Pub Date : 2018-09-01DOI: 10.1097/GRH.0000000000000020
A. Dougherty, Miriam Kasten, Maureen McDonald, Njeri Angela, M. Kawooya, A. Matovu, K. DeStigter
Objective: The aim of this study was to determine the prevalence of high-risk obstetric conditions identified by point-of-care ultrasound in a rural Ugandan community and compare them with known rates in high-income settings. Methods: Pregnant women in a rural Ugandan clinic were offered a screening obstetric ultrasound at a late second or third trimester antenatal visit (Clearvue 350). Appropriate follow-up was determined by a preset algorithm. Placental abnormalities, multiple gestations, and fetal malpresentation were recorded. Descriptive statistics were used for analysis. Results: Fetal malpresentation in the third trimester was found in 15% [confidence interval (CI), 11.7–18.6] of pregnancies. Rates of multiple gestations and placental location abnormalities were 4% (CI, 2.7–5.2) and 1.7% (CI, 0.8–2.5), respectively. Overall, prevalence of abnormal placentation was comparable to published rates, although persistent fetal malpresentation was higher than in the United States. The rate of multiple gestations is on par with United States data despite lack of access to artificial reproductive technology. Conclusions: Given that placental abnormalities, multiple gestations, and fetal malpresentation in a rural Ugandan population are at least as common as in high-income countries, and emergency obstetric care is more difficult to access in Uganda, the contribution of these conditions to maternal mortality is likely higher in rural Uganda. Ultrasound can be used to identify and refer patients to higher-level facilities for safe delivery.
{"title":"Exploring the prevalence of high-risk obstetric conditions diagnosed by point-of-care ultrasound evaluation in a rural Ugandan population: a cohort study","authors":"A. Dougherty, Miriam Kasten, Maureen McDonald, Njeri Angela, M. Kawooya, A. Matovu, K. DeStigter","doi":"10.1097/GRH.0000000000000020","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000020","url":null,"abstract":"Objective: The aim of this study was to determine the prevalence of high-risk obstetric conditions identified by point-of-care ultrasound in a rural Ugandan community and compare them with known rates in high-income settings. Methods: Pregnant women in a rural Ugandan clinic were offered a screening obstetric ultrasound at a late second or third trimester antenatal visit (Clearvue 350). Appropriate follow-up was determined by a preset algorithm. Placental abnormalities, multiple gestations, and fetal malpresentation were recorded. Descriptive statistics were used for analysis. Results: Fetal malpresentation in the third trimester was found in 15% [confidence interval (CI), 11.7–18.6] of pregnancies. Rates of multiple gestations and placental location abnormalities were 4% (CI, 2.7–5.2) and 1.7% (CI, 0.8–2.5), respectively. Overall, prevalence of abnormal placentation was comparable to published rates, although persistent fetal malpresentation was higher than in the United States. The rate of multiple gestations is on par with United States data despite lack of access to artificial reproductive technology. Conclusions: Given that placental abnormalities, multiple gestations, and fetal malpresentation in a rural Ugandan population are at least as common as in high-income countries, and emergency obstetric care is more difficult to access in Uganda, the contribution of these conditions to maternal mortality is likely higher in rural Uganda. Ultrasound can be used to identify and refer patients to higher-level facilities for safe delivery.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":"e20"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42598161","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 : 2018-09-01DOI: 10.1097/GRH.0000000000000019
Devora Aharon, O. Carpinello, L. Bishop, A. DeCherney
Objective: To report a finding of persistently elevated estradiol (E2) after prolonged mifepristone use for treatment of progesterone-receptor positive meningioma, an association which has not previously been reported. Design: This is a case report. Setting: Outpatient Reproductive Endocrine clinic at a tertiary referral center. Case Report: A 48-year-old gravida 1 para 0-0-1-0 with progesterone-receptor positive meningioma, recurrent after multiple debulking surgeries. Patient was treated with mifepristone for 11 years with symptomatic improvement and tumor shrinkage. Levels of follicle-stimulating hormone, luteinizing hormone, and estradiol (E2) were followed throughout the patient’s course of mifepristone therapy. E2 levels were found to be persistently elevated to 500–700 pg/mL. Materials and Methods: Enhanced E2 assay, a liquid-chromatography tandem mass spectrometry (LC-MS/MS) based assay, was measured simultaneously with the routinely used immunoassay for 5 years in attempt to obtain a more accurate assessment. Results: E2 levels using the standard immunoassay were found to be persistently elevated while the patient was taking mifepristone. Using the enhanced LC-MS/MS assay, E2 was initially elevated, however was subsequently low. After the patient discontinued the medication, E2 levels as measured by the immunoassay normalized. Conclusions: Prolonged mifepristone use was found to be associated with markedly elevated E2 levels in our patient. If this is a true elevation, it may help explain the incidence of endometrial hyperplasia and endometrial polyps with prolonged mifepristone use. However, this was likely a false elevation, potentially due to cross-reactivity of mifepristone with the immunoassay, given the normal values obtained with the enhanced LC-MS/MS E2 assay. Whether prolonged mifepristone use may cause true or falsely elevated E2 in a wider population, and the mechanism through which it does so, should be further investigated.
{"title":"Elevated estradiol with prolonged mifepristone to treat progesterone-receptor positive meningioma","authors":"Devora Aharon, O. Carpinello, L. Bishop, A. DeCherney","doi":"10.1097/GRH.0000000000000019","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000019","url":null,"abstract":"Objective: To report a finding of persistently elevated estradiol (E2) after prolonged mifepristone use for treatment of progesterone-receptor positive meningioma, an association which has not previously been reported. Design: This is a case report. Setting: Outpatient Reproductive Endocrine clinic at a tertiary referral center. Case Report: A 48-year-old gravida 1 para 0-0-1-0 with progesterone-receptor positive meningioma, recurrent after multiple debulking surgeries. Patient was treated with mifepristone for 11 years with symptomatic improvement and tumor shrinkage. Levels of follicle-stimulating hormone, luteinizing hormone, and estradiol (E2) were followed throughout the patient’s course of mifepristone therapy. E2 levels were found to be persistently elevated to 500–700 pg/mL. Materials and Methods: Enhanced E2 assay, a liquid-chromatography tandem mass spectrometry (LC-MS/MS) based assay, was measured simultaneously with the routinely used immunoassay for 5 years in attempt to obtain a more accurate assessment. Results: E2 levels using the standard immunoassay were found to be persistently elevated while the patient was taking mifepristone. Using the enhanced LC-MS/MS assay, E2 was initially elevated, however was subsequently low. After the patient discontinued the medication, E2 levels as measured by the immunoassay normalized. Conclusions: Prolonged mifepristone use was found to be associated with markedly elevated E2 levels in our patient. If this is a true elevation, it may help explain the incidence of endometrial hyperplasia and endometrial polyps with prolonged mifepristone use. However, this was likely a false elevation, potentially due to cross-reactivity of mifepristone with the immunoassay, given the normal values obtained with the enhanced LC-MS/MS E2 assay. Whether prolonged mifepristone use may cause true or falsely elevated E2 in a wider population, and the mechanism through which it does so, should be further investigated.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":"e19"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49171146","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 : 2018-09-01DOI: 10.1097/grh.0000000000000015
Y. Morimoto, M. Ida, Tomoko Inoue, A. Fukuda
{"title":"Application of holistic medicine in the field of reproductive medicine: is it right to only focus on cells and organs? It is a time to convert to a new paradigm in reproductive medicine","authors":"Y. Morimoto, M. Ida, Tomoko Inoue, A. Fukuda","doi":"10.1097/grh.0000000000000015","DOIUrl":"https://doi.org/10.1097/grh.0000000000000015","url":null,"abstract":"","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48318056","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 : 2018-06-01DOI: 10.1097/grh.0000000000000009
N. Pierce, E. Mocanu
{"title":"Female age and assisted reproductive technology","authors":"N. Pierce, E. Mocanu","doi":"10.1097/grh.0000000000000009","DOIUrl":"https://doi.org/10.1097/grh.0000000000000009","url":null,"abstract":"","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/grh.0000000000000009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42780738","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 : 2018-06-01DOI: 10.1097/GRH.0000000000000008
B. Perlman, D. Kulak, L. Goldsmith, G. Weiss
Background: The hormonal changes which occur leading up to menopause have been described in multiple cross-sectional and longitudinal studies. Results from these studies document the occurrence of marked alterations in pituitary-hypothalamic function, along with the changes in the ovary, which play a role in the etiology of menopause. However, the role of pituitary-hypothalamic function in the menopausal transition (MT) has been generally overlooked. Methods: Literature searches were performed using PubMed, Scopus, and Medline, for articles with content related to menopause and the MT. The searches were restricted to English language observational studies and reviews of human studies and clinical trials. Results: During the MT, in addition to a reduction in the number of ovarian follicles, there is a marked reduction in the sensitivity of the central nervous system to both the positive and negative feedback effects of estrogen. These changes in sensitivity explain menstrual irregularities and systemic systems which are present in the time before the final menstrual period. Although the timing of menopause is difficult to predict, broad patterns in hormonal changes are seen, including a slow drop in inhibin B levels, followed by a monotropic rise in follicle-stimulating hormone during the late reproductive period. The MT is marked by irregular cycles with unpredictable luteinizing hormone levels and unpredictable ovulation. The levels of estrogen remain stable, or are even elevated through most of the MT, and levels of estrogen do not begin to decrease until late in the MT. The Stages of Reproductive Aging Workshop guidelines have improved the homogeneity of classifications in studies. Conclusions: On the basis of longitudinal hormone studies, it is clear that desensitization of the hypothalamic-pituitary-ovarian feedback loop plays an important role, in addition to a decrease in follicle number and insensitivity of remaining follicles to the positive feedback of estrogen, to trigger ovulation. Further studies in humans are needed to elucidate the mechanisms responsible for these perimenopausal changes if proper therapeutic modalities for the symptoms associated with menopause can be developed.
{"title":"The etiology of menopause: not just ovarian dysfunction but also a role for the central nervous system","authors":"B. Perlman, D. Kulak, L. Goldsmith, G. Weiss","doi":"10.1097/GRH.0000000000000008","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000008","url":null,"abstract":"Background: The hormonal changes which occur leading up to menopause have been described in multiple cross-sectional and longitudinal studies. Results from these studies document the occurrence of marked alterations in pituitary-hypothalamic function, along with the changes in the ovary, which play a role in the etiology of menopause. However, the role of pituitary-hypothalamic function in the menopausal transition (MT) has been generally overlooked. Methods: Literature searches were performed using PubMed, Scopus, and Medline, for articles with content related to menopause and the MT. The searches were restricted to English language observational studies and reviews of human studies and clinical trials. Results: During the MT, in addition to a reduction in the number of ovarian follicles, there is a marked reduction in the sensitivity of the central nervous system to both the positive and negative feedback effects of estrogen. These changes in sensitivity explain menstrual irregularities and systemic systems which are present in the time before the final menstrual period. Although the timing of menopause is difficult to predict, broad patterns in hormonal changes are seen, including a slow drop in inhibin B levels, followed by a monotropic rise in follicle-stimulating hormone during the late reproductive period. The MT is marked by irregular cycles with unpredictable luteinizing hormone levels and unpredictable ovulation. The levels of estrogen remain stable, or are even elevated through most of the MT, and levels of estrogen do not begin to decrease until late in the MT. The Stages of Reproductive Aging Workshop guidelines have improved the homogeneity of classifications in studies. Conclusions: On the basis of longitudinal hormone studies, it is clear that desensitization of the hypothalamic-pituitary-ovarian feedback loop plays an important role, in addition to a decrease in follicle number and insensitivity of remaining follicles to the positive feedback of estrogen, to trigger ovulation. Further studies in humans are needed to elucidate the mechanisms responsible for these perimenopausal changes if proper therapeutic modalities for the symptoms associated with menopause can be developed.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":"e8"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/GRH.0000000000000008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43874300","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 : 2018-06-01DOI: 10.1097/GRH.0000000000000011
A. Maheshwari
Cryopreservation of embryos is increasing worldwide. As more data are available we are now able to report on outcomes. With better outcomes for women and pregnancies as a result of frozen embryo transfer, we need to consider the implications of using it in routine practice especially in preference to current strategy of fresh embryo transfer.
{"title":"Cryopreservation of embryos: outcomes and implications","authors":"A. Maheshwari","doi":"10.1097/GRH.0000000000000011","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000011","url":null,"abstract":"Cryopreservation of embryos is increasing worldwide. As more data are available we are now able to report on outcomes. With better outcomes for women and pregnancies as a result of frozen embryo transfer, we need to consider the implications of using it in routine practice especially in preference to current strategy of fresh embryo transfer.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":"e11"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/GRH.0000000000000011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48892381","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 : 2018-06-01DOI: 10.1097/GRH.0000000000000012
P. Koninckx, A. Ussia, L. Adamyan, V. Gomel
The result of infertility treatment can be assessed accurately by the monthly fecundity rate and the cumulative pregnancy rate (CPR). The monthly fecundity rate, decreasing over time, and the time needed to reach the ultimate CPR are key factors in decision making. Depending on the clinical assessment, infertility treatment will be either with in vitro fertilization (IVF)/assisted reproduction technologies (ART) or with a diagnostic laparoscopy associated with reproductive surgery, which thereafter my require require IVF/ART. The comparison of IVF/ART treatment versus reproductive surgery is therefore the wrong debate as the CPR’s of reproductive surgery and of IVF are additive. Decisions should be based on the ultimate CPR’s and on effort and time, not on personal preferences. The large majority of women with infertility should have a diagnostic laparoscopy during which reproductive surgery can be performed if needed. IVF/ART treatment without a diagnosis decreases the ultimate CPR and is not without potentially serious adverse effects. Having excellent reproductive surgery readily available to patients, similar to the availability of IVF would increase CPR in women with infertility and decrease the overall cost.
{"title":"Reproductive surgery in the 21st century","authors":"P. Koninckx, A. Ussia, L. Adamyan, V. Gomel","doi":"10.1097/GRH.0000000000000012","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000012","url":null,"abstract":"The result of infertility treatment can be assessed accurately by the monthly fecundity rate and the cumulative pregnancy rate (CPR). The monthly fecundity rate, decreasing over time, and the time needed to reach the ultimate CPR are key factors in decision making. Depending on the clinical assessment, infertility treatment will be either with in vitro fertilization (IVF)/assisted reproduction technologies (ART) or with a diagnostic laparoscopy associated with reproductive surgery, which thereafter my require require IVF/ART. The comparison of IVF/ART treatment versus reproductive surgery is therefore the wrong debate as the CPR’s of reproductive surgery and of IVF are additive. Decisions should be based on the ultimate CPR’s and on effort and time, not on personal preferences. The large majority of women with infertility should have a diagnostic laparoscopy during which reproductive surgery can be performed if needed. IVF/ART treatment without a diagnosis decreases the ultimate CPR and is not without potentially serious adverse effects. Having excellent reproductive surgery readily available to patients, similar to the availability of IVF would increase CPR in women with infertility and decrease the overall cost.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":"e12"},"PeriodicalIF":0.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/GRH.0000000000000012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44576819","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 : 2018-03-01DOI: 10.1097/grh.0000000000000003
Alan H DeCherney
{"title":"Why Global Reproductive Health?","authors":"Alan H DeCherney","doi":"10.1097/grh.0000000000000003","DOIUrl":"https://doi.org/10.1097/grh.0000000000000003","url":null,"abstract":"","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130548/pdf/nihms-883014.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38930294","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 : 2018-01-01DOI: 10.1097/GRH.0000000000000004
R. Kennedy
Fertility rates are falling internationally. In contrast, infertility is one of themost common conditions in the world leading tomoderate or severe disability. The International Federation of Fertility Societies, as a global actor in reproductive health, has as its core mission increasing knowledge in this field, particularly in developing and middle income countries. This commentary sets out the IFFS strategy for delivering this mission and its interdependencies with other organizations with a similar focus and the World Health Organisation.
{"title":"IFFS strategy 2017 and beyond","authors":"R. Kennedy","doi":"10.1097/GRH.0000000000000004","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000004","url":null,"abstract":"Fertility rates are falling internationally. In contrast, infertility is one of themost common conditions in the world leading tomoderate or severe disability. The International Federation of Fertility Societies, as a global actor in reproductive health, has as its core mission increasing knowledge in this field, particularly in developing and middle income countries. This commentary sets out the IFFS strategy for delivering this mission and its interdependencies with other organizations with a similar focus and the World Health Organisation.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"3 1","pages":"e4"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61697644","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 : 2018-01-01DOI: 10.1097/GRH.0000000000000007
L. Cui, Yizhou Liu, Yueru Meng, Bing-qian Zhang, R. Tang, Zi-jiang Chen
Introduction: Increased multiple pregnancy rate and resultant complications are some of the greatest concerns for in vitro fertilization (IVF) due to the practice of multiple embryo transfer. Although in some countries elective single embryo transfer has already been mandatory, in majority of other countries, clinical counsel still plays very important role to affect expected number of embryos transferred (ENET). Here we aim to explore the impact factors for ENET of IVF patients in order to provide scientific suggestions for clinical counsel before ET. Methods: We performed a survey of impact factors on ENET using a self-designed questionnaire in a total of 1154 IVF couples. Questions about policy change, medical concerns, and social-cultural information were included. Results: When the policy for restriction of family size was lifted, the percentages for double embryos transferred (77.8% vs. 63.7%) and multiple embryos transferred (8.0% vs. 3.9%) decreased significantly, while more tended to choose single embryo transfer (SET) (14.2% vs. 32.4%, P<0.01). Patients of more advanced age weremore likely to choose SET (12.9% for 18–24 y, 11.8% for 25–29 y, 12.0% for 30–34 y, 22.4% for 35–39 y, and 28.6% for over 40 y, P=0.01). More subjects with previous labor preferred SET than those without (23.3% vs. 12.4%, P<0.01). In addition, the proportion of SET choice was significantly decreased with infertility duration prolonged (1 vs. 2 y vs. 3 vs. ≥ 4 y: 24.2% vs. 14.9% vs. 11.1% vs. 11.2%, P< 0.01). On the basis of further investigation for reasons of ENET, specific formula including individual weighted policy, medical, and social-cultural factors was derived. Conclusions: Collectively, ENET for IVF patients is a complex, multi-factorial decision. The heterogeneity between patients due to differential policy restriction, medical concerns, and social-cultural background should be fully considered in clinical counsel about ENET.
导论:多胎妊娠率的增加和由此产生的并发症是体外受精(IVF)中由于多胎移植的一些最大的担忧。尽管在一些国家选择性单胚胎移植已经是强制性的，但在其他大多数国家，临床咨询仍然在影响胚胎移植的预期数量(ENET)方面发挥着非常重要的作用。本研究旨在探讨体外受精患者ENET的影响因素，为体外受精前的临床咨询提供科学的建议。方法:采用自行设计的问卷对1154对体外受精夫妇进行ENET影响因素调查。包括有关政策变化、医疗问题和社会文化信息的问题。结果:家庭规模限制政策解除后，双胚胎移植比例(77.8% vs. 63.7%)和多胚胎移植比例(8.0% vs. 3.9%)显著降低，单胚胎移植比例(14.2% vs. 32.4%， P<0.01)增加。高龄患者更有可能选择SET(18-24岁12.9%，25-29岁11.8%，30-34岁12.0%，35-39岁22.4%，40岁以上28.6%，P=0.01)。有劳动史者比无劳动史者更倾向于SET(23.3%比12.4%，P<0.01)。此外，随着不孕持续时间的延长，选择SET的比例显著降低(1 y对2 y、3 y对≥4 y: 24.2%对14.9%、11.1%对11.2%，P< 0.01)。在进一步调查ENET原因的基础上，导出了包含个人加权政策、医疗和社会文化因素的具体公式。结论:总的来说，IVF患者的ENET是一个复杂的、多因素的决定。在临床咨询ENET时应充分考虑不同政策限制、医疗问题和社会文化背景导致的患者之间的异质性。
{"title":"Expected numbers of embryos to transfer in in vitro fertilization: what affects?","authors":"L. Cui, Yizhou Liu, Yueru Meng, Bing-qian Zhang, R. Tang, Zi-jiang Chen","doi":"10.1097/GRH.0000000000000007","DOIUrl":"https://doi.org/10.1097/GRH.0000000000000007","url":null,"abstract":"Introduction: Increased multiple pregnancy rate and resultant complications are some of the greatest concerns for in vitro fertilization (IVF) due to the practice of multiple embryo transfer. Although in some countries elective single embryo transfer has already been mandatory, in majority of other countries, clinical counsel still plays very important role to affect expected number of embryos transferred (ENET). Here we aim to explore the impact factors for ENET of IVF patients in order to provide scientific suggestions for clinical counsel before ET. Methods: We performed a survey of impact factors on ENET using a self-designed questionnaire in a total of 1154 IVF couples. Questions about policy change, medical concerns, and social-cultural information were included. Results: When the policy for restriction of family size was lifted, the percentages for double embryos transferred (77.8% vs. 63.7%) and multiple embryos transferred (8.0% vs. 3.9%) decreased significantly, while more tended to choose single embryo transfer (SET) (14.2% vs. 32.4%, P<0.01). Patients of more advanced age weremore likely to choose SET (12.9% for 18–24 y, 11.8% for 25–29 y, 12.0% for 30–34 y, 22.4% for 35–39 y, and 28.6% for over 40 y, P=0.01). More subjects with previous labor preferred SET than those without (23.3% vs. 12.4%, P<0.01). In addition, the proportion of SET choice was significantly decreased with infertility duration prolonged (1 vs. 2 y vs. 3 vs. ≥ 4 y: 24.2% vs. 14.9% vs. 11.1% vs. 11.2%, P< 0.01). On the basis of further investigation for reasons of ENET, specific formula including individual weighted policy, medical, and social-cultural factors was derived. Conclusions: Collectively, ENET for IVF patients is a complex, multi-factorial decision. The heterogeneity between patients due to differential policy restriction, medical concerns, and social-cultural background should be fully considered in clinical counsel about ENET.","PeriodicalId":92638,"journal":{"name":"Global reproductive health","volume":"67 1","pages":"e7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/GRH.0000000000000007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61697654","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}
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