Pub Date : 2023-05-12DOI: 10.1097/GRH.0000000000000070
Ya-nan Zhang, Peng Liu, Dan Qi, Sheng-rui Zhao, Zi-jiang Chen, Ting Han, Lei Yan
Introduction: Whether hysteroscopy should routinely be conducted before embryo transfer remains uncertain especially when transvaginal ultrasonography (TVS) is normal. We aimed to investigate the hysteroscopic findings for patients with infertility or recurrent spontaneous abortion and with normal TVS. Methods: Patients who underwent TVS and hysteroscopy in the hospital from January 2014 to May 2019 were enrolled. Propensity score matching (1:1) was carried out for TVS positive and negative result groups. The positive results of hysteroscopy in the primary and secondary infertility patients were further compared. The prevalence rates of various diseases in different age groups were summarized and analyzed. Results: A total of 1532 individuals were enrolled in the study group and 19,118 cases in the control group. A total of 1495 cases with TVS positive results were matched using propensity score matching (1:1). The prevalence of uterine diseases in the TVS positive group was significantly higher than that in the TVS negative group (P<0.001).The prevalence of endometrial polyps and endometrial hyperplasia in patients with primary infertility was significantly higher than that with secondary infertility (P<0.001). The diagnostic sensitivity of TVS for major uterine cavity diseases, confirmed by hysteroscopy was relatively low (12.7%; 11.9%–13.6%). Conclusions: Hysteroscopy can detect a considerable number of uterine lesions even after normal TVS results. The sensitivity of TVS for the diagnosis of intrauterine lesions is relatively low. We suggest that hysteroscopy be recommended for patients with infertility or recurrent spontaneous abortion.
{"title":"Hysteroscopic alterations in women with infertility or recurrent spontaneous abortion in case of normal transvaginal ultrasonography","authors":"Ya-nan Zhang, Peng Liu, Dan Qi, Sheng-rui Zhao, Zi-jiang Chen, Ting Han, Lei Yan","doi":"10.1097/GRH.0000000000000070","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000070","url":null,"abstract":"Introduction: Whether hysteroscopy should routinely be conducted before embryo transfer remains uncertain especially when transvaginal ultrasonography (TVS) is normal. We aimed to investigate the hysteroscopic findings for patients with infertility or recurrent spontaneous abortion and with normal TVS. Methods: Patients who underwent TVS and hysteroscopy in the hospital from January 2014 to May 2019 were enrolled. Propensity score matching (1:1) was carried out for TVS positive and negative result groups. The positive results of hysteroscopy in the primary and secondary infertility patients were further compared. The prevalence rates of various diseases in different age groups were summarized and analyzed. Results: A total of 1532 individuals were enrolled in the study group and 19,118 cases in the control group. A total of 1495 cases with TVS positive results were matched using propensity score matching (1:1). The prevalence of uterine diseases in the TVS positive group was significantly higher than that in the TVS negative group (P<0.001).The prevalence of endometrial polyps and endometrial hyperplasia in patients with primary infertility was significantly higher than that with secondary infertility (P<0.001). The diagnostic sensitivity of TVS for major uterine cavity diseases, confirmed by hysteroscopy was relatively low (12.7%; 11.9%–13.6%). Conclusions: Hysteroscopy can detect a considerable number of uterine lesions even after normal TVS results. The sensitivity of TVS for the diagnosis of intrauterine lesions is relatively low. We suggest that hysteroscopy be recommended for patients with infertility or recurrent spontaneous abortion.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47533032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-13DOI: 10.1097/GRH.0000000000000068
Mohamed Iqbal Cassim, T. Mohamed, J. Adam, C. Niesler, A. Chikandiwa
Background: Despite the application of various methods to augment ovarian responsiveness, the management of poor ovarian responders remains challenging and pregnancy rates following in vitro fertilization are poor. Advances in adult stem cell research and their clinical application has prompted interest in their use in assisted reproduction. We report the first double-blind, randomized, placebo-controlled clinical study using autologous human stromal vascular fraction (SVF) containing adipose-derived stem cells (ADSCs) for ovarian rejuvenation. Materials and methods: Thirty patients were recruited. Twenty-one had lower-than-expected reserves for their age and 9 had premature ovarian insufficiency. Patients were randomized into a placebo group (10) and an intervention group (20). SVF was obtained from adipose tissue following abdominal liposuction; the ADSC component was characterized using flow cytometry. Three equal insertions, adjusted based on ovarian volume, were performed at monthly intervals via an ultrasound-guided transvaginal needle puncture. The SVF was not cultured before transplantation. Those in the placebo group were then crossed over to the intervention group and received a single SVF (maximally concentrated) insertion (crossover group). Results: The median viable SVF cell number inserted per patient over 3 months, and the percentage of mesenchymal stem cells (MSC) thereof, was 1.6×106 and 13.2%, respectively. Resulting anti-Mullerian hormone (AMH) changes were variable over the treatment course with a notable placebo effect. Patients with premature ovarian insufficiency showed no change in AMH, both to intervention and placebo. Despite this, a temporary return of menses was noted in a third of patients while on treatment. Patients with low reserves for age showed an increase in AMH, although not statistically significant when compared to placebo. In the crossover group, insertions were limited to one intervention comprising all cells; here a significantly higher median of 3.4×106 SVF cells were injected containing an average of 16.9% MSCs. No significant change in AMH was noted. To date 12 patients have undergone ovarian stimulation and in vitro fertilization after stem cell therapy; of these 9 have had embryo transfers with a resulting pregnancy rate of 33%. There were also 2 spontaneous pregnancies. Conclusion: Although the application of SVF-derived ADSCs for ovarian rejuvenation remains experimental, the current study provides further support for the safety of this approach and presents encouraging results as to its efficacy in assisted reproduction.
{"title":"Use of autologous adipose-derived mesenchymal stem cells for ovarian rejuvenation in poor responder IVF patients: a phase 1 randomized placebo-controlled double-blind crossover study","authors":"Mohamed Iqbal Cassim, T. Mohamed, J. Adam, C. Niesler, A. Chikandiwa","doi":"10.1097/GRH.0000000000000068","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000068","url":null,"abstract":"Background: Despite the application of various methods to augment ovarian responsiveness, the management of poor ovarian responders remains challenging and pregnancy rates following in vitro fertilization are poor. Advances in adult stem cell research and their clinical application has prompted interest in their use in assisted reproduction. We report the first double-blind, randomized, placebo-controlled clinical study using autologous human stromal vascular fraction (SVF) containing adipose-derived stem cells (ADSCs) for ovarian rejuvenation. Materials and methods: Thirty patients were recruited. Twenty-one had lower-than-expected reserves for their age and 9 had premature ovarian insufficiency. Patients were randomized into a placebo group (10) and an intervention group (20). SVF was obtained from adipose tissue following abdominal liposuction; the ADSC component was characterized using flow cytometry. Three equal insertions, adjusted based on ovarian volume, were performed at monthly intervals via an ultrasound-guided transvaginal needle puncture. The SVF was not cultured before transplantation. Those in the placebo group were then crossed over to the intervention group and received a single SVF (maximally concentrated) insertion (crossover group). Results: The median viable SVF cell number inserted per patient over 3 months, and the percentage of mesenchymal stem cells (MSC) thereof, was 1.6×106 and 13.2%, respectively. Resulting anti-Mullerian hormone (AMH) changes were variable over the treatment course with a notable placebo effect. Patients with premature ovarian insufficiency showed no change in AMH, both to intervention and placebo. Despite this, a temporary return of menses was noted in a third of patients while on treatment. Patients with low reserves for age showed an increase in AMH, although not statistically significant when compared to placebo. In the crossover group, insertions were limited to one intervention comprising all cells; here a significantly higher median of 3.4×106 SVF cells were injected containing an average of 16.9% MSCs. No significant change in AMH was noted. To date 12 patients have undergone ovarian stimulation and in vitro fertilization after stem cell therapy; of these 9 have had embryo transfers with a resulting pregnancy rate of 33%. There were also 2 spontaneous pregnancies. Conclusion: Although the application of SVF-derived ADSCs for ovarian rejuvenation remains experimental, the current study provides further support for the safety of this approach and presents encouraging results as to its efficacy in assisted reproduction.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"8 1","pages":"e68 - e68"},"PeriodicalIF":0.0,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49490168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-03DOI: 10.1097/GRH.0000000000000067
Samira Barbara, Amina Oumeziane, Fatima Nanouche, Karima Djerroudib, Nadjia Boucekine, N. Chabane, Nawal Tazairt, Ahlem Lacheheb, Samia Chemoul, Rachida Bourihane, S. Mouhoub, P. Devroey
Introduction: Follicles (FOs) of 16–22 mm produce more mature oocytes compared with small FOs as reported. In patients with poor ovarian response, late trigger results in premature luteinization, and an early trigger increases the number of immature oocytes. The purpose of this study was to demonstrate that metaphase II oocytes collected from FO of 11–15 mm results in similar pregnancy outcomes as metaphase II of oocytes collected from FO >16 mm when a dual trigger is used in patients with poor ovarian response. Materials and method: This was a prospective cohort study. A total of 122 patients were included according to the Bologna criteria for “poor ovarian responders”. From 2018 to 2020, controlled ovarian stimulation using antagonist protocols was used for ovarian stimulation. Two-dimensional ultrasound combined with hormonal assessment were used to monitor ovarian stimulation. Ovulation was induced with 0.2 mg gonadotropin-releasing hormone agonist and 5000 IU human chorionic gonadotropin when at least 1 FO ≥16 mm; 36 hours later, oocyte retrieval was performed. FO were collected separately. For all laboratory steps, oocytes were treated according to size FO. A single cleavage stage embryo was transferred. The luteal phase was supported with micronized progesterone. Excess embryos were cryopreserved according to FO size. If pregnancy did not occur, a single frozen embryo was replaced. Two groups of punctate FOs were analyzed: group 1 (G1) =246 FO size 11–15 mm, group 2 (G2) =238 FO size ≥16 mm. Results: In all, 122 cycles were started, 27 were cancelled. Forty-six fresh embryo transfers in G1 and 49 in G2 were performed, 31 frozen embryo transfers for G1 and 10 for G2. There were no significant differences in fertilization rate, clinical pregnancy rate (CPR), and live birth rate. Logistic regression adjusting the CPR to FO size and other influencing factors revealed no predictors for CPR and live birth rate. Conclusion: Study showed similar pregnancy outcomes regardless of FO size.
{"title":"Oocytes collected from small follicles after a dual trigger with gonadotropin-releasing hormone agonist (Gn-RHa) and human chorionic gonadotropin (hCG) for final oocyte maturation, in poor responder patient do not impact negatively ICSI cycles outcomes","authors":"Samira Barbara, Amina Oumeziane, Fatima Nanouche, Karima Djerroudib, Nadjia Boucekine, N. Chabane, Nawal Tazairt, Ahlem Lacheheb, Samia Chemoul, Rachida Bourihane, S. Mouhoub, P. Devroey","doi":"10.1097/GRH.0000000000000067","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000067","url":null,"abstract":"Introduction: Follicles (FOs) of 16–22 mm produce more mature oocytes compared with small FOs as reported. In patients with poor ovarian response, late trigger results in premature luteinization, and an early trigger increases the number of immature oocytes. The purpose of this study was to demonstrate that metaphase II oocytes collected from FO of 11–15 mm results in similar pregnancy outcomes as metaphase II of oocytes collected from FO >16 mm when a dual trigger is used in patients with poor ovarian response. Materials and method: This was a prospective cohort study. A total of 122 patients were included according to the Bologna criteria for “poor ovarian responders”. From 2018 to 2020, controlled ovarian stimulation using antagonist protocols was used for ovarian stimulation. Two-dimensional ultrasound combined with hormonal assessment were used to monitor ovarian stimulation. Ovulation was induced with 0.2 mg gonadotropin-releasing hormone agonist and 5000 IU human chorionic gonadotropin when at least 1 FO ≥16 mm; 36 hours later, oocyte retrieval was performed. FO were collected separately. For all laboratory steps, oocytes were treated according to size FO. A single cleavage stage embryo was transferred. The luteal phase was supported with micronized progesterone. Excess embryos were cryopreserved according to FO size. If pregnancy did not occur, a single frozen embryo was replaced. Two groups of punctate FOs were analyzed: group 1 (G1) =246 FO size 11–15 mm, group 2 (G2) =238 FO size ≥16 mm. Results: In all, 122 cycles were started, 27 were cancelled. Forty-six fresh embryo transfers in G1 and 49 in G2 were performed, 31 frozen embryo transfers for G1 and 10 for G2. There were no significant differences in fertilization rate, clinical pregnancy rate (CPR), and live birth rate. Logistic regression adjusting the CPR to FO size and other influencing factors revealed no predictors for CPR and live birth rate. Conclusion: Study showed similar pregnancy outcomes regardless of FO size.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"8 1","pages":"e67 - e67"},"PeriodicalIF":0.0,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46726014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-14DOI: 10.1097/GRH.0000000000000066
O. Ogunsola, Atinuke Adeyi, O. Ashiru
Introduction: Heavy metals are naturally existing constituents of the earth that have a high specific density (above 5 g/cm3) and atomic weights (>40.4 Da). Once taken into the body, heavy metals are distributed in the blood and deposited in tissues. The contamination chain follows a cyclic order: from industry, to the atmosphere, soil, water, and foods, then humans. At Martlife detox clinic, a comprehensive treatment plan based on the Mayr method of detoxification designed for the removal of heavy metals is available. To begin with, a bio-energetic test which reveals the types of heavy metals present in the patient’s body is conducted. Thereafter, therapies targeted at extracting the heavy metals and neutralizing their effect on the reproductive organs are commenced. Methods: Patient A underwent a metal toxicity test using urine samples at Genova Diagnostics laboratory in the United States. Patient A afterward underwent a bioenergetics test followed by a detoxification plan during the following month at the Martlife Detox Clinic. We performed a repeat test after detoxication at the Genova Diagnostics laboratory to know the outcome of the detoxication. Results: Genova Diagnostics laboratory’s first metal toxicity test revealed significantly high values of copper, manganese, vanadium, rubidium, gadolinium, and cesium. It also revealed similar outcomes with the bioenergetics testing before the detoxication process began at Martlife Detox Clinic. The repeat test showed that the detoxication process was successful. Conclusion(s): Our findings conclude that the modern Mayr method effectively reduces toxic levels of heavy metals. The bioenergetics test, which is less invasive, cheaper, and faster than the urine test, can also be used to check for toxins in the body.
{"title":"Successful removal of heavy metals and environmental toxins using modern Mayr chelating detoxication in a patient: a model for prefertility treatment screening","authors":"O. Ogunsola, Atinuke Adeyi, O. Ashiru","doi":"10.1097/GRH.0000000000000066","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000066","url":null,"abstract":"Introduction: Heavy metals are naturally existing constituents of the earth that have a high specific density (above 5 g/cm3) and atomic weights (>40.4 Da). Once taken into the body, heavy metals are distributed in the blood and deposited in tissues. The contamination chain follows a cyclic order: from industry, to the atmosphere, soil, water, and foods, then humans. At Martlife detox clinic, a comprehensive treatment plan based on the Mayr method of detoxification designed for the removal of heavy metals is available. To begin with, a bio-energetic test which reveals the types of heavy metals present in the patient’s body is conducted. Thereafter, therapies targeted at extracting the heavy metals and neutralizing their effect on the reproductive organs are commenced. Methods: Patient A underwent a metal toxicity test using urine samples at Genova Diagnostics laboratory in the United States. Patient A afterward underwent a bioenergetics test followed by a detoxification plan during the following month at the Martlife Detox Clinic. We performed a repeat test after detoxication at the Genova Diagnostics laboratory to know the outcome of the detoxication. Results: Genova Diagnostics laboratory’s first metal toxicity test revealed significantly high values of copper, manganese, vanadium, rubidium, gadolinium, and cesium. It also revealed similar outcomes with the bioenergetics testing before the detoxication process began at Martlife Detox Clinic. The repeat test showed that the detoxication process was successful. Conclusion(s): Our findings conclude that the modern Mayr method effectively reduces toxic levels of heavy metals. The bioenergetics test, which is less invasive, cheaper, and faster than the urine test, can also be used to check for toxins in the body.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"8 1","pages":"e66 - e66"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43709526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-27DOI: 10.1097/GRH.0000000000000065
Kidane G. Haileyes, H. Asfaw, S. G. Ayele, L. D. kitawu
Background: Despite the effectiveness, convenience, and reversibility of fertility, long-acting reversible contraceptive (LARC) method use is still low in the world and Sub-Saharan Africa, including Ethiopia. Myths and misconceptions are believed to be one of the major reported barriers and impediments to LARC use. Objective: The purpose of this study was to investigate myths and misconceptions about LARC use among women of reproductive age in Debre Brehan town, Ethiopia, at governmental health centers. Methods: A qualitative study using a qualitative descriptive design was conducted from January 24 to April 15, 2022. Twenty-nine reproductive-age women who came for family planning services and 6 key informants were selected using a purposive sampling technique, and an in-depth interview technique with semistructured questionnaires was used to collect the data. The analysis was conducted using the thematic analysis method and ATLAS. ti9 qualitative software was used to support the analysis. Result: The findings of this study revealed that women had a variety of myths and misconceptions about the use of long-acting reversible contraception, including that it had an adverse impact on reproductive health problems and a predisposition to maternal and fetal illness; that the method was unsafe and ineffective in its characteristics; and that, socio-culturally, it was an unacceptable and undesirable method for women to use. Conclusion: This study indicates that there are widespread myths and misconceptions regarding long-acting reversible contraception use in reproductive-age women, which emanate from different concerns in the community. Measures should be taken by the concerned body to dispel or at least reduce these myths and misconceptions.
{"title":"Myth and misconception about long-acting reversible contraception use among reproductive age group women in Debre Berhan governmental health centers, Ethiopia: qualitative study","authors":"Kidane G. Haileyes, H. Asfaw, S. G. Ayele, L. D. kitawu","doi":"10.1097/GRH.0000000000000065","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000065","url":null,"abstract":"Background: Despite the effectiveness, convenience, and reversibility of fertility, long-acting reversible contraceptive (LARC) method use is still low in the world and Sub-Saharan Africa, including Ethiopia. Myths and misconceptions are believed to be one of the major reported barriers and impediments to LARC use. Objective: The purpose of this study was to investigate myths and misconceptions about LARC use among women of reproductive age in Debre Brehan town, Ethiopia, at governmental health centers. Methods: A qualitative study using a qualitative descriptive design was conducted from January 24 to April 15, 2022. Twenty-nine reproductive-age women who came for family planning services and 6 key informants were selected using a purposive sampling technique, and an in-depth interview technique with semistructured questionnaires was used to collect the data. The analysis was conducted using the thematic analysis method and ATLAS. ti9 qualitative software was used to support the analysis. Result: The findings of this study revealed that women had a variety of myths and misconceptions about the use of long-acting reversible contraception, including that it had an adverse impact on reproductive health problems and a predisposition to maternal and fetal illness; that the method was unsafe and ineffective in its characteristics; and that, socio-culturally, it was an unacceptable and undesirable method for women to use. Conclusion: This study indicates that there are widespread myths and misconceptions regarding long-acting reversible contraception use in reproductive-age women, which emanate from different concerns in the community. Measures should be taken by the concerned body to dispel or at least reduce these myths and misconceptions.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"8 1","pages":"e65 - e65"},"PeriodicalIF":0.0,"publicationDate":"2023-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44415612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.1097/grh.0000000000000060
B. Ibitoye, O. Akadiri, F. Ibitoye, Olaleke A. Fasasi
{"title":"WHO fact sheet on infertility (definition of infertility), published in Global Reproductive Health (2021)","authors":"B. Ibitoye, O. Akadiri, F. Ibitoye, Olaleke A. Fasasi","doi":"10.1097/grh.0000000000000060","DOIUrl":"https://doi.org/10.1097/grh.0000000000000060","url":null,"abstract":"","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61697439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-26DOI: 10.1097/GRH.0000000000000064
S. Everingham, A. Whittaker
Introduction: Global reproductive destinations are constantly changing, and so is the cross-border reproductive movement of both gametes and intended parents seeking to build families. Quantifying the use of cross-border surrogacy is difficult given no reliable data exists on the global patterns of use of CBRC generally or surrogacy in particular. Methods: Approximately 150 surrogacy agencies in countries offering surrogacy to foreigners were invited to provide consolidated data on the number of commissioning singles and couples who signed with their agency for surrogacy services over the 2018–2020 calendar years, by nationality of the biological intended parent(s). Twenty-four agencies (16%) reported on 5968 clients. Results: Other than the United States, agencies were involved predominately in arrangements for foreigners. In the United States, other than the large domestic market, France, Australia, and Israel were large source countries. Australia and France were also large source countries for Canada. China was overwhelmingly the largest source country engaging in Ukraine. In Georgia, other than Georgian nationals, China, Israel, and the United States were the largest foreign source countries. In Greece, apart from locals, the largest source countries were Italy and Australia. Colombia reported a wide spread of foreign clientele with Israel, the United States, and Canada as the largest. COVID-19 had a significant impact on enrolments in Georgia and Ukraine—each experienced large declines in enrolments when comparing 2019–2020. In contrast, despite travel bans in 2020, agencies in 3 of 4 unregulated countries continued to report increases in enrolments. Conclusions: The global cross-border surrogacy market remains highly volatile, experiencing rapid growth and decline, especially in newer destinations. Source countries providing surrogacy clients are based partly on proximity and cultural ties, but more so on affordability. Further research is required to monitor the effects of engagement in newer destinations with fewer protections.
{"title":"Trends in engagement in surrogacy by nationality 2018–2020: a survey of surrogacy agencies","authors":"S. Everingham, A. Whittaker","doi":"10.1097/GRH.0000000000000064","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000064","url":null,"abstract":"Introduction: Global reproductive destinations are constantly changing, and so is the cross-border reproductive movement of both gametes and intended parents seeking to build families. Quantifying the use of cross-border surrogacy is difficult given no reliable data exists on the global patterns of use of CBRC generally or surrogacy in particular. Methods: Approximately 150 surrogacy agencies in countries offering surrogacy to foreigners were invited to provide consolidated data on the number of commissioning singles and couples who signed with their agency for surrogacy services over the 2018–2020 calendar years, by nationality of the biological intended parent(s). Twenty-four agencies (16%) reported on 5968 clients. Results: Other than the United States, agencies were involved predominately in arrangements for foreigners. In the United States, other than the large domestic market, France, Australia, and Israel were large source countries. Australia and France were also large source countries for Canada. China was overwhelmingly the largest source country engaging in Ukraine. In Georgia, other than Georgian nationals, China, Israel, and the United States were the largest foreign source countries. In Greece, apart from locals, the largest source countries were Italy and Australia. Colombia reported a wide spread of foreign clientele with Israel, the United States, and Canada as the largest. COVID-19 had a significant impact on enrolments in Georgia and Ukraine—each experienced large declines in enrolments when comparing 2019–2020. In contrast, despite travel bans in 2020, agencies in 3 of 4 unregulated countries continued to report increases in enrolments. Conclusions: The global cross-border surrogacy market remains highly volatile, experiencing rapid growth and decline, especially in newer destinations. Source countries providing surrogacy clients are based partly on proximity and cultural ties, but more so on affordability. Further research is required to monitor the effects of engagement in newer destinations with fewer protections.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"8 1","pages":"e64 - e64"},"PeriodicalIF":0.0,"publicationDate":"2022-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48512202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-16DOI: 10.1097/GRH.0000000000000062
A. Sahile, G. E. Bekele, Kidist Bibiso, Z. M. Gebremariam
Background: Globally, abortion-related maternal deaths significantly decreased, but the opposite was true for Sub-Saharan Africa, where there was a significant increment in abortion-related maternal deaths. Health care providers are in constant conflict with the legalization of abortion, for viewing induced abortion as immoral. Objective: To assess the willingness and associated factors of comprehensive abortion care among health care professionals in Public health facilities of Bole Sub-City, Addis Ababa, Ethiopia, 2021. Methods: An institution-based cross-sectional study was undertaken among 367 health care professionals from April 1 to August 30, 2021. Willingness was measured as willing and not willing, as well as the level of agreement to provide abortion care under justifiable conditions. The data were collected by a structured and pretested self-administered questionnaire. Binary (bivariate and multivariate) logistics regression was used for the identification of predictors of willingness with its respective 95% CI and a P-value of <0.05 statistically significant levels. The finding was presented in texts and tables. Findings: A total of 367 study participants were involved in the study giving a response rate of 100%. The overall level of willingness was 42.3% (95% CI: 37.25%–47.35%). Being male [adjusted odds ratio (AOR): 1.987, 95% CI: 1.111–3.551, P<0.05], having a lower weekly religious attendance (AOR: 2.88; 95% CI: 1.687–4.930, P<0.001), and perceiving unsafe abortion as a health problem (AOR: 6.15; 95% CI: 3.79–9.97; P<0.05) were predictors associated with an increased level of willingness. Conclusions and Recommendations: A low level of willingness to provide comprehensive abortion was observed in the study. Being male, having a lower religious attendance, and having the perception that unsafe abortion is a health problem were predictors associated with an increased level of willingness to provide comprehensive abortion care. Stakeholders, government, and policymakers were recommended to work on the identified predictors of willingness in the study settings.
{"title":"Willingness and associated factors of comprehensive abortion services provision by health care professionals in selected public health facilities of Addis Ababa, Ethiopia","authors":"A. Sahile, G. E. Bekele, Kidist Bibiso, Z. M. Gebremariam","doi":"10.1097/GRH.0000000000000062","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000062","url":null,"abstract":"Background: Globally, abortion-related maternal deaths significantly decreased, but the opposite was true for Sub-Saharan Africa, where there was a significant increment in abortion-related maternal deaths. Health care providers are in constant conflict with the legalization of abortion, for viewing induced abortion as immoral. Objective: To assess the willingness and associated factors of comprehensive abortion care among health care professionals in Public health facilities of Bole Sub-City, Addis Ababa, Ethiopia, 2021. Methods: An institution-based cross-sectional study was undertaken among 367 health care professionals from April 1 to August 30, 2021. Willingness was measured as willing and not willing, as well as the level of agreement to provide abortion care under justifiable conditions. The data were collected by a structured and pretested self-administered questionnaire. Binary (bivariate and multivariate) logistics regression was used for the identification of predictors of willingness with its respective 95% CI and a P-value of <0.05 statistically significant levels. The finding was presented in texts and tables. Findings: A total of 367 study participants were involved in the study giving a response rate of 100%. The overall level of willingness was 42.3% (95% CI: 37.25%–47.35%). Being male [adjusted odds ratio (AOR): 1.987, 95% CI: 1.111–3.551, P<0.05], having a lower weekly religious attendance (AOR: 2.88; 95% CI: 1.687–4.930, P<0.001), and perceiving unsafe abortion as a health problem (AOR: 6.15; 95% CI: 3.79–9.97; P<0.05) were predictors associated with an increased level of willingness. Conclusions and Recommendations: A low level of willingness to provide comprehensive abortion was observed in the study. Being male, having a lower religious attendance, and having the perception that unsafe abortion is a health problem were predictors associated with an increased level of willingness to provide comprehensive abortion care. Stakeholders, government, and policymakers were recommended to work on the identified predictors of willingness in the study settings.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"7 1","pages":"e62 - e62"},"PeriodicalIF":0.0,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41990730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-11-11DOI: 10.1097/GRH.0000000000000063
D. Klu
Background: Pregnancy loss experiences due to stillbirths, miscarriages, and abortion among women have a negative effect on maternal health, leading to maternal mortality and strain on the health system. This study, therefore, seeks to examine the individual, proximate, and household factors associated with pregnancy loss experiences among ever pregnant women in Ghana. Methods: Data for this study were obtained from the 2014 Ghana Demographic and Health Survey (GDHS) conducted between early September and mid-December 2014. The weighted sample comprised 2321 ever pregnant women aged 15–49 years. Data were analyzed with SPSS version 25 using both descriptive and multilevel logistic regression modelling. Results: The study found that 48% of ever pregnant women have experienced pregnancy loss in Ghana. The multilevel regression analysis shows that ever pregnant women aged 25–34 years and 35–49 years had a higher likelihood of losing pregnancy. Pregnant women with secondary/higher education were less likely to lose their pregnancy. pregnant women who reside in urban areas has lower odds of pregnancy loss. Ever pregnant women who were currently married and those who were formerly married were more likely to experience pregnancy loss than never married women. Ever pregnant women who had access to an improved source of drinking water had a higher probability of losing their pregnancy. Interestingly, ever pregnant women who attended antenatal care services 1–3 times and 4 or more times were more likely to experience pregnancy loss. Conclusion: Individual, household, and proximate factors, such as pregnant women’s age, educational level, place of residence, religion, marital status, occupational type, household source of drinking water, and a number of antenatal visits, are strong significant predictors of pregnancy loss experiences among pregnant women in Ghana. These factors should be considered in strengthening existing programs and developing new interventions to decrease pregnancy loss and ensure safe motherhood.
{"title":"Multilevel analysis of factors predicting pregnancy loss experiences among pregnant women in Ghana: a further analysis of nationally representative data","authors":"D. Klu","doi":"10.1097/GRH.0000000000000063","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000063","url":null,"abstract":"Background: Pregnancy loss experiences due to stillbirths, miscarriages, and abortion among women have a negative effect on maternal health, leading to maternal mortality and strain on the health system. This study, therefore, seeks to examine the individual, proximate, and household factors associated with pregnancy loss experiences among ever pregnant women in Ghana. Methods: Data for this study were obtained from the 2014 Ghana Demographic and Health Survey (GDHS) conducted between early September and mid-December 2014. The weighted sample comprised 2321 ever pregnant women aged 15–49 years. Data were analyzed with SPSS version 25 using both descriptive and multilevel logistic regression modelling. Results: The study found that 48% of ever pregnant women have experienced pregnancy loss in Ghana. The multilevel regression analysis shows that ever pregnant women aged 25–34 years and 35–49 years had a higher likelihood of losing pregnancy. Pregnant women with secondary/higher education were less likely to lose their pregnancy. pregnant women who reside in urban areas has lower odds of pregnancy loss. Ever pregnant women who were currently married and those who were formerly married were more likely to experience pregnancy loss than never married women. Ever pregnant women who had access to an improved source of drinking water had a higher probability of losing their pregnancy. Interestingly, ever pregnant women who attended antenatal care services 1–3 times and 4 or more times were more likely to experience pregnancy loss. Conclusion: Individual, household, and proximate factors, such as pregnant women’s age, educational level, place of residence, religion, marital status, occupational type, household source of drinking water, and a number of antenatal visits, are strong significant predictors of pregnancy loss experiences among pregnant women in Ghana. These factors should be considered in strengthening existing programs and developing new interventions to decrease pregnancy loss and ensure safe motherhood.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"7 1","pages":"e63 - e63"},"PeriodicalIF":0.0,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48864084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-12DOI: 10.1097/GRH.0000000000000059
F. Parikh, Sujatha G. Sawkar, Sapna Agarwal, P. Makwana, Meenal S. Khandeparkar, Nandkishore Naik, Mangesh V. Sanap, S. Joshi, A. Athalye
Introduction: To evaluate the effects of intraovarian platelet-rich plasma (IOPRP) instillation in young Indian women with diminished ovarian reserve (DOR). Methods: This prospective, ongoing, cohort study was performed by recruiting 45 consenting Indian women with DOR (group A). Up to 3 cycles of IOPRP instillation were performed after minimal ovarian stimulation. Outcome measures were changes in antral follicle counts (AFC), anti-Müllerian hormone (AMH) levels, an increase in total and mature oocytes retrieved and establishment of pregnancy. The pregnancy rates in 51 women with the same inclusion criteria during the same time period were compared (group B). Results: In group A, baseline mean AFC was 3.44±2.35 (n=45); mean AFC increased after IOPRP-1 (3.89±2.21, n=45, P=0.1198<0.05 vs. baseline), IOPRP-2 (4.91±2.79, n=33, P=0.0056<0.05 vs. baseline), and IOPRP-3 (4.95±2.84, n=19, P=0.0002<0.05 vs. baseline). Mean AMH was 0.85±0.44 ng/mL. The changes in average AMH levels showed significance after IOPRP-2 (P=0.048<0.05). In group B, mean baseline AFC was 4.74±2.19, mean baseline AMH was 0.98±0.38 ng/mL. In group A, frozen embryo transfer was performed in 32/45 women and 15 clinical pregnancies were established. In group B, 44/51 women underwent frozen embryo transfer, 11 clinical pregnancies were established. The clinical pregnancy rate per transfer was 46.88%/embryo transfer in group A versus 25%/embryo transfer in group B. Conclusions: IOPRP instillation can improve AFC and can enhance pregnancy results in women with DOR. Increase in AMH levels and the number of total and mature oocytes was observed after 2 IOPRP. Significantly higher pregnancy rates (P=0.0009<0.05) were observed in women with IOPRP versus matched controls without IOPRP.
{"title":"A novel method of intraovarian instillation of platelet rich plasma to improve reproductive outcome in young Indian women with diminished ovarian reserve","authors":"F. Parikh, Sujatha G. Sawkar, Sapna Agarwal, P. Makwana, Meenal S. Khandeparkar, Nandkishore Naik, Mangesh V. Sanap, S. Joshi, A. Athalye","doi":"10.1097/GRH.0000000000000059","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000059","url":null,"abstract":"Introduction: To evaluate the effects of intraovarian platelet-rich plasma (IOPRP) instillation in young Indian women with diminished ovarian reserve (DOR). Methods: This prospective, ongoing, cohort study was performed by recruiting 45 consenting Indian women with DOR (group A). Up to 3 cycles of IOPRP instillation were performed after minimal ovarian stimulation. Outcome measures were changes in antral follicle counts (AFC), anti-Müllerian hormone (AMH) levels, an increase in total and mature oocytes retrieved and establishment of pregnancy. The pregnancy rates in 51 women with the same inclusion criteria during the same time period were compared (group B). Results: In group A, baseline mean AFC was 3.44±2.35 (n=45); mean AFC increased after IOPRP-1 (3.89±2.21, n=45, P=0.1198<0.05 vs. baseline), IOPRP-2 (4.91±2.79, n=33, P=0.0056<0.05 vs. baseline), and IOPRP-3 (4.95±2.84, n=19, P=0.0002<0.05 vs. baseline). Mean AMH was 0.85±0.44 ng/mL. The changes in average AMH levels showed significance after IOPRP-2 (P=0.048<0.05). In group B, mean baseline AFC was 4.74±2.19, mean baseline AMH was 0.98±0.38 ng/mL. In group A, frozen embryo transfer was performed in 32/45 women and 15 clinical pregnancies were established. In group B, 44/51 women underwent frozen embryo transfer, 11 clinical pregnancies were established. The clinical pregnancy rate per transfer was 46.88%/embryo transfer in group A versus 25%/embryo transfer in group B. Conclusions: IOPRP instillation can improve AFC and can enhance pregnancy results in women with DOR. Increase in AMH levels and the number of total and mature oocytes was observed after 2 IOPRP. Significantly higher pregnancy rates (P=0.0009<0.05) were observed in women with IOPRP versus matched controls without IOPRP.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"7 1","pages":"e59 - e59"},"PeriodicalIF":0.0,"publicationDate":"2022-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48970759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}