Therapeutic advances in reproductive health最新文献

Background: Fertility preservation is an important quality of life issue for women of reproductive age undergoing gonadotoxic treatment. The possibility of administering an adjuvant long-acting gonadotropin-releasing hormone agonist (GnRHa) with the aim of reducing the number of follicles susceptible to the effects of chemotherapy and thus reducing the risk of ovarian damage is considered in some international society guidelines, particularly in certain cancers such as breast cancer. Nowadays, the administration of long-acting GnRHa after controlled ovarian hyperstimulation (COH) for fertility preservation by cryopreservation of oocytes or embryos is increasingly used. However, cases of ovarian hyperstimulation syndrome (OHSS) have been reported following the use of long-acting GnRHa after COH for fertility preservation, indicating that the potential adverse effects of this treatment need to be further investigated.

Objectives: The aim of this systematic review was to comprehensively characterize patients who developed OHSS after treatment with long-acting GnRHa following COH for fertility preservation.

Methods: A comprehensive search of major electronic databases through January 2023 was performed. Studies reporting the use of long-acting GnRHa after COH for fertility preservation and the development of OHSS were included. Risk of bias was assessed using a modified version of the Newcastle-Ottawa scale. Results were synthesized qualitatively.

Results: Three studies with five patients met the eligibility criteria. The majority of patients were diagnosed with breast cancer and all patients underwent COH for oocyte cryopreservation. OHSS occurred in all patients after administration of long-acting GnRHa. The interval between ovulation induction and administration of long-acting GnRHa thereafter ranged from 3 to 5 days. All patients were treated conservatively and recovered without complications.

Conclusion: Current evidence suggests that the use of long-acting GnRHa after COH for fertility preservation may be associated with OHSS. Healthcare providers should thoroughly discuss the benefits and risks of this intervention with their patients before making a decision. Further studies are needed to fully elucidate the causal relationship between long-acting GnRHa and OHSS in this population.

The vaginal contraceptive ring is very effective and user dependent. In this article, we will discuss the different types of vaginal contraceptive rings, namely, the etonogestrel/ethinyl estradiol (ENG/EE) ring (NuvaRing, Merck, Rahway, NJ, USA) and the segesterone acetate (SA)/EE (Annovera, Mayne Pharma, Raleigh, NC, USA) ring. The details of dosing and administration, indications, advantages, disadvantages, and cost-effectiveness are presented. This literature review was conducted using PubMed and Google Scholar. The search terms included 'vaginal contraceptive ring', 'etonogestrel/ethinyl estradiol ring', and 'segesterone acetate/ethinyl estradiol ring'. The search was then sorted by year from 2000 until present, and the most recent articles were reviewed. The purpose of this article is to provide a comprehensive reference on the two vaginal contraceptive rings widely used in the United States for clinicians to guide management. Both vaginal contraceptive rings are combination of hormonal contraceptives that suppress ovulation and create physiologic conditions unfavorable for pregnancy. The ENG/EE ring is designed to be replaced monthly, while the SA/EE ring is a single device used over the course of 1 year. Common side effects of both devices include headaches, nausea, vomiting, and vaginitis. Serious adverse reactions can occur with the vaginal contraceptive rings including venous thromboembolism, psychiatric events, and hypersensitivity. Both devices are contraindicated in patients at high risk for arterial or venous thrombotic events, patients with a history of breast cancer or other estrogen/progesterone cancers, and patients with severe liver disease. Overall, the vaginal contraceptive ring is well tolerated and liked by patients. Patients should be well counseled on known severe adverse reactions. The vaginal contraceptive ring is more expensive than other forms of contraception and this should be an important point of discussion with patients.

Many factors associated with assisted reproductive technologies significantly influence the success of pregnancy after in vitro fertilization (IVF) either directly or indirectly. These factors include sperm processing techniques, egg retrieval, intrauterine artificial insemination, intracytoplasmic sperm injection, and embryo transfer. Among these technologies, sperm quality is one of the most critical factors for a successful IVF pregnancy. The method used for sperm processing plays a crucial role in determining the quality of sperm. Several widely used sorting techniques, such as conventional swim-up, density gradient centrifugation, magnetic activated cell sorting, and hyaluronic acid, have been extensively compared in various studies. Previous studies have shown that each sperm processing method causes varying degrees of sperm damage, particularly in sperm motility, concentration, morphological features, viability, and DNA integrity. However, sperm processing techniques have been developed slowly, and the impact of these methods on pregnancy rates is still unclear. Further exploration is needed. In this review, we aim to compare the results of different sperm processing techniques concerning sperm quality and IVF pregnancy rates. We will also discuss possible clinical approaches, such as microfluidics and integrated approaches, for testing and improving sperm quality.

About 20% of women undergoing in vitro fertilization struggle with poor ovarian response, indicating a poor prognosis related to low response following ovarian stimulation. Indeed, poor ovarian response, that is associated with both high cancelation rates and low live birth rates, still represents one of the most important therapeutic challenges in in vitro fertilization. In this context, natural cycle/modified natural cycle-in vitro fertilization, as a 'milder' approach, could be a reasonable alternative to high-dose/conventional ovarian stimulation in poor ovarian responders, with the aim to retrieve a single oocyte with better characteristics that may result in a single top-quality embryo, transferred to a more receptive endometrium. Moreover, modified natural cycle-in vitro fertilization may be cost-effective because of the reduced gonadotropin consumption. Several studies have been published during the last 20 years reporting conflicting results regarding the use of natural cycle/modified natural cycle-in vitro fertilization in women with poor ovarian response; however, while most of the studies concluded that mild stimulation regimens, including natural cycle/modified natural cycle-in vitro fertilization, have low, but acceptable success rates in this difficult group of patients, others did not replicate these findings. The aim of this narrative review is to appraise the current evidence regarding the use of natural cycle/modified natural cycle-in vitro fertilization in poor ovarian responders.

The rates of maternal overweight and obesity, but also excess gestational weight gain, are increasing. Pregnancy complications, including gestational diabetes mellitus, gestational hypertension, pre-eclampsia and delivery of a preterm or growth restricted baby, are higher for both women with overweight and obesity and women who gain excess weight during their pregnancy. Other conditions such as polycystic ovary syndrome are also strongly linked to overweight and obesity and worsened pregnancy complications. All of these conditions place women at increased risk for future cardiometabolic diseases. If overweight and obesity, but also excess gestational weight gain, can be reduced in women of reproductive age, then multiple comorbidities associated with pregnancy complications may also be reduced in the years after childbirth. This narrative review highlights the association between maternal overweight and obesity and gestational weight gain, with gestational diabetes, pre-eclampsia, polycystic ovary syndrome and delivery of a preterm or growth restricted baby. This review also addresses how these adverse conditions are linked to cardiometabolic diseases after birth. We report that while the independent associations between obesity and gestational weight gain are evident across many of the adverse conditions assessed, whether body mass index or gestational weight gain is a stronger driving factor for many of these is currently unclear. Mechanisms linking gestational diabetes mellitus, gestational hypertension, pre-eclampsia, preterm delivery and polycystic ovary syndrome to heightened risk for cardiometabolic diseases are multifactorial but relate to cardiovascular and inflammatory pathways that are also found in overweight and obesity. The need for post-partum cardiovascular risk assessment and follow-up care remains overlooked. Such early detection and intervention for women with pregnancy-related complications will significantly attenuate risk for cardiovascular disease.

Background: Family planning helps to reduce the number of high-risk births and prevent unplanned pregnancies and mother-to-child transmission of HIV. The main purpose of this study was to determine the usage of family planning and its associated factors among women living with HIV who attended care and treatment clinics.

Methods: This was a health facility-based cross-sectional study conducted among 332 sexually active reproductive-age women living with HIV who visited care and treatment clinics from 15 April and 15 June 2017. We used a systematic sampling technique for sample selection. The data were collected using pretested and structured questionnaires through face-to-face interviews. Seriously ill women living with HIV who were unable to respond to the questionnaire and refused to participate were excluded from this study. Logistic regression was fitted, and an odds ratio with a 95% confidence interval with a p value less than 0.05 was used to identify factors associated with modern family planning use.

Result: The study revealed that the overall use of the modern family planning method was 56.3%, and the most common method used was injectable (37.4%) followed by implants (28.9%). About 19% of the users reported dual contraceptive use. About 58% got family planning from antiretroviral therapy clinics. Almost all the women (97.6%) had heard of seven modern family planning methods. Desire to have another child was the most common (79.7%) reason for not using family planning. Women who attended primary/secondary education (adjusted odds ratio: 2.61; 95% confidence interval: 1.29-5.28], who had no future fertility desire (adjusted odds ratio: 2.94; 95% confidence interval: 1.51-5.73), who had discussed family planning with their husband (adjusted odds ratio: 2.06; 95% confidence interval: 1.04-4.10), and who were counseled by the antiretroviral therapy provider about family planning (adjusted odds ratio: 4.53; 95% confidence interval: 1.70-12.06) were more likely to use family planning methods than their counterparts.

Conclusion: The results of this study revealed that the use of modern family planning was low. There is a high frequency of implant usage, fear of mother-to-child transmission as a motivator for family planning usage, and low dual method usage. Hence, improving women's education, involving husbands, and consistent family planning counseling by antiretroviral therapy providers are promising strategies to improve the uptake of modern family planning by women living with HIV.

A major challenge in the assisted reproduction laboratory is to set up reproducible and efficient criteria to identify the embryo with the highest developmental potential. Over the years, several methods have been used worldwide with this purpose. Initially, standard morphology assessment was the only available strategy. It is now universally recognized that besides being a very subjective embryo selection strategy, morphology evaluation alone has a very poor prognostic value. More recently, the availability of time-lapse incubators allowed a continuous monitoring of human embryo development. This technology has spread quickly and many fertility clinics over the world produced a remarkable amount of data. To date, however, a general consensus on which variables, or combination of variables, should play a central role in embryo selection is still lacking. Many confounding factors, concerning both patient features and clinical and biological procedures, have been observed to influence embryo development. In addition, several studies have reported unexpected positive outcomes, even in the presence of abnormal developmental criteria. While it does not seem that time-lapse technology is ready to entirely replace the more invasive preimplantation genetic testing in identifying the embryo with the highest implantation potential, it is certainly true that its application is rapidly growing, becoming progressively more accurate. Studies involving artificial intelligence and deep-learning models as well as combining morphokinetic with other non-invasive markers of embryo development, are currently ongoing, raising hopes for its successful applicability for clinical purpose in the near future. The present review mainly focuses on data published starting from the first decade of 2000, when time-lapse technology was introduced as a routine clinical practice in the infertility centers.

While the most common symptom associated with endometriosis is pelvic pain, the systemic manifestations of the disease and the accompanying adverse psychological, emotional, social, familial, sexual, educational and workplace effects are increasingly recognized. Elagolix is an oral gonadotropin-releasing hormone receptor antagonist that is approved for the management of moderate to severe pain associated with endometriosis. However, the benefits of elagolix extend beyond reducing pain symptoms. This article reviews the non-pain systemic manifestations associated with endometriosis and summarizes the beneficial effects of elagolix on non-pain outcomes. This includes improvements in quality of life, reductions in fatigue and improvements in workplace and household productivity. These results indicate that elagolix provides non-pain benefits in women with endometriosis and improves outcomes that are clinically meaningful to patients.