 8 patients laparoscopy (LSC) group. IUBS placement had 34% (28/82) of patients in the US group and 12.5% (1/8) in the LSC group. There were no intraoperative or postoperative complications (uterine perforations, excessive bleeding, or infections) in either group. The rate of repeated procedures, implantation, pregnancy, and live birth rates (LBR) were not different when comparing septoplasty with and without IUBS. However, for patients diagnosed with septum class-2, -3, and -4, septoplasty improved their pre-treatment-LBR from 21.6% (8/37) to 77.1% (27/35) post-treatment (p = 0.00005) and decreased pre-treatment miscarriage rate (MR) from 73% (27/37) to post-treatment 29% (7/24) (p = 0.0007) in both groups.

Conclusion: Hysteroscopic septum resection with transabdominal US guidance in the office setting is a safe and effective procedure in patients with infertility. Office hysteroscopy should be considered in the management of patients with uterine septum to improve LBR and reduce MR. The value of IUBS needs further evaluation in a larger sample-size study.

Background: High fertility and rapid population growth can threaten human development and increase risks to maternal and child health. The diffusion of the benefits of lower fertility requires readiness to plan, and willingness and ability to adopt and use family planning measures.

Objective: This assessment aimed to explore the readiness, willingness, and ability (RWA) among selected Ethiopian communities, and identify the facilitators and impediments of fertility transition.

Design: This exploratory phenomenological qualitative study collects data from purposefully selected community members and experts in Addis Ababa, Arbaminch, and Jigjiga.

Method: The analysis follows deductive coding and a thematic presentation of findings under the RWA domains. Readiness deals with four themes: (1) the rationalization of the value of children, (2) recognition of the burden of high-risk fertility, (3) readiness to define the ideal number of children, and (4) socio-cultural norms about family size. Willingness contains three themes: (1) the psychosocial legitimacy of contraceptives, (2) the religious legitimacy of contraceptives, and (3) women's power to cope with barriers to family planning. The ability domain contains (1) women's knowledge about contraception and (2) access to and utilization of contraceptives.

Results: The communities involved in this study recognized the burden of high-risk fertility behaviors (early-age fertility, and frequent and many births), but they prefer large family sizes. Consequently, they exhibit good family planning willingness and practice for birth spacing but not for birth limitation. Recognizing the socio-economic burden of high-risk fertility, accepting and using contraceptives for the health of mothers and children are possible facilitators of fertility transition. Conversely, the desire for high parity, husbands and religious disapproval of contraceptives, side effects of contraceptives, and limited access to method mix are possible impediments.

Conclusion: The RWA to space births are adequately diffused and adopted by the community, but birth limitation is not yet recognized. Beyond promoting birth spacing, Ethiopia's fertility transition requires a shift in societal values from large to small family size. Overcoming barriers to contraceptive use also requires tailored efforts to improve the availability of method mix and involve male and religious leaders.

Background: Globally, over 15 million preterm births (PTB) occur annually, with sub-Saharan Africa bearing a disproportionate burden. In Kenya, studies conducted between 2017 and 2021 at the hospital level show a PTB prevalence ranging from 15.9% to 20.2%. However, current PTB prevalence and associated factors remain underexplored despite their significant public health implications. Understanding the prevalence and factors associated with PTB is critical for effective interventions.

Objectives: This study aimed to determine the prevalence of PTB and also to identify individual- and community-level factors influencing PTB among women of reproductive age in Kenya.

Design: The study utilised a cross-sectional design, analysing data from the 2022 Kenya Demographic and Health Survey.

Methods: A sample of 7291 women aged 15-49 was analysed using weighted multilevel logistic regression in Stata 17.0. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) and a significance threshold of p < 0.05 were used to identify predictors of PTB.

Results: The prevalence of PTB was 7.14%. Women aged 25-34 (aOR = 0.67; 95% CI: 0.49-0.94) and 35+ (aOR = 0.86; 95% CI: 0.59-1.24) were less likely to experience PTB compared to younger women (15-24 years). Attending four or more antenatal care visits reduced PTB likelihood (aOR = 0.68; 95% CI: 0.53-0.88). Women in the richest wealth index had higher odds of PTB (aOR = 2.28; 95% CI: 1.39-3.74), while medium community literacy levels increased PTB risk (aOR = 1.56; 95% CI: 1.21-2.03).

Conclusion: This study highlights that individual- and community-level factors significantly influence PTB in Kenya. Addressing disparities in socio-demographic and obstetric factors through targeted, multipronged strategies is essential for reducing PTB rates and improving maternal and neonatal outcomes.

Background: In 2020 in sub-Saharan Africa, 25% of new human immunodeficiency virus (HIV) infections occurred among young women (15-24 years). In Uganda, the HIV prevalence is three times higher among young women at 2.9% compared to 0.8% among their male counterparts. HIV status disclosure is a gateway to preventive services.

Objectives: We set out to estimate the prevalence of HIV status disclosure to current male partners, and the predictors among the adolescent girls and young women living with HIV (AGYWLHIV) in a semi-rural northern Uganda.

Design: In a cross-sectional study design, a consecutive sample of the AGYWLHIV was recruited from six antiretroviral therapy clinics between November 2022 and April 2023.

Methods: Participants were administered an interviewer-guided questionnaire. They were asked whether they have ever disclosed their HIV status to their current male partners. They were also asked about their socio-demographics, sexual and reproductive health profiles, knowledge and perceptions of dual protection, and safer conception methods for AGYWLHIV. Percentages to estimate prevalence, Chi-square tests to assess associations, simple and multivariate modified Poisson regression to identify predictors at p < 0.05 and 95% confidence intervals (CI) were considered.

Results: Overall, 423 participants with a median age of 22 (IQR 4) years participated in the study. The prevalence of HIV status disclosure to the current male partners was found at 73.3% (95% CI 69.0-77.5). The predictors for HIV status disclosure were found to include the women's knowledge of their HIV status (APR 1.1 (95% CI 1.0-1.2), p 0.032), knowledge of their male partner's HIV status (APR 0.8 (95% CI 0.7-0.9), p 0.003), and the male partners' disclosure of their HIV status to the women (APR 0.7 (95% CI 0.5-0.9), p <0.016).

Conclusion: About three-fourths of the AGYWLHIV in semi-rural northern Uganda disclosed their HIV status to their male partners. The predictors of disclosure included the women's knowledge of their HIV status, knowledge of their male partner's HIV status, and the male partner's reciprocal disclosure of their HIV status. To enhance disclosure rates, post-test, and disclosure counseling for both individuals and couples is recommended as part of the routine HIV testing, treatment, and care programs.