Publisher: BMC (Biomed Central)   (Total: 308 journals)

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Showing 1 - 200 of 308 Journals sorted alphabetically
Acta Neuropathologica Communications     Open Access   (Followers: 1, SJR: 2.683, CiteScore: 5)
Acta Veterinaria Scandinavica     Open Access   (Followers: 4, SJR: 0.655, CiteScore: 1)
Addiction Science & Clinical Practice     Open Access   (Followers: 11, SJR: 1.224, CiteScore: 3)
Advances in Simulation     Open Access   (Followers: 7)
Agriculture & Food Security     Open Access   (Followers: 29, SJR: 0.575, CiteScore: 2)
AIDS Research and Therapy     Open Access   (Followers: 16, SJR: 1.08, CiteScore: 2)
Algorithms for Molecular Biology     Open Access   (Followers: 4, SJR: 1.333, CiteScore: 2)
Allergy, Asthma and Clinical Immunology     Open Access   (Followers: 29, SJR: 0.732, CiteScore: 2)
Alzheimer's Research & Therapy     Open Access   (Followers: 5, SJR: 2.449, CiteScore: 6)
Animal Biotelemetry     Open Access   (Followers: 2, SJR: 1.067, CiteScore: 2)
Animal Diseases     Open Access  
Animal Microbiome     Open Access   (Followers: 3)
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 13, SJR: 1.104, CiteScore: 3)
Annals of General Psychiatry     Open Access   (Followers: 28, SJR: 0.784, CiteScore: 2)
Annals of Occupational and Environmental Medicine     Open Access   (Followers: 15, SJR: 0.452, CiteScore: 1)
Annals of Surgical Innovation and Research     Open Access   (Followers: 3, SJR: 0.328, CiteScore: 1)
Antimicrobial Resistance and Infection Control     Open Access   (Followers: 13, SJR: 1.573, CiteScore: 3)
Archives of Physiotherapy     Open Access   (Followers: 20)
Archives of Public Health     Open Access   (Followers: 13, SJR: 1.244, CiteScore: 3)
Arthritis Research & Therapy     Open Access   (Followers: 18, SJR: 2.154, CiteScore: 4)
Asthma Research and Practice     Open Access   (Followers: 2)
Basic and Clinical Andrology     Open Access   (SJR: 0.564, CiteScore: 2)
Behavioral and Brain Functions     Open Access   (Followers: 5, SJR: 0.986, CiteScore: 3)
Big Data Analytics     Open Access   (Followers: 34)
BioData Mining     Open Access   (Followers: 5, SJR: 0.982, CiteScore: 2)
Bioelectronic Medicine     Open Access   (Followers: 1)
Biological Procedures Online     Open Access   (SJR: 1.352, CiteScore: 4)
Biological Research     Open Access   (Followers: 1, SJR: 0.654, CiteScore: 2)
Biology Direct     Open Access   (Followers: 10, SJR: 1.694, CiteScore: 3)
Biology of Sex Differences     Open Access   (Followers: 2, SJR: 1.902, CiteScore: 4)
Biomarker Research     Open Access   (Followers: 3)
Biomaterials Research     Open Access   (Followers: 6, SJR: 0.735, CiteScore: 3)
Biomedical Dermatology     Open Access  
BioMedical Engineering OnLine     Open Access   (Followers: 7, SJR: 0.542, CiteScore: 2)
BioPsychoSocial Medicine     Open Access   (Followers: 9, SJR: 0.416, CiteScore: 1)
Biotechnology for Biofuels     Open Access   (Followers: 9, SJR: 1.899, CiteScore: 6)
BMC Anesthesiology     Open Access   (Followers: 18, SJR: 0.807, CiteScore: 2)
BMC Biochemistry     Open Access   (Followers: 15, SJR: 0.708, CiteScore: 2)
BMC Bioinformatics     Open Access   (Followers: 215, SJR: 1.479, CiteScore: 2)
BMC Biology     Open Access   (Followers: 63, SJR: 3.842, CiteScore: 5)
BMC Biomedical Engineering     Open Access  
BMC Biophysics     Open Access   (Followers: 4, SJR: 0.682, CiteScore: 2)
BMC Biotechnology     Open Access   (Followers: 17, SJR: 1.012, CiteScore: 3)
BMC Cancer     Open Access   (Followers: 34, SJR: 1.464, CiteScore: 3)
BMC Cardiovascular Disorders     Open Access   (Followers: 25, SJR: 0.909, CiteScore: 2)
BMC Chemical Engineering     Open Access  
BMC Clinical Pathology     Open Access   (Followers: 8, SJR: 1.141, CiteScore: 3)
BMC Complementary Medicine and Therapies     Open Access   (Followers: 24, SJR: 0.858, CiteScore: 3)
BMC Dermatology     Open Access   (Followers: 14, SJR: 0.796, CiteScore: 2)
BMC Developmental Biology     Open Access   (Followers: 14, SJR: 1.43, CiteScore: 2)
BMC Ear, Nose and Throat Disorders     Open Access   (Followers: 1, SJR: 0.653, CiteScore: 2)
BMC Ecology     Open Access   (Followers: 24, SJR: 1.076, CiteScore: 2)
BMC Emergency Medicine     Open Access   (Followers: 25, SJR: 0.572, CiteScore: 1)
BMC Endocrine Disorders     Open Access   (Followers: 7, SJR: 0.965, CiteScore: 2)
BMC Energy     Open Access  
BMC Evolutionary Biology     Open Access   (Followers: 74, SJR: 1.656, CiteScore: 3)
BMC Family Practice     Open Access   (Followers: 16, SJR: 1.137, CiteScore: 2)
BMC Gastroenterology     Open Access   (Followers: 13, SJR: 1.231, CiteScore: 3)
BMC Genetics     Open Access   (Followers: 32, SJR: 1.16, CiteScore: 3)
BMC Genomics     Open Access   (Followers: 92, SJR: 2.11, CiteScore: 4)
BMC Geriatrics     Open Access   (Followers: 19, SJR: 1.257, CiteScore: 3)
BMC Health Services Research     Open Access   (Followers: 20, SJR: 1.151, CiteScore: 2)
BMC Hematology     Open Access   (Followers: 7, SJR: 0.545, CiteScore: 1)
BMC Immunology     Open Access   (Followers: 11, SJR: 0.993, CiteScore: 3)
BMC Infectious Diseases     Open Access   (Followers: 21, SJR: 1.576, CiteScore: 3)
BMC Intl. Health and Human Rights     Open Access   (Followers: 8, SJR: 1.006, CiteScore: 2)
BMC Materials     Open Access   (Followers: 1)
BMC Medical Education     Open Access   (Followers: 50, SJR: 0.765, CiteScore: 2)
BMC Medical Ethics     Open Access   (Followers: 25, SJR: 1.016, CiteScore: 2)
BMC Medical Genetics     Open Access   (Followers: 9, SJR: 1.109, CiteScore: 2)
BMC Medical Genomics     Open Access   (Followers: 5, SJR: 1.688, CiteScore: 3)
BMC Medical Imaging     Open Access   (Followers: 11, SJR: 0.536, CiteScore: 2)
BMC Medical Informatics and Decision Making     Open Access   (Followers: 25, SJR: 0.812, CiteScore: 2)
BMC Medical Physics     Open Access   (Followers: 8)
BMC Medical Research Methodology     Open Access   (Followers: 8, SJR: 2.221, CiteScore: 3)
BMC Medicine     Open Access   (Followers: 15, SJR: 4.219, CiteScore: 7)
BMC Microbiology     Open Access   (Followers: 17, SJR: 1.242, CiteScore: 3)
BMC Molecular and Cell Biology     Open Access   (Followers: 50, SJR: 1.277, CiteScore: 3)
BMC Molecular Biology     Open Access   (Followers: 207, SJR: 1.216, CiteScore: 2)
BMC Musculoskeletal Disorders     Open Access   (Followers: 30, SJR: 0.951, CiteScore: 2)
BMC Nephrology     Open Access   (Followers: 10, SJR: 1.098, CiteScore: 3)
BMC Neurology     Open Access   (Followers: 23, SJR: 1.006, CiteScore: 2)
BMC Neuroscience     Open Access   (Followers: 18, SJR: 1.12, CiteScore: 2)
BMC Nursing     Open Access   (Followers: 31, SJR: 0.766, CiteScore: 2)
BMC Nutrition     Open Access   (Followers: 12)
BMC Obesity     Open Access   (Followers: 9)
BMC Ophthalmology     Open Access   (Followers: 22, SJR: 0.921, CiteScore: 2)
BMC Oral Health     Open Access   (Followers: 7, SJR: 0.867, CiteScore: 2)
BMC Palliative Care     Open Access   (Followers: 39, SJR: 1.105, CiteScore: 2)
BMC Pediatrics     Open Access   (Followers: 21, SJR: 1.278, CiteScore: 2)
BMC Pharmacology     Open Access   (Followers: 3)
BMC Pharmacology & Toxicology     Open Access   (Followers: 8, SJR: 0.785, CiteScore: 2)
BMC Physiology     Open Access   (Followers: 4, SJR: 0.936, CiteScore: 2)
BMC Plant Biology     Open Access   (Followers: 20, SJR: 1.887, CiteScore: 4)
BMC Pregnancy and Childbirth     Open Access   (Followers: 24, SJR: 1.427, CiteScore: 3)
BMC Proceedings     Full-text available via subscription   (Followers: 2, SJR: 0.302, CiteScore: 1)
BMC Psychiatry     Open Access   (Followers: 41, SJR: 1.346, CiteScore: 3)
BMC Psychology     Open Access   (Followers: 22, SJR: 0.817, CiteScore: 2)
BMC Public Health     Open Access   (Followers: 228, SJR: 1.337, CiteScore: 3)
BMC Pulmonary Medicine     Open Access   (Followers: 7, SJR: 1.373, CiteScore: 3)
BMC Research Notes     Open Access   (Followers: 4, SJR: 0.691, CiteScore: 2)
BMC Rheumatology     Open Access   (Followers: 5)
BMC Sports Science, Medicine and Rehabilitation     Open Access   (Followers: 36, SJR: 0.926, CiteScore: 2)
BMC Structural Biology     Open Access   (Followers: 8, SJR: 1.024, CiteScore: 2)
BMC Surgery     Open Access   (Followers: 10, SJR: 0.693, CiteScore: 2)
BMC Systems Biology     Open Access   (Followers: 16, SJR: 1.109, CiteScore: 2)
BMC Urology     Open Access   (Followers: 14, SJR: 0.853, CiteScore: 2)
BMC Veterinary Research     Open Access   (Followers: 20, SJR: 0.934, CiteScore: 2)
BMC Women's Health     Open Access   (Followers: 16, SJR: 0.931, CiteScore: 2)
BMC Zoology     Open Access   (Followers: 1)
BMJ Evidence-Based Medicine     Hybrid Journal   (Followers: 9)
Borderline Personality Disorder and Emotion Dysregulation     Open Access   (Followers: 10)
Breast Cancer Research     Open Access   (Followers: 22, SJR: 3.026, CiteScore: 6)
Burns & Trauma     Open Access   (Followers: 14)
CABI Agriculture and Bioscience     Open Access   (Followers: 2)
Cancer & Metabolism     Open Access   (Followers: 7)
Cancer Cell Intl.     Open Access   (Followers: 7, SJR: 1.13, CiteScore: 3)
Cancer Communications     Open Access  
Cancer Convergence     Open Access   (Followers: 1)
Cancer Imaging     Open Access   (Followers: 3, SJR: 1.012, CiteScore: 3)
Cancer Nanotechnology     Open Access   (Followers: 2, SJR: 1.168, CiteScore: 4)
Cancers of the Head & Neck     Open Access   (Followers: 3)
Carbon Balance and Management     Open Access   (Followers: 5, SJR: 0.977, CiteScore: 2)
Cardio-Oncology     Open Access  
Cardiovascular Diabetology     Open Access   (Followers: 10, SJR: 2.157, CiteScore: 5)
Cardiovascular Ultrasound     Open Access   (Followers: 6, SJR: 0.812, CiteScore: 2)
Cell Communication and Signaling     Open Access   (Followers: 3, SJR: 2.211, CiteScore: 4)
Cell Division     Open Access   (Followers: 1, SJR: 2.445, CiteScore: 4)
Cellular & Molecular Biology Letters     Hybrid Journal   (Followers: 3)
Cerebellum & Ataxias     Open Access   (Followers: 1)
Chemistry Central J.     Open Access   (Followers: 5, SJR: 0.607, CiteScore: 3)
Child and Adolescent Psychiatry and Mental Health     Open Access   (Followers: 30, SJR: 0.901, CiteScore: 2)
Chinese Medicine     Open Access   (Followers: 2, SJR: 0.57, CiteScore: 2)
Chinese Neurosurgical J.     Open Access  
Chiropractic & Manual Therapies     Open Access   (Followers: 5, SJR: 0.599, CiteScore: 2)
Clinical and Molecular Allergy     Open Access   (Followers: 5, SJR: 0.933, CiteScore: 3)
Clinical Diabetes and Endocrinology     Open Access   (Followers: 23)
Clinical Epigenetics     Open Access   (Followers: 11, SJR: 2.435, CiteScore: 5)
Clinical Hypertension     Open Access   (Followers: 5)
Conflict and Health     Open Access   (Followers: 8, SJR: 1.851, CiteScore: 3)
Contraception and Reproductive Medicine     Open Access   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1, SJR: 0.755, CiteScore: 2)
Cost Effectiveness and Resource Allocation     Open Access   (Followers: 5, SJR: 0.888, CiteScore: 2)
Critical Care     Open Access   (Followers: 82, SJR: 2.48, CiteScore: 5)
Current Opinion in Molecular Therapeutics     Full-text available via subscription   (Followers: 13)
Diabetology & Metabolic Syndrome     Open Access   (Followers: 7, SJR: 0.943, CiteScore: 2)
Diagnostic and Prognostic Research     Open Access  
Diagnostic Pathology     Open Access   (Followers: 14, SJR: 0.818, CiteScore: 2)
Disaster and Military Medicine     Open Access   (Followers: 5)
Emerging Themes in Epidemiology     Open Access   (Followers: 14, SJR: 1.003, CiteScore: 2)
Energy, Sustainability and Society     Open Access   (Followers: 18, SJR: 0.607, CiteScore: 2)
Environmental Health     Open Access   (Followers: 15, SJR: 1.662, CiteScore: 4)
Environmental Health and Preventive Medicine     Open Access   (Followers: 4, SJR: 0.5, CiteScore: 1)
Environmental Microbiome     Open Access   (SJR: 0.768, CiteScore: 2)
Epigenetics & Chromatin     Open Access   (Followers: 8, SJR: 3.767, CiteScore: 5)
European J. of Medical Research     Open Access   (Followers: 2, SJR: 0.55, CiteScore: 1)
European Review of Aging and Physical Activity     Open Access   (Followers: 12, SJR: 1.308, CiteScore: 4)
Experimental & Translational Stroke Medicine     Open Access   (Followers: 10, SJR: 0.98, CiteScore: 3)
Experimental Hematology & Oncology     Open Access   (Followers: 6, SJR: 0.842, CiteScore: 2)
ExRNA     Open Access  
Eye and Vision     Open Access   (Followers: 1)
Fertility Research and Practice     Open Access   (Followers: 2)
Fibrogenesis & Tissue Repair     Open Access   (SJR: 1.531, CiteScore: 4)
Fisheries and Aquatic Sciences     Open Access   (Followers: 3, SJR: 0.199, CiteScore: 0)
Fluids and Barriers of the CNS     Open Access   (Followers: 3, SJR: 2.054, CiteScore: 5)
Frontiers in Zoology     Open Access   (Followers: 12, SJR: 1.597, CiteScore: 3)
Genes and Environment     Open Access   (Followers: 1, SJR: 0.516, CiteScore: 1)
Genetics Selection Evolution     Open Access   (Followers: 7, SJR: 1.745, CiteScore: 4)
Genome Biology     Open Access   (Followers: 41)
Genome Medicine     Open Access   (Followers: 7, SJR: 4.537, CiteScore: 7)
Global Health Research and Policy     Open Access   (Followers: 4)
Globalization and Health     Open Access   (Followers: 9, SJR: 1.262, CiteScore: 2)
Gut Pathogens     Full-text available via subscription   (Followers: 6, SJR: 1.066, CiteScore: 3)
Gynecologic Oncology Research and Practice     Open Access   (Followers: 1)
Harm Reduction J.     Open Access   (SJR: 1.445, CiteScore: 3)
Head & Face Medicine     Open Access   (Followers: 1, SJR: 0.62, CiteScore: 2)
Health and Quality of Life Outcomes     Open Access   (Followers: 15, SJR: 1.069, CiteScore: 3)
Health Research Policy and Systems     Open Access   (Followers: 16, SJR: 1.11, CiteScore: 2)
Hereditary Cancer in Clinical Practice     Open Access   (Followers: 2, SJR: 0.848, CiteScore: 2)
Hereditas     Open Access   (Followers: 1, SJR: 0.278, CiteScore: 1)
Human Genomics     Open Access   (Followers: 3, SJR: 1.501, CiteScore: 3)
Human Resources for Health     Open Access   (Followers: 12, SJR: 1.301, CiteScore: 2)
Immunity & Ageing     Open Access   (Followers: 10, SJR: 1.218, CiteScore: 3)
Implementation Science     Open Access   (Followers: 23, SJR: 2.443, CiteScore: 4)
Implementation Science Communications     Open Access   (Followers: 6)
Infectious Agents and Cancer     Open Access   (SJR: 0.855, CiteScore: 2)
Infectious Diseases of Poverty     Open Access   (Followers: 3, SJR: 1.212, CiteScore: 3)
Inflammation and Regeneration     Open Access   (Followers: 2)
Intl. Breastfeeding J.     Open Access   (Followers: 26, SJR: 0.913, CiteScore: 3)
Intl. J. for Equity in Health     Open Access   (Followers: 9, SJR: 1.04, CiteScore: 2)
Intl. J. of Behavioral Nutrition and Physical Activity     Open Access   (Followers: 32, SJR: 2.626, CiteScore: 6)
Intl. J. of Health Geographics     Open Access   (Followers: 9, SJR: 1.385, CiteScore: 3)
Intl. J. of Mental Health Systems     Open Access   (Followers: 7, SJR: 0.721, CiteScore: 2)
Intl. J. of Pediatric Endocrinology     Open Access   (Followers: 12)
Intl. J. of Retina and Vitreous     Open Access   (Followers: 4)
Investigative Genetics     Open Access   (Followers: 1, SJR: 1.809, CiteScore: 3)
Irish Veterinary J.     Open Access   (Followers: 4, SJR: 0.657, CiteScore: 1)
Israel J. of Health Policy Research     Open Access   (SJR: 0.488, CiteScore: 1)
Italian J. of Pediatrics     Open Access   (Followers: 2, SJR: 0.685, CiteScore: 2)
J. of Angiogenesis Research     Open Access   (Followers: 2)

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Fertility Research and Practice
Number of Followers: 2  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2054-7099
Published by BMC (Biomed Central) Homepage  [308 journals]
  • Onco-fertility and personalized testing for potential for loss of ovarian
           reserve in patients undergoing chemotherapy: proposed next steps for
           development of genetic testing to predict changes in ovarian reserve

    • Abstract: Women of reproductive age undergoing chemotherapy face the risk of irreversible ovarian insufficiency. Current methods of ovarian reserve testing do not accurately predict future reproductive potential for patients undergoing chemotherapy. Genetic markers that more accurately predict the reproductive potential of each patient undergoing chemotherapy would be critical tools that would be useful for evidence-based fertility preservation counselling. To assess the possible approaches to take to develop personalized genetic testing for these patients, we review current literature regarding mechanisms of ovarian damage due to chemotherapy and genetic variants associated with both the damage mechanisms and primary ovarian insufficiency. The medical literature point to a number of genetic variants associated with mechanisms of ovarian damage and primary ovarian insufficiency. Those variants that appear at a higher frequency, with known pathways, may be considered as potential genetic markers for predictive ovarian reserve testing. We propose developing personalized testing of the potential for loss of ovarian function for patients with cancer, prior to chemotherapy treatment. There are advantages of using genetic markers complementary to the current ovarian reserve markers of AMH, antral follicle count and day 3 FSH as predictors of preservation of fertility after chemotherapy. Genetic markers will help identify upstream pathways leading to high risk of ovarian failure not detected by present clinical markers. Their predictive value is mechanism-based and will encourage research towards understanding the multiple pathways contributing to ovarian failure after chemotherapy.
      PubDate: 2021-06-30
  • Low dose hCG supplementation in a Gn-RH-agonist trigger protocol is
           associated with worse pregnancy outcomes: a retrospective cohort study

    • Abstract: Background A number of studies have looked at dual triggers with hCG and GnRH agonist (GnRHa) in varying doses, but the question remains: what is the optimal dose of hCG to minimize ovarian hyperstimulation syndrome (OHSS) and still offer adequate pregnancy rates' The purpose of this study was to compare pregnancy and OHSS rates following dual trigger for oocyte maturation with GnRHa and a low-dose hCG versus hCG alone. A secondary objective was the assess pregnancy outcomes in subsequent frozen cycles for the same population. Methods A total of 963 women < 41 years old, with a BMI 18–40 kg/m2 and an AMH > 2 ng/mL who underwent fresh autologous in vitro fertilization (IVF) with GnRH antagonist protocol at a University-based fertility center were included in this retrospective cohort study. Those who received a low dose dual trigger with hCG (1000u) and GnRHa (2 mg) were compared to those who received hCG alone (10,000u hCG/250-500 μg Ovidrel). Differences in implantation rates, pregnancy, live birth, and OHSS were investigated. Results The dual trigger group was younger (mean 33.6 vs 34.1 years), had a higher AMH (6.3 vs 4.9 ng/mL,) more oocytes retrieved (18.1 vs 14.9) and a higher fertilized oocyte rate (80% vs 77%) compared with the hCG only group. Yet, the dual trigger group had a lower probability of clinical pregnancy (gestational sac, 43.4% vs 52.8%) and live birth (33.4% vs 45.8%), all of which were statistically significant. There were 3 cases of OHSS, all in the hCG-only trigger group. In subsequent frozen cycles, pregnancy rates were comparable between the two groups. Conclusions The dual trigger group had a better prognosis based on age and AMH levels and had better stimulation outcomes, but significantly worse pregnancy outcomes, suggesting the low dose hCG (1000u) in the dual trigger may not have provided adequate luteal support, compared to an hCG-only trigger (10,000u hCG/250-500 μg Ovidrel). Interestingly, the pregnancy rates were comparable in subsequent frozen cycles, further supporting the hypothesis that the issue lies in inadequate luteal phase support, rather than embryo quality. Based on these findings, our program has changed the protocol to 1500u of hCG in a dual trigger.
      PubDate: 2021-05-28
  • Reducing day 3 baseline monitoring bloodwork and ultrasound for patients
           undergoing timed intercourse and intrauterine insemination treatment

    • Abstract: Background In the current context of a global pandemic it is imperative for fertility clinics to consider the necessity of individual tests and eliminate those that have limited utility and may impose unnecessary risk of exposure. The purpose of this study was to implement and evaluate a multi-modal quality improvement (QI) strategy to promote resource stewardship by reducing routine day 3 (d3) bloodwork and transvaginal ultrasound (TVUS) for patients undergoing intrauterine insemination (IUI) and timed intercourse (IC) treatment cycles. Methods After literature review, clinic stakeholders at an academic fertility centre met to discuss d3 testing utility and factors contributing to d3 bloodwork/TVUS in IC/IUI treatment cycles. Consensus was reached that it was unnecessary in patients taking oral/no medications. The primary intervention changed the default setting on the electronic order set to exclude d3 testing for IC/IUI cycles with oral/no medications. Exceptions required active test selection. Protocols were updated and education sessions were held. The main outcome measure was the proportion of cycles receiving d3 bloodwork/TVUS during the 8-week post-intervention period compared with the 8-week pre-intervention period. Balancing measures included provider satisfaction, pregnancy rates, and incidence of cycle cancellation. Results A significant reduction in the proportion of cycles receiving d3 TVUS (57.2% vs 20.8%, p < 0.001) and ≥ 1 blood test (58.6% vs 22.8%, p < 0.001) was observed post-intervention. There was no significant difference in cycle cancellation or pregnancy rates pre- and post-intervention (p = 0.86). Treatment with medications, cyst history, prescribing physician, and treatment centre were associated with receiving d3 bloodwork/TVUS. 74% of providers were satisfied with the intervention. Conclusion A significant reduction in IC/IUI treatment cycles that received d3 bloodwork/TVUS was achieved without measured negative treatment impacts. During a pandemic, eliminating routine d3 bloodwork/TVUS represents a safe way to reduce monitoring appointments and exposure.
      PubDate: 2021-04-30
  • Mid-trimester cesarean scar pregnancy: a case report

    • Abstract: Background This article reports a unique case of cesarean scar pregnancy, demonstrating importance of early management and diagnosis. Case presentation A 30-year-old pregnant woman with prior history of two cesarean sections found to have cesarean scar pregnancy at approximately 13 weeks’ gestation and underwent a gravid hysterectomy. Conclusions While rare, cesarean scar pregnancies should be considered on the differential diagnosis of any pregnant patient with history of cesarean section who presents in early pregnancy with vaginal bleeding and/or cramping. Given the increased rates of cesarean sections in the times of COVID-19, one may anticipate seeing more cases of cesarean scar pregnancies.
      PubDate: 2021-04-23
  • Association of Tumor Necrosis Factor-α -308G>A, -238G>A and
           -376G>A polymorphisms with recurrent pregnancy loss risk in the Greek

    • Abstract: Background Promoter region SNPs in TNF-α have been studied in association with Recurrent Pregnancy Loss (RPL) occurrence in various populations. Among them, −238G > A, −308G > A and − 376G > A have been frequently investigated for their potential role in recurrent abortions. The aim of the present study is to evaluate the correlation among TNF-α 238, TNF-α 308 and TNF-α 376 polymorphisms and recurrent pregnancy loss risk in Greek women. Methods This study included 94 Caucasian women with at least two miscarriages of unexplained aetiology, before the 20th week of gestation. The control group consisted of 89 Caucasian women of proven fertility, with no history of pregnancy loss. DNA samples were subjected to PCR amplification using specific primers. Sanger sequencing was applied to investigate the presence of TNF-α 238, TNF-α 308, TNF-α 376 polymorphisms in all samples. Results The TNF-α 238 and TNF-α 308 variants were both detected in RPL and control groups (7.45% vs 4.49 and 45.16% vs 36.73%, respectively), but with no statistically significant association (p-value 0.396 and 0.374, respectively). The TNF-α 376 variant was not detected at all in both control and RPL groups. When TNF-α 238 and TNF-α 308 genotypes were combined no association with RPL was detected (p-value = 0.694). In subgroup analysis by parity, RPL patients carrying the A allele reported less previous births. Conclusions This is the first study demonstrating TNF-α 238 and TNF-α 308 gene expression and the absence of TNF-α 376 variant in Greek women with RPL. However, no association emerged between each polymorphism studied and the occurrence of recurrent pregnancy loss. Accordingly, TNF-α -308G > A, −238G > A and -376G > A variants are not considered genetic markers for identifying women at increased risk of recurrent pregnancy loss in the Greek population.
      PubDate: 2021-04-10
  • MAML1: a coregulator that alters endometrial epithelial cell adhesive

    • Abstract: Background Abnormalities in endometrial receptivity has been identified as a major barrier to successful embryo implantation. Endometrial receptivity refers to the conformational and biochemical changes occurring in the endometrial epithelial layer which make it adhesive and receptive to blastocyst attachment. This takes place during the mid-secretory phase of woman’s menstrual cycle and is a result of a delicate interplay between numerous hormones, cytokines and other factors. Outside of this window, the endometrium is refractory to an implanting blastocyst. It has been shown that Notch ligands and receptors are dysregulated in the endometrium of infertile women. Mastermind Like Transcriptional Coactivator 1 (MAML1) is a known coactivator of the Notch signaling pathway. This study aimed to determine the role of MAML1 in regulating endometrial receptivity. Methods The expression and localization of MAML1 in the fertile human endometrium (non-receptive proliferative phase versus receptive mid-secretory phase) were determined by immunohistochemistry. Ishikawa cells were used as an endometrial epithelial model to investigate the functional consequences of MAML1 knockdown on endometrial adhesive capacity to HTR8/SVneo (trophoblast cell line) spheroids. After MAML1 knockdown in Ishikawa cells, the expression of endometrial receptivity markers and Notch dependent and independent pathway members were assessed by qPCR. Two-tailed unpaired or paired student’s t-test were used for statistical analysis with a significance threshold of P < 0.05. Results MAML1 was localized in the luminal epithelium, glandular epithelium and stroma of human endometrium and the increased expression identified in the mid-secretory phase was restricted only to the luminal epithelium (P < 0.05). Functional analysis using Ishikawa cells demonstrated that knockdown of MAML1 significantly reduced epithelial adhesive capacity (P < 0.01) to HTR8/SVneo (trophoblast cell line) spheroids compared to control. MAML1 knockdown significantly affected the expression of classical receptivity markers (SPP1, DPP4) and this response was not directly via hormone receptors. The expression level of Hippo pathway target Ankyrin repeat domain-containing protein 1 (ANKRD1) was also affected after MAML1 knockdown in Ishikawa cells. Conclusion Our data strongly suggest that MAML1 is involved in regulating the endometrial adhesive capacity and may facilitate embryo attachment, either directly or indirectly through the Notch signaling pathway.
      PubDate: 2021-03-27
  • Self-reported infertility diagnoses and treatment history approximately 20
           years after fertility treatment initiation

    • Abstract: Background Infertility history may have important implications for clinical practice and scientific discovery. Previous research on the validity of self-reported infertility measurements has been limited in scope and duration (< 5 years). In this study, we validated self-reported infertility history measures 15–23 years after fertility treatment initiation among women who utilized assisted reproductive technology (ART). Methods Women who received ART treatments from three Boston infertility clinics and who enrolled in a prior study (1994–2003) were re-contacted in 2018 for the AfteR Treatment Follow-up Study (ART-FS). Infertility history was collected from clinical records and two self-report questionnaires (at ART initiation and at ART-FS enrollment). Treatment history included specific details (fresh or frozen embryo transfers, number of cycles) and treatment recall prior to ART initiation. Self-reported infertility diagnoses included polycystic ovary syndrome (PCOS), endometriosis, uterine factor infertility, tubal factor infertility, diminished ovarian reserve/advanced maternal age, male factor infertility, and other/unknown. We compared self-reported measures from 2018 to self-reported and clinical data from prior study initiation, using Cohen’s kappa, sensitivity, specificity, and 95% confidence intervals. Results Of 2644 women we attempted to recontact, 808 completed the ART-FS, with an average follow-up of 19.6 years (standard deviation: 2.7). Recall of fertility treatment usage had moderate sensitivity (IVF = 0.85, Clomiphene/Gonadotropin = 0.81) but low specificity across different infertility treatment modalities (IVF = 0.63, Clomiphene/Gonadotropin = 0.55). Specific IVF details had low to moderate validity and reliability with clinical records. Reliability of recalled infertility diagnosis was higher when compared to self-report at ART initiation (PCOS K = 0.66, Endometriosis K = 0.76, Tubal K = 0.73) than when compared to clinical records (PCOS K = 0.31, Endometriosis K = 0.48, Tubal K = 0.62) and varied by diagnosis. Conclusions The ability of women to recall specific IVF treatment details was moderately accurate and recall of self-reported infertility diagnosis varied by diagnosis and measurement method.
      PubDate: 2021-03-12
  • The prevalence of depression symptoms among infertile women: a systematic
           review and meta-analysis

    • Abstract: Background Infertile women’s mental health problems, including depression, are key fertility health issues that affect infertile women more severely than infertile men. Depression may threaten the health of individuals and reduce the quality of their lives. Considering the role and impact of depression on responses to infertility treatments, a systematic review and meta-analysis were conducted to investigate the prevalence of depression symptoms among infertile women. Methods International databases (PubMed, Cochrane Library, Web of Sciences, Scopus, Embase, and PsycINFO), national databases (SID and Magiran), and Google Scholar were searched by two independent reviewers for articles published from 2000 to April 5, 2020. The search procedure was performed in both Persian and English using keywords such as “depression,” “disorders,” “infertility,” “prevalence,” and “epidemiology.” The articles were evaluated in terms of their titles, abstracts, and full texts. The reviewers evaluated the quality of the articles using the Newcastle–Ottawa Scale, after which they analyzed the findings using STATA version 14. The I2 and Egger’s tests were performed to examine heterogeneity and publication bias, respectively. Results Thirty-two articles were subjected to the meta-analysis, and a random effects model was used in the examination given the heterogeneity of the articles. The samples in the reviewed studies encompassed a total of 9679 infertile women. The lowest and highest pooled prevalence rates were 21.01% (95% confidence interval [CI]: 15.61–34.42), as determined using the Hospital Anxiety and Depression Scale, and 52.21% (95% CI: 43.51–60.91), as ascertained using the Beck Depression Inventory, respectively. The pooled prevalence values of depression among infertile women were 44.32% (95% CI: 35.65–52.99) in low- and middle-income countries and 28.03% (95% CI: 19.61–36.44) in high-income countries. Conclusion The prevalence of depression among infertile women was higher than that among the general population of a given country. Especially in low- and middle-income countries, appropriate measures, planning, and policy that target the negative effects of depression on infertile women’s lives should be established to reduce related problems.
      PubDate: 2021-03-04
  • A rare case of extensive placenta accreta in twin pregnancy after GnRH
           agonist treatment of adenomyosis

    • Abstract: Background Adenomyosis remains an enigma for the reproductive endocrinologist. It is thought to contribute to sub-fertility, and its only curative treatment is hysterectomy. However, studies have documented increased live birth rates in women with adenomyosis who were treated with gonadotropin releasing hormone agonist (GnRHa). Case Here we present a case of a 52-year-old woman with adenomyosis who had three failed frozen embryo transfers (FETs) prior to initiating a 6-month trial of GnRHa. GnRHa therapy resulted in a decrease in uterine size from 11.5 × 7.9 × 7.0 cm to 7.8 × 6.2 × 5.9 cm and a decrease in the junctional zone (JZ) thickness from 19 to 9 mm. Subsequently, she underwent her fourth FET, which resulted in live birth of twins. The delivery was complicated by expansive accretas of both placentas requiring cesarean hysterectomy. The final pathology of the placentas demonstrated an extensive lack of decidualized endometrium that was even absent outside the basal plate. Conclusions GnRHa therapy in patients with adenomyosis may improve implantation rates after FET. Previous molecular studies indicate that genetic variance in the expression of the gonadotropin releasing hormone receptor (GnRHR) could explain the expansive lack of decidualized endometrium after GnRHa therapy. Further investigations are needed to determine if GnRHa therapy contributes to the pathologic process of placenta accreta.
      PubDate: 2021-03-03
  • The clinical relevance of luteal phase progesterone support in true
           natural cycle cryopreserved blastocyst stage embryo transfers: a
           retrospective cohort study

    • Abstract: Background More than 67% of all embryos transferred in the United States involve frozen-thawed embryos. Progesterone supplementation is necessary in medicated cycles to luteinize the endometrium and prepare it for implantation, but little data is available to show if this is beneficial in true natural cycles. We evaluated the use of luteal phase progesterone supplementation for cryopreserved/warmed blastocyst transfers in true natural cycles not using an ovulatory trigger. Methods Retrospective cohort study in a single academic medical center. We studied the use of luteal phase progesterone supplementation in patients undergoing true natural cycle cryopreserved blastocyst embryo transfers. Our primary outcome measure was ongoing pregnancy rate, with other pregnancy outcomes being evaluated (i.e. implantation rate, miscarriage rate, ectopic rate, and multifetal gestation). Categorical data were analyzed utilizing Fisher’s exact test and all binary variables were analyzed using log-binomial regression to produce a risk ratio. Results Two hundred twenty-nine patients were included in the analysis with 149 receiving luteal phase progesterone supplementation and 80 receiving no luteal phase support. Patient demographic and cycle characteristics, and embryo quality were similar between the two groups. No difference was seen in ongoing pregnancy rate (49.0% vs. 47.5%, p = 0.8738), clinical pregnancy rate (50.3% vs. 47.5%, p = 0.7483), positive HCG rate (62.4% vs. 57.5%, p = 0.5965), miscarriage/abortion rate (5.4% vs. 2.5%, p = 0.2622), ectopic pregnancy rate (0% vs. 1.3%, p = 0.3493), or multifetal gestations (7.4% vs. 3.8%, p = 0.3166). Conclusion(s) The addition of luteal phase progesterone support in true natural cycle cryopreserved blastocyst embryo transfers did not improve pregnancy outcomes and therefore the routine use in practice cannot be recommended based on this study, but the utilization should not be discouraged without further studies. Capsule Progesterone supplementation as luteal phase support in true natural cycle cryopreserved blastocyst transfers does not improve ongoing pregnancies.
      PubDate: 2021-02-09
  • Fertility education: what’s trending on Instagram

    • Abstract: Objective To determine the prevalence, authorship, and types of fertility-related information shared on Instagram targeted toward a new patient interested in fertility options using hashtag and content analysis. Secondary outcomes included comparison of post content stratified by author type (physicians versus patients). Methods A list of ten hashtags consisting of fertility terms for the new patient was derived. Content analysis was performed in April 2019 on the top 50 and most recent 50 posts for each hashtag to determine authorship and content type. The distribution of fertility terms in posts made by physicians was compared to that of patients and differences in use of terms were analyzed. Results Our search yielded 3,393,636 posts. The two most popular hashtags were IVF (N = 912,049), and Infertility (N = 852,939).
      Authors hip of the top posts for each hashtag (N = 1000) were as follows: patients (67 %), physicians (10 %), for-profit commercial groups (6.0 %), allied health professional (4.5 %), professional societies (1 %), and other (11 %). Of these posts, 60 % related to patient experiences, 10 % advertisements, 10 % outreach, and 8 % educational. Physicians were more likely to author posts related to oocyte cryopreservation compared to IVF, while patients were more likely to author posts about IVF (p < 0.0001). Conclusions Over 3 million posts related to fertility were authored on Instagram. A majority of fertility posts are being mobilized by patients to publicly display and share their personal experiences. Concurrent with the rising utilization of planned oocyte cryopreservation, there is a trend toward physicians educating their patients about the process using social media as a platform. Physician participation on social media may offer a low-cost platform for networking and connecting with patients. Future studies examining the educational quality of posts by author type should be explored.
      PubDate: 2021-01-18
  • The causes of infertility in women presenting to gynaecology clinics in
           Harare, Zimbabwe; a cross sectional study

    • Abstract: Background Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care. Methods A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited. Results Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2–4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was ‘unexplained’ in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception. Conclusion Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.
      PubDate: 2021-01-05
  • Evaluation of oocyte quality in Polycystic ovary syndrome patients
           undergoing ART cycles

    • Abstract: Background To evaluate factors affecting oocyte/embryo quality in PolyCystic Ovary Syndrome (PCOS) patients undergoing Assisted Reproductive Technology (ART) cycles. Methods This case-control retrospective study was performed on PCOS patients referred to the infertility department of Imam Khomeini Hospital in Ahvaz from October 2017 to September 2019. Demographic and reproductive characterizations including age, gender, abortion history and infertility type (primary and secondary infertility) were extracted from patient’s records. TSH, AMH, LH, FSH, prolactin, lipid profile and blood glucose was measured. Biochemistry pregnancy was checked by determination of serum βHCG level and then, clinical pregnancy was confirmed by observing of pregnancy sac and fetal heart rate using Transvaginal USS. Results One-hundred thirty-five patients include 45 PCOS and 90 Non-PCOS patients with mean age of 31.93 ± 5.04 and 30.8 ± 5.38 (p = 0.24) were considered as case and control groups respectively. Retrieved oocyte numbers were significantly higher in PCOS patients (p = 0.024), but there was no significant difference in number of oocyte subtypes (MI, MII and GV) between two groups. The embryo numbers and its subtypes did not differ significantly in both groups. The clinical pregnancy rate was insignificantly lower in PCOS patients (p = 0.066) and there was a significant correlation between retrieved oocyte numbers with age(r= -0.2, p= 0.022) and AMH level (r = 0.433, p < 0.0001) respectively. Cholesterol level had shown a positive significant correlation with number of MI oocytes (r = 0.421, p = 0.026) and MII oocytes significantly affected by age (r= -0.250, p = 0.004) and AMH level (r = 0.480, p < 0.0001). Using Receiver operation characteristic (ROC) curve analysis, the cut-off value of total number of oocytes was > 10.5 with area under curve of 0.619±0.054(sensitivity 55.56% and specificity 69.66%) Conclusions The results of this study showed that although the number of oocytes in PCOS patients was significantly higher than non-PCOS patients, the quality of oocytes was not statistically different. The number and quality of embryos were not significantly different in both groups. Our results indicated a significant relationship between the level of AMH and the number of retrieved oocytes and embryos. We found there is a significant correlation between cholesterol level and number of MI oocytes.
      PubDate: 2021-01-05
  • Predictive factors for intrauterine insemination outcomes: a review

    • Abstract: Purpose Intrauterine insemination (IUI) is a frequently utilized method of assisted reproduction for patients with mild male factor infertility, anovulation, endometriosis, and unexplained infertility. The purpose of this review is to discuss factors that affect IUI outcomes, including infertility diagnosis, semen parameters, and stimulation regimens. Methods We reviewed the published literature to evaluate how patient and cycle specific factors affect IUI outcomes, specifically clinical pregnancy rate, live birth rate, spontaneous abortion rate and multiple pregnancy rate. Results Most data support IUI for men with a total motile count > 5 million and post-wash sperm count > 1 million. High sperm DNA fragmentation does not consistently affect pregnancy rates in IUI cycles. Advancing maternal and paternal age negatively impact pregnancy rates. Paternal obesity contributes to infertility while elevated maternal BMI increases medication requirements without impacting pregnancy outcomes. For ovulation induction, letrozole and clomiphene citrate result in similar pregnancy outcomes and are recommended over gonadotropins given increased risk for multiple pregnancies with gonadotropins. Letrozole is preferred for obese women with polycystic ovary syndrome. IUI is most effective for women with ovulatory dysfunction and unexplained infertility, and least effective for women with tubal factor and stage III-IV endometriosis. Outcomes are similar when IUI is performed with ovulation trigger or spontaneous ovulatory surge, and ovulation may be monitored by urine or serum. Most pregnancies occur within the first four IUI cycles, after which in vitro fertilization should be considered. Conclusions Providers recommending IUI for treatment of infertility should take into account all of these factors when evaluating patients and making treatment recommendations.
      PubDate: 2020-12-11
  • A cross-sectional survey of fertility knowledge in obstetrics and
           gynecology residents

    • Abstract: Background To evaluate fertility knowledge among current Obstetrics and Gynecology (OB-GYN) residents using a recently published validated instrument, the Fertility and Infertility Treatment Knowledge Score (FIT-KS). Methods OB-GYN residents in the United States were recruited through an email to all residency coordinators nationwide. They were asked to voluntarily respond to a short questionnaire including demographic information and the FIT-KS instrument, through an online survey platform. Of approximately 5000 OB-GYN residents in the country, 177 responded. Results The sample was 91% female, with 69% between the ages of 26 and 30. Participants evenly represented all 4 years of training. Mean FIT-KS score was 21.2 (73% correct; range 17–26). No statistically significant differences were noted across the level of training. Several knowledge gaps were noted. Residents could define the common assisted reproductive technologies; however overestimated their success rates per cycle. Conclusions Substantial gaps exist in fertility knowledge among OB-GYN residents, with understanding of male fertility and success rates of Assisted Reproductive Technologies (ART) being particularly limited. Knowledge of fertility does not change throughout residency training, demonstrating consistent gaps in fertility knowledge. Knowledge during post graduate year (PGY)-1 year is consistent with mean scores found in prior research in Internal Medicine residents (65%), as well as a cohort of female medical students and obstetrics and gynecology residents and fellows (64.9%) (Fertil Steril 108:711-7, 2017; Fertil Steril 110:e239, 2018).
      PubDate: 2020-12-09
  • Association of depression with sexual function in women with history of

    • Abstract: Purpose The present study aimed to investigate the relationship between depression and sexual function in women with recurrent pregnancy loss. Methods In a cross-sectional correlational study, 130 consecutive patients with history of recurrent pregnancy loss were included who referred to Avicenna Fertility Center in Tehran, Iran during November 2018–February 2019. The outcomes were sexual dysfunction (Assessed with the Female Sexual Function Index) and depression (Evaluated with the Beck’s Depression Inventory). The study data were analyzed by using Mann-Whitney and Kruskal-Wallis tests. Results The study findings revealed that 40.8% of the participants suffered from some degrees of depression. The data analysis revealed that depression had a significant inverse correlation with sexual function and its domains (r = − 0.392, p < 0.001, R2= 0.15). The spouse’ education level and economic status demonstrated a significant relationship with women’s sexual function (p = 0.01, p = 0.033). A significant relationship was also detected between women’s depression and economic status (p = 0.028). Conclusions The study findings showed that women with RPL who had severe depression indicated lower score of sexual function. Since psychological and sexual problems are not reported to health care providers due to giving priority to fertility issues or considering such issues as taboos, the assessment of sexual and mental health needs to be part of the consultation in women with history of RPL, whether the patient seeks help for depression and sexual dysfunction or not.
      PubDate: 2020-12-08
  • Primary and secondary infertility in Africa: systematic review with

    • Abstract: BACKGROUND Infertility is a practical concern of Africans due to social disgrace and exclusion. This meta-analysis aims to analyze the proportion of primary and secondary infertility and identify the etiologic factors based on the studies conducted in Africa. METHODS An internet-based search was conducted on the following databases; PubMed/Medline, EMBASE, Cochrane library, and google scholar. Both population and institution-based studies conducted among African couples, males, and females were included. Data extraction and critical appraisal of the articles were done by two independent investigators. Meta-analysis using a random effect model was conducted by Stata version 14. Forest plot, heterogeneity test, and funnel plot for publication bias were performed. RESULTS The pooled proportion of primary and secondary infertility in Africa was 49.91% (I2 = 98.7, chi-square = 1509.01, degree of freedom = 19 and p < 0.001) and 49.79% (I2 = 98.7, chi-square = 1472.69, degree of freedom = 19 and p < 0.001) respectively. The pooled prevalence of the causes of infertility indicated that 54.01% and 22.26% of the infertility cases were respectively due to female and male-related problems. In 21.36% of infertility cases, both sexes were affected, while 10.4% of the causes of infertility were unexplained. The pooled prevalence of mostly reported causes of male infertility was 31% (oligospermia), 19.39% (asthenozoospermia), and 19.2% (varicocele). The most commonly identified causes of female infertility were pelvic inflammatory disease, tubal factors, and abortion with a pooled prevalence of 39.38%, 39.17%, and 36.41% respectively. Conclusions In Africa, the proportion of primary and secondary infertility is approximately equal. Infertility is mostly due to female-related causes like; pelvic inflammatory diseases, uterine tube related problems, and abortion. Oligospermia, asthenozoospermia, and varicocele were the commonest causes of male-related infertility. It is suggested that interpretation and utilization of these findings should consider the presence of substantial heterogeneity between the included studies.
      PubDate: 2020-12-02
  • Cognitive testing of a survey instrument for self-assessed menstrual cycle
           characteristics and androgen excess

    • Abstract: Background In large population-based studies, there is a lack of existing survey instruments designed to ascertain menstrual cycle characteristics and androgen excess status including hirsutism, alopecia, and acne. Our objective was to cognitively test a survey instrument for self-assessed menstrual cycle characteristics androgen excess. Methods Questions to assess menstrual characteristics and health were designed using existing surveys and clinical experience. Pictorial self-assessment tools for androgen excess were also developed with an experienced medical illustrator to include the modified Ferrimen-Galway, acne and androgenic alopecia. These were combined into an online survey instrument using REDCap. Of the 219 questions, 120 were selected for cognitive testing to assess question comprehension in a population representative of the future study population. Results Cognitive testing identified questions and concepts not easily comprehended, recalled, or had problematic response choices. Comprehension examples included simplifying the definition for polycystic ovary syndrome and revising questions on historic menstrual regularity and bleeding duration. Recall and answer formation examples include issues with recalling waist size, beverage consumption, and interpretation of questions using symbols (> or <). The survey was revised based on feedback and subsequently used in the Ovulation and Menstruation (OM) Health Pilot study. Conclusion We present a cognitively tested, novel survey instrument to assess menstrual cycle characteristics and androgen excess.
      PubDate: 2020-11-09
  • Oocyte cryopreservation in the setting of a vascular endothelial growth
           factor (VEGF)-producing paraneoplastic syndrome: a case report and review
           of literature

    • Abstract: Background Many reproductive aged women with new oncologic diagnoses choose to undergo emergency oocyte or embryo cryopreservation prior to initiating potentially gonadal toxic oncologic therapies. Ovarian hyperstimulation syndrome (OHSS) is a potential complication of these treatments and can be particularly dangerous in these patients due to their underlying medical illness and by delaying lifesaving oncology treatment. This case report details a multipronged approach to OHSS prevention in a patient with a paraneoplastic syndrome defined by overproduction of vascular endothelial growth factor (VEGF), which is also primarily responsible for OHSS. Case presentation A 29 year old nulligravid woman was diagnosed with a rare multisystem paraneoplastic syndrome (Polyradiculoneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder and skin changes, known as POEMS) and presented for fertility preservation consultation prior to autologous stem cell transplant. She successfully underwent oocyte cryopreservation without complications due to aggressive OHSS prophylaxis with both a dopamine agonist and aromatase inhibitor during and after stimulation and a gonadotropin releasing hormone agonist (GnRH-A) for final oocyte maturation, without delay in her subsequent oncology treatment. Conclusions This is the first report of a patient with POEMS undergoing controlled ovarian hyperstimulation (COH). Oocyte cryopreservation was successful and without complications due to a combination of prophylactic measures against OHSS (cabergoline, letrozole and GnRH-A trigger) and close collaboration between reproductive endocrinology and oncology. This case demonstrates the use of combined measures in targeting VEGF overproduction and OHSS risk during COH.
      PubDate: 2020-10-28
  • Triple stimulation (TriStim) before bilateral oophorectomy in a young
           woman with ovarian cancer: a case report and review of the literature

    • Abstract: Background Double ovarian stimulation (DuoStim) involves two rounds of controlled ovarian stimulation (COS) and oocyte retrieval in immediate succession. It represents a promising approach to increase oocyte yield for patients with diminished ovarian reserve or those with limited time before fertility-threatening oncologic treatment. We report the case of a 31-year-old woman with Stage IC endometrioid ovarian cancer who underwent a triple stimulation or “TriStim,” completing three rounds of COS and oocyte retrieval within 42 days prior to bilateral salpingo-oophorectomy. Case presentation A 31 year old nulligravid woman presented for fertility preservation counseling following a bilateral ovarian cystectomy that revealed Stage IC endometroid adenocarcinoma arising within endometrioid borderline tumors. The patient was counseled for bilateral salpingo-oophorectomy, lymph node dissection, and omentectomy followed by three cycles of carboplatin/paclitaxel. Prior to this, all within six weeks, the patient underwent three rounds of controlled ovarian stimulation using an antagonist protocol and human chorionic gonadotropin (hCG) trigger, resulting in vitrification of nine two-pronuclear zygotes (2PN), after which definitive surgery was performed. Conclusions Advantages of DuoStim procedures are increasingly recognized, especially for oncology patients with limited time before potentially sterilizing cancer treatment. To our knowledge, this is the first report of a triple stimulation (“TriStim”). Our case highlights that triple stimulation is a viable option for patients needing urgent fertility preservation in order to maximize egg and embryo yield within a limited time period.
      PubDate: 2020-10-26
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