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Therapeutic Advances in Reproductive Health
Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2633-4941
Published by Sage Publications Homepage  [1093 journals]
  • Conception rates after fluoroscopy-guided fallopian tubal cannulation: an
           alternative to in vitro fertilization for patients with tubal occlusion

    • Authors: Jeffrey W. Wang, Gabriella M. Rustia, Mary Wood-Molo, Jordan Tasse, David Tabriz, Ulku C. Turba, Bulent Arslan, Sreekumar Madassery
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Objective:Previous studies show good technical success rates for fallopian tube recanalization. Scarce literature exists regarding advance techniques currently used by interventional radiologists during fallopian tube recanalization procedures. This study investigates the level of intervention and tubal patency and its association with technical success and associated pregnancy outcomes.Methods:We retrospectively evaluated fallopian tube recanalization procedures performed at a single center in a 24-year period. A total of 160 couples undergoing a basic infertility evaluation were included. Hysterosalpingography with high pressure contrast injection followed by selective contrast, guidewire catheterization at the tubal ostium, and/or microcatheter/microwire recanalization were performed. Comparisons of the tubal fertilization rate by relevant characteristics were tested for statistical significance with t tests for continuous data or with Pearson chi-square tests for categorical data.Results:Technical success rate was 94% (319 of 341 tubes). High pressure contrast injection alone (184 of 341, 54%), selective catheterization (40%), and microcatheter/microwire (6%) interventions yielded technical success rates of 98%, 90%, and 73%, respectively. The overall rate of conception was 35% (17 of 48).Conclusion:Current techniques of fallopian tube recanalization offer a desirable and safe option with high technical success for patients seeking treatment for infertility due to proximal fallopian tube obstruction.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-10-09T05:53:20Z
      DOI: 10.1177/2633494120954248
      Issue No: Vol. 14 (2020)
       
  • Update on the management of poor ovarian response in IVF: the shift from
           Bologna criteria to the Poseidon concept

    • Authors: Panagiotis Drakopoulos, Erlisa Bardhi, Liese Boudry, Alberto Vaiarelli, Antonis Makrigiannakis, Sandro C. Esteves, Herman Tournaye, Christophe Blockeel
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Despite the considerate progress to which assisted reproduction technology (ART) has been subject since 1978, some issues remain unresolved. Notably, the clinical management of patients with a poor ovarian response is still a challenge in everyday practice, frustrating to both the patient and the fertility expert. Poor ovarian responders (PORs) embody 9–24% of patients undergoing ovarian stimulation, meaning that up to one in four patients conceals a poor reproductive prognosis. The last decade has witnessed the attempts of the medical community to standardize diagnosis of POR with the developing of the Bologna Criteria and the subsequent evolution of the low prognosis patient elaborated in the POSEIDON classification. The aim of this article is to summarize all evidence concerning etiology and management of poor ovarian response, including the most recent advances and future prospects in this regard.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-07-31T12:23:19Z
      DOI: 10.1177/2633494120941480
      Issue No: Vol. 14 (2020)
       
  • Controversies in the diagnosis of polycystic ovary syndrome

    • Authors: Preetham Rao, Priya Bhide
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Polycystic ovary syndrome is a common endocrinological condition which is found to be prevalent in 5–10% of women of reproductive age. Historically, a combination of anovulation and androgen excess was considered a hallmark in the diagnosis of polycystic ovary syndrome. Addition of ultrasound features of polycystic ovary syndrome has improved the detection of variation in the polycystic ovary syndrome phenotype. Despite the widespread use of consensus diagnostic criteria, there remain several unresolved controversies in the diagnosis of polycystic ovary syndrome. Difficulty arises in methods of assessment and types of androgens to be measured to detect biochemical hyperandrogenism, setting a cut-off value for the diagnosis of clinical hyperandrogenism, setting an ultrasound threshold of antral follicle count to diagnose polycystic ovaries and also diagnosing this condition in adolescence where there is no clear definition for ‘irregular cycles’. This article looks at various controversies in the diagnosis of polycystic ovary syndrome.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-30T04:44:42Z
      DOI: 10.1177/2633494120913032
      Issue No: Vol. 14 (2020)
       
  • Intimate partner violence among postpartum women at a teaching hospital in
           Nigeria’s Federal Capital City: pattern and materno-fetal outcomes

    • Authors: Godwin O. Akaba, Habiba I. Abdullahi
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Background:Intimate partner violence is an important public health and human rights issue. Previous studies have considered intimate partner violence in pregnancy mainly among pregnant women attending antenatal clinics thereby missing out a few who may encounter this problem in late pregnancy or just before delivery. This study had the objective of ascertaining the prevalence, pattern of intimate partner violence, and associated materno-fetal outcomes.Method:This was a cross-sectional study conducted between January 2017 and June 2017 among postpartum mothers at a Nigerian Teaching Hospital just before being discharged home. The abuse assessment score was adapted and used to interview women regarding possible intimate partner violence experiences within the past 1 year and during the pregnancy after obtaining written consent.Results:Out of 349 postpartum women interviewed, 102/349 (29.2%) experienced intimate partner violence in the past 1 year, while 18/349 (5.2%) of intimate partner violence occurred in the index pregnancy. Sexual partners were the main perpetuators of intimate partner violence, 67/102 (65.7%), while 35/102 (34.3%) were by someone else other than their sexual partners. Among those abused in the current pregnancy, 10/18 (55.6%) were abused once and the remaining 8/18 (44.4%) were abused more than once. Intimate partner violence was associated with higher chances of cesarean section (p = 0.001), increased risk of lesser birth weight babies (p = 0.014), and maternal complications in pregnancy (p = 0.030).Conclusion:The prevalence of intimate partner violence in pregnancy in Abuja is high with associated poor materno-fetal outcomes. Enforcing existing legislations and screening for intimate partner violence during routine antenatal care may help reduce its prevalence and ensure a positive pregnancy experience for Nigerian women.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-29T08:51:54Z
      DOI: 10.1177/2633494120928346
      Issue No: Vol. 14 (2020)
       
  • Serum estradiol levels in infertile men with non-obstructive azoospermia

    • Authors: Nader Salama, Saeed Blgozah
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Purpose:To report the different patterns of estradiol levels in infertile men with non-obstructive azoospermia and correlate these levels with their clinical and laboratory findings.Materials and methods:A retrospective study was launched, and a retrieval of data for infertile men with non-obstructive azoospermia (n = 166) and fertile controls (n = 40) was performed. The retrieved data included demographics, clinical findings, scrotal duplex, semen analysis, and hormonal assay (testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol).Results:Our findings showed a wide spectrum of estradiol concentrations. The patients were arranged into three groups (high, normal, and low estradiol groups). The normal estradiol group was the most prevalent (71.1%). Testosterone, gonadotrophins, testicular volumes, and the number of patients with jobs in polluted workplaces showed significant differences among the study groups (p = 0.001,
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-29T06:35:47Z
      DOI: 10.1177/2633494120928342
      Issue No: Vol. 14 (2020)
       
  • Risk factors for women’s non-utilization of decentralized primary health
           care facilities for postnatal care in rural western Ethiopia

    • Authors: Habtamu Tolera, Tegegne Gebre-Egziabher, Helmut Kloos
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Objective:Evidence suggests postnatal care contributes to reductions in maternal mortality. In Ethiopia, the proportion of women who do not utilize postnatal care after birth is high and the frequency of postnatal checks falls short of the four visits recommended by World Health Organization. This study examined risk factors associated with non-utilization of decentralized local health facilities, namely, health posts, health centers, and a primary hospital, for postnatal care services in Gida Ayana Woreda in rural western Ethiopia.Methods:In this study, 454 mothers were examined for the following risk factors: kebele (the smallest administrative unit in Ethiopia) in which decentralized health care facilities were located, postnatal woman’s age, antenatal care service visit, experience of postnatal complications, knowledge of postnatal complications, knowledge of the recommended number of postnatal care visits, knowledge of the availability/provision of postnatal care, and health extension workers’ home visits. Bivariate and multivariable logistic regression analyses were applied to identify predictors of non-utilization of decentralized local facilities for postnatal care services.Results:Over half (55.7%) of the women did not utilize postnatal care within 42 days of delivery, and only 10.0% utilized the care considered appropriate according to World Health Organization guidelines. After adjusting for various potential confounding factors, we found the following risks to be strongly associated with non-utilization of decentralized health care facilities for postnatal care services: some outer rural administrative decentralization entities such as Angar, Lalistu, and Ejere kebeles; age 35 years or older (adjusted odds ratio = 3.4, 95% confidence interval: 1.4–8.3), not receiving antenatal care during this pregnancy (adjusted odds ratio = 2.0, 95% confidence interval: 1.1–3.7), no experience of any postnatal complications (adjusted odds ratio = 3.3, 95% confidence interval: 1.7–6.4), and no knowledge of at least one postnatal complication (adjusted odds ratio = 2.0, 95% confidence interval: 1.2–3.3). Risk factors highly but less strongly associated with women’s non-utilization of postnatal care services were no knowledge of the standard number of postnatal care visits recommended, no knowledge about the availability/provision of services at a local health facility, and no home visit from health extension worker by day 3 post-delivery.Conclusion:The risk factors for women’s non-utilization of decentralized health care facilities for postnatal care identified in this study need to be considered in interventions for enhancing the utilization of the service and reducing maternal and newborn deaths in rural western Ethiopia. Strengthening of postnatal care services, especially in the more remote kebeles, should include upgrading of the referral system and expansion of counseling of women by health extension workers.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-26T05:03:58Z
      DOI: 10.1177/2633494120928340
      Issue No: Vol. 14 (2020)
       
  • The insulin signaling pathway is dysregulated in cumulus cells from obese,
           infertile women with polycystic ovarian syndrome with an absence of
           clinical insulin resistance

    • Authors: Mauricio B. Chehin, Renato Fraietta, Aline R. Lorenzon, Tatiana C.S. Bonetti, Eduardo L.A. Motta
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Methods:This is a cohort study, conducted at a university-based reproductive medicine center and private reproductive medicine center that aimed to evaluate granulosa cumulus cell gene expression in the insulin signaling pathway in Polycystic Ovary Syndrome (PCOS) patients undergoing in vitro fertilization (IVF) treatment and to compare the cumulus gene expression between normal weight and obese women without clinical insulin resistance. Fifteen PCOS patients, nine normal weight patients and six obese patients presenting normal HOMA IR (Homeostasis Model Assessment–Insulin Resistance), participated. Patients underwent oocyte retrieval for IVF and after the procedure, granulosa cumulus cells were removed from the oocytes for RNA extraction. Quantitative polymerase chain reaction (PCR) array analysis of 84 genes from insulin signaling pathway was conducted. The results were expressed as fold up- or fold down-expression in obese patients compared with normal weight patients. Any fold change ⩾3 or ⩽3 and any p ⩽ 0.05 were considered statistically significant.Results:There were 10 genes that were overexpressed in obese compared with normal weight women, BCL2L1, BRAF, CBL, DOK1, FBP1, FRS2, MTOR, PCK2, RPS6KA1, and SORBS1, that had a fold change ⩾3 and p ⩽ 0.05.Discussion:In the obese group, the overexpressed genes are mainly responsible for the proliferation and differentiation of cumulus cells during oocyte maturation, insulin resistance, apoptosis regulation, and glucose metabolism during early embryogenesis, suggesting that in the follicular environment, insulin resistance is present even in the absence of clinical signs.Conclusion:Together, our findings and the related literature suggest that those alterations may be associated with the worse prognosis of follicular development and oocyte maturation observed in PCOS obese women.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-18T12:47:13Z
      DOI: 10.1177/2633494120906866
      Issue No: Vol. 14 (2020)
       
  • Ejaculatory abstinence in semen analysis: does it make any sense'

    • Authors: Shah Dupesh, Natarajan Pandiyan, Radha Pandiyan, Jeeva Kartheeswaran, Bhaskar Prakash
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Background:The precise effect of ejaculatory abstinence on semen parameters is highly debatable, especially among subfertile men. Previous studies on effect of abstinence time on different semen parameters have reported controversial results. The aim of this study was to retrospectively assess the variance of semen parameters with different periods of ejaculatory abstinence among both a population of normozoospermic (n = 1621) and oligozoospermic (n = 416) Tamil men, presenting to a fertility clinic for an infertility evaluation (N = 2037).Materials and Methods:A retrospective analysis of 2037 semen analysis reports involved grouping patients based on their ejaculatory abstinence, that is, 30 days. All semen parameters were assessed as per the World Health Organization (WHO, 2010) recommended guidelines. The unpaired two-tailed t-test and Welch’s analysis of variance (ANOVA) combined with Games–Howell post hoc test were used for statistical analysis. A p value
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-15T07:13:19Z
      DOI: 10.1177/2633494120906882
      Issue No: Vol. 14 (2020)
       
  • Laboratory and clinical management of leukocytospermia and hematospermia:
           a review

    • Authors: Kajal Khodamoradi, Manish Kuchakulla, Manish Narasimman, Zahra Khosravizadeh, Aleena Ali, Nancy Brackett, Emad Ibrahim, Ranjith Ramasamy
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Leukocytospermia and hematospermia are defined as the presence of abnormally high white blood cell and red blood cell concentration in the semen, respectively. Numerous etiologies and various implications on fertility have been identified. In a small proportion of men, the presence of white blood cells or red blood cells can adversely affect sperm quality by the production of reactive oxygen species. Several methods have been used to assess the presence of white blood cells and red blood cells in samples, such as identification of round cells, immunohistochemical staining using monoclonal antibodies, the Endtz test, the peroxidase test, and flow cytometry or microscopy. In addition, techniques have been identified to separate sperm samples from white blood cells and red blood cells for cryopreservation to improve outcomes in assisted reproductive technology. In this review, laboratory and clinical management of leukocytospermia and hematospermia are discussed. Currently available diagnostic methods and treatment options are outlined, and available optimal cryopreservation techniques for samples with white blood cells or red blood cells are summarized.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-06-11T06:55:44Z
      DOI: 10.1177/2633494120922511
      Issue No: Vol. 14 (2020)
       
  • The stair-step approach in treatment of anovulatory PCOS patients

    • Authors: Eran Horowitz, Ariel Weissman
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Clomiphene citrate (CC) is a widely accepted first-line treatment for anovulatory patients with polycystic ovarian syndrome (PCOS). The current practice is to prescribe CC with gradual dose increments until ovulation is achieved. Typically, progesterone withdrawal bleeding is induced between each dose increment and before the commencement of gonadotropin therapy in CC-resistant patients. It has been recently suggested that dose increments of CC can be administered once failure to induce ovulation at a certain dose has been documented, without induction of progesterone withdrawal bleeding, and this approach has been nicknamed the clomiphene-citrate stair-step (CC-SS) protocol. The same principle has been found feasible before introducing gonadotropin therapy in CC-resistant PCOS patients. Our objective was to review the world literature on the CC-SS protocol and to summarize our own experience with extending the CC-SS approach to initiation of gonadotropin therapy. Studies on CC-SS protocol (n = 4) have found that this approach leads to a significant reduction of the time to ovulation and to an increased ovulation rate. In our own retrospective case series, 18 CC-resistant PCOS patients initiated gonadotropin stimulation without induction of progesterone withdrawal bleeding, using the chronic low-dose regimen. The time to ovulation in the study group was 54.2 ± 6.2 days, while the estimated time to ovulation calculated according to the traditional approach was approximately 110 days. The clinical pregnancy rate was 44% (8/18), and all pregnancies were singletons. One patient miscarried; hence, the live birth rate was 38.9% (7/18). In summary, the CC-SS approach and its extension to the initiation of gonadotropin therapy results in considerable reduction of the time to ovulation, and favorable ovulation rates and reproductive outcome. Large-scale confirmation of these findings by properly designed randomized controlled trials may lead to a change of practice in the treatment of anovulatory infertility in PCOS patients, allowing simplification of treatment and a shorter time to ovulation and pregnancy.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-05-22T12:24:18Z
      DOI: 10.1177/2633494120908818
      Issue No: Vol. 14 (2020)
       
  • Studies on the basic issues relevant to sperm cryopreservation in humans

    • Authors: Huanhuan Hu, Xiaowei Shi, Guojie Ji, Rui Liu, Jing Zhang, Han Zhang, Mingwen Li
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Rapid freezing and vitrification are becoming popular for sperm freezing in humans; however, basic and critical issues relevant to sperm cryopreservation remain to be resolved. The aims of the present study were to study the effects of osmolality of freezing medium, sperm concentrations, thawing methods, and sugars (sucrose and trehalose) on sperm motility and DNA integrity by rapid freezing using 0.5 ml standard straws loaded with 100 µl sperm each. The results showed that (1) the post-thaw recovery rates of total motility and progressive motility of sperm cryopreserved in freezing medium containing 0.25 M sucrose with 442 mOsm/kg osmolality were significantly higher (p  0.05) by sperm concentrations in the range from 5 to 20 × 106 sperm/ml, (3) thawing method 37°C for 2 min was better than 42°C for 15 s in terms of post-thaw recovery rates of both total and progressive motilities (p 
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-05-22T12:19:56Z
      DOI: 10.1177/2633494120909375
      Issue No: Vol. 14 (2020)
       
  • Reaching women with obesity to support weight loss before pregnancy:
           feasibility and qualitative assessment

    • Authors: Denise Simon, Anjali J. Kaimal, Emily Oken, Marie-France Hivert
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Background:We sought to assess attitudes toward weight and barriers to recruitment of women with obesity for a potential preconception weight-loss/lifestyle modification intervention.Methods:We performed a qualitative study involving women of reproductive age (18–45) with obesity (body mass index ⩾30 kg/m2) who were considering a pregnancy in the next 2 years. We evaluated four methods of recruitment. We used previously validated survey questions to evaluate risk perceptions. In a subset, we used semistructured interviews for topics that required more in-depth information: domains included attitudes toward weight-related issues, intentions, and barriers to engagement in a structured weight-loss program. We performed qualitative analyses of interview transcripts using immersion crystallization.Results:We recruited the majority (80/82, 98%) of women using e-recruitment strategies. Eighty-one women filled out the survey and 39 completed an interview. Three-quarters of the women surveyed (60 of 81) reported attempts to lose weight in the past year and 77% (68/81) of survey respondents cited jobs and work schedules as a barrier to adopting healthy habits. More than 87% (34 of 39) of women interviewed reported willingness to participate in a structured weight-loss program prior to getting pregnant. Of these, 74% (25 of 34) stated they would consider delaying their attempts at a future pregnancy in order to participate in such a program.Conclusions:E-recruitment is a promising strategy for recruitment for preconception weight-loss and lifestyle modification program. Most women state a willingness to delay pregnancy attempts to participate in a weight-loss program.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-05-13T05:06:36Z
      DOI: 10.1177/2633494120909106
      Issue No: Vol. 14 (2020)
       
  • Surgical adhesions among women undergoing laparoscopic gynecological
           surgery with or without adhesiolysis – prevalence, severity, and
           implications: retrospective cohort study at a University Hospital

    • Authors: Naser Al-Husban, Yousef Elayyan, Malab El-Qudah, Bayan Aloran, Rima Batayneh
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Objective:To find out the prevalence of adhesions, severity, and their relation to the current clinical scenario and to the type of previous surgery.Methods and Materials:A retrospective study of patients who already had different previous abdominopelvic surgery and subsequently underwent gynecological laparoscopic surgery for various indications. The patients’ clinical and operative notes were reviewed and analyzed.Results:There were 654 procedures performed. The most common indication for the laparoscopic surgery was secondary infertility 23.5%, followed by adnexal lesions 22.0% and primary infertility 19.6%. Intraoperative adhesions were found in 45.3%. Adhesions were deemed relevant to the clinical scenario in 21.3%. Patients who had a previous history of open (traditional) surgery were more likely to be found with adhesions in comparison with patients with history of laparoscopic surgery (odds ratio: 2.7, 95% confidence interval: 1.4–5.3, p = 0.0025). The presence of adhesions was found to be strongly associated with previous abdominopelvic surgery than non-abdominopelvic surgery (odds ratio: 4.3, p = 0.0078, 95% confidence interval: 1.5–12.5). The most common location of the adhesions was abdominal (36.1%), mixed abdominal and pelvic (35.1%), and pelvic adhesions (28.1%). Severe adhesions were found in 36.1%; 13.6% of converted laparoscopy to open surgery was due to adhesions. Cesarean sections were significantly associated with adhesions. Patients who had cesarean sections were more likely to have adhesions than those who had not (odds ratio: 5.7, 95% confidence interval: 3.8–8.6, p < 0.0001). Adhesiolysis was done without complications in 19.6% of patients with adhesions.Conclusion:Adhesions were prevalent in gynecological patients with previous abdominopelvic surgery. They were a significant contributor to the gynecological and reproductive issues. To minimize the risk of postoperative adhesions, laparoscopic approach should be encouraged instead of traditional surgery and rates of cesarean section should be reduced. Further high-quality studies are needed to establish conclusion and practical guidance toward the use of adhesion barriers.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-05-11T06:51:01Z
      DOI: 10.1177/2633494120906010
      Issue No: Vol. 14 (2020)
       
  • Attitudes and experiences of health care professionals when caring for
           transgender men undergoing fertility preservation by egg freezing: a
           qualitative study

    • Authors: Gabriela Armuand, Cecilia Dhejne, Jan I. Olofsson, Margareta Stefenson, Kenny A. Rodriguez-Wallberg
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Background:As gender-affirming treatment may have a negative impact on fertility, reproductive health counseling to patients seeking medical or surgical gender-affirming treatment should be provided, including the option to undergo fertility preservation (FP). Experiences of transgender men undergoing FP treatments aimed at oocyte freezing have reported a negative impact of the treatments on gender dysphoria. No previous studies have investigated the experiences of health care professionals’ (HCP) when caring for transgender men undergoing such treatments.Aim:The aim of this study was to investigate HCP’s attitudes and experiences when meeting transgender men undergoing FP through oocyte freezing.Methods:Individual interviews were conducted in 2016 with 13 HCPs working at a Reproductive Medicine clinic in Sweden. Data were analyzed by thematic content analysis.Results:The main theme found, How to maintain professionalism, showed that HCPs experienced important challenges to their professionalism when their preconceived opinions and values about gender and transgender were confronted.Discussion:Our findings demonstrate the need of continuous efforts on assessing learning needs as well as addressing preconceived opinions and values of HCP. By gaining knowledge and self-confidence in the care of transgender individuals undergoing FP, a professional care for transgender people can be achieved and a safe environment can be established for the patients. This in turn may alleviate some of the distress that may arise when transgender men undergo FP.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-04-30T07:28:50Z
      DOI: 10.1177/2633494120911036
      Issue No: Vol. 14 (2020)
       
  • The obligate need for accuracy in reporting preclinical studies relevant
           to clinical trials: autologous germline mitochondrial supplementation for
           assisted human reproduction as a case study

    • Authors: Jonathan L. Tilly, Dori C. Woods
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      A now large body of work has solidified the central role that mitochondria play in oocyte development, fertilization, and embryogenesis. From these studies, a new technology termed autologous germline mitochondrial energy transfer was developed for improving pregnancy success rates in assisted reproduction. Unlike prior clinical studies that relied on the use of donor, or nonautologous, mitochondria for microinjection into eggs of women with a history of repeated in vitro fertilization failure to enhance pregnancy success, autologous germline mitochondrial energy transfer uses autologous mitochondria collected from oogonial stem cells of the same woman undergoing the fertility treatment. Initial trials of autologous germline mitochondrial energy transfer during - in vitro fertilization at three different sites with a total of 104 patients indicated a benefit of the procedure for improving pregnancy success rates, with the birth of children conceived through the inclusion of autologous germline mitochondrial energy transfer during in vitro fertilization. However, a fourth clinical study, consisting of 57 patients, failed to show a benefit of autologous germline mitochondrial energy transfer–in vitro fertilization versus in vitro fertilization alone for improving cumulative live birth rates. Complicating this area of work further, a recent mouse study, which claimed to test the long-term safety of autologous mitochondrial supplementation during in vitro fertilization, raised concerns over the use of the procedure for reproduction. However, autologous mitochondria were not actually used for preclinical testing in this mouse study. The unwarranted fears that this new study’s erroneous conclusions could cause in women who have become pregnant through the use of autologous germline mitochondrial energy transfer during-in vitro fertilization highlight the critical need for accurate reporting of preclinical work that has immediate bearing on human clinical studies.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-04-23T06:11:34Z
      DOI: 10.1177/2633494120917350
      Issue No: Vol. 14 (2020)
       
  • Patient perspectives and experiences with in vitro fertilization and
           genetic testing options

    • Authors: Erin Rothwell, Brandy Lamb, Erin Johnson, Shawn Gurtcheff, Naomi Riches, Melinda Fagan, Maya Sabatello, Erica Johnstone
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Objective:Decision-making and patient experiences with embryo selection during in vitro fertilization often include genetic testing options. The purpose of this study was to gain insight about the experiences and perspectives of women using in vitro fertilization and genetic technologies.Methods:Interviews (n = 37) were conducted among female patients who had undergone in vitro fertilization, underwent expanded carrier screening, and were offered pre-implantation genetic testing for aneuploidy between July 2016 and July 2017. The interviews were transcribed and a content analysis was conducted on the transcripts.Results:Categories that emerged from the data analysis included unexpected outcomes, uncertainty, unanticipated emotional consequences, too much emphasis on the woman’s contributions and questions about embryo viability. Patient experiences with genetic technologies during in vitro fertilization played a significant role within these results.Conclusion:The emotional and psychological impacts of infertility during in vitro fertilization were the primary concerns discussed by participants. Future research is needed to identify ways to help manage unexpected outcomes and continuous uncertainty, including the increasing use of genetic technologies, to not add to the psychological burden of infertility. There is a need to explore more support options or counseling services for patients struggling with infertility during in vitro fertilization treatment.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-04-16T01:00:39Z
      DOI: 10.1177/2633494119899942
      Issue No: Vol. 14 (2020)
       
  • Characteristics of polycystic ovary syndrome throughout life

    • Authors: Yvonne V. Louwers, Joop S.E. Laven
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. It is a complex disease in which genetic, endocrine, environmental, and behavioral factors are intertwined, giving rise to a heterogeneous phenotype with reproductive, metabolic, and psychological characteristics. Polycystic ovary syndrome affects women’s health and their quality of life across the life course. During different life stages, the polycystic ovary syndrome phenotype can change, which requires a personalized diagnostic approach and treatment. Polycystic ovary syndrome is a major cause of anovulatory infertility; this disorder is also associated with hirsutism and acne. Diagnosing polycystic ovary syndrome during adolescence is challenging because the polycystic ovary syndrome criteria include normal physiological events that occur during puberty. With increasing age, the syndrome evolves from a reproductive disease to a more metabolic disorder. Along with metabolic disturbances, including insulin resistance and abnormalities of energy expenditure, polycystic ovary syndrome is recognized as a major risk factor for the development of type 2 diabetes and cardiovascular disease in later life. Moreover, there is evidence for familial clustering of endocrine and metabolic features of polycystic ovary syndrome. Environmental factors such as diet and obesity appear to contribute to the phenotype. Treatment should be tailored to the specific concerns and needs of the individual patient and involves restoring fertility, treatment of the metabolic complaints, treatment of androgen excess, and providing endometrial protection. The complexity of the disorder, and the impact on quality of life, requires a timely diagnosis, screening for complications, and management strategies for the long-term health issues associated with polycystic ovary syndrome. The syndrome remains underdiagnosed, and women experience significant delays to diagnosis.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-03-18T10:43:48Z
      DOI: 10.1177/2633494120911038
      Issue No: Vol. 14 (2020)
       
  • What is new in the landscape of insulin-sensitizing agents for polycystic
           ovary syndrome treatment

    • Authors: Daniela Romualdi, Valeria Versace, Antonio Lanzone
      Abstract: Therapeutic Advances in Reproductive Health, Volume 14, Issue , January-December 2020.
      Polycystic ovary syndrome, the most common gynecological endocrinopathy, is burdened with a state of hyperinsulinemia and insulin resistance in 50–80% of affected women. Wherever the origin of these metabolic abnormalities lies, their pathogenetic role in determining, perpetuating, and worsening the clinical traits of the syndrome is ascertained. Many studies have already highlighted possible mechanisms: hyperinsulinemia and insulin resistance may contribute to hyperandrogenemia, chronic anovulation, and other comorbidities of the syndrome by differentially affecting the endocrine glands (ovaries, adrenals, and pituitary) and peripheral tissues (fat mass and skeletal muscle). Based on these evidences, in the past years, thorough research has been focused on the possible role of insulin-sensitizing agents in the treatment of polycystic ovary syndrome. Many compounds were tested to verify their efficacy against polycystic ovary syndrome–related metabolic dysfunction, both relying on previous acquired experiences in the field of diabetes mellitus and experimenting new agents, in particular, those belonging to the class of nutraceuticals. We sought to summarize the most relevant aspects of insulin-sensitizing treatments in polycystic ovary syndrome, by reporting the relevant literature on this topic and by keeping an attentive eye on the newly published international guidelines on polycystic ovary syndrome 2018. This overview encompasses metformin, thiazolidinediones, inositols, alpha-lipoic acid, and GLP1-R analogues. Starting from the analysis of the mechanisms of action, we anchored to the state of the art of the use of these drugs in polycystic ovary syndrome, to the most recent evidences for clinical practice and to the remaining open questions around indications, dose, treatment schedules, and side effects.
      Citation: Therapeutic Advances in Reproductive Health
      PubDate: 2020-02-28T06:15:56Z
      DOI: 10.1177/2633494120908709
      Issue No: Vol. 14 (2020)
       
 
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