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Alon I, Cassou M, Golan OC, Ravitsky V. Mapping Ethical, Legal, and Social Implications (ELSI) of gamete donation. J Assist Reprod Genet 2024:10.1007/s10815-024-03229-z. [PMID: 39183224 DOI: 10.1007/s10815-024-03229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/08/2024] [Indexed: 08/27/2024] Open
Abstract
RESEARCH QUESTION This scoping review investigates the Ethical, Legal, and Social Implications (ELSI) of gamete donation, a critical facet of Assisted Reproductive Technologies, by analyzing the evolving research scope, methodological approaches, and the geographical skew in the literature. Despite the increased global uptake of donor gametes, current scholarship predominantly emanates from Western contexts and focuses on majoritized groups. This bias constrains the universality of research findings and limits their applicability across varied legal, cultural, and social contexts, underscoring a need for broader inclusivity. DESIGN We addressed 867 pivotal articles published between 1999 and 2019. RESULTS Our analysis reveals a discernible escalation in research volume, with 62% based on empirical research. The intellectual landscape unfolds into four dominant clusters: Regulatory Frameworks, Incentives, and Access; Family Dynamics and Genetic Linkages; Identity and Privacy in Donor Conception; and Cultural and Societal Attitudes towards GD. Each cluster highlights nuanced dimensions of gamete donation, from regulatory intricacies and psychological welfare to identity ethics and cultural perceptions. CONCLUSION Our findings advocate for a shift towards more globally representative and methodologically inclusive research. By integrating diverse cultural narratives and expanding geographical breadth, future research can offer holistic understandings of gamete donation, fostering equitable and culturally resonant practices and policies worldwide.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Autonomous University of Madrid, Madrid, Spain.
- University of Montreal, Montreal, Canada.
| | | | - Orit Cherny Golan
- University of Montreal, Montreal, Canada
- Yezreel Valley College, Yezreel Valley, Israel
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Lopez Laporte MA, Shahin J, Blotsky A, Malhamé I, Dayan N. Trends in maternal ICU admissions at a quaternary centre in Montreal, Canada, and impact of maternal age on critical care outcomes. Obstet Med 2024; 17:84-91. [PMID: 38784185 PMCID: PMC11110742 DOI: 10.1177/1753495x231184686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/10/2023] [Indexed: 05/25/2024] Open
Abstract
Background Advancing maternal age is increasingly prevalent and is associated with severe maternal morbidity often requiring intensive care unit (ICU) admission. Objectives To describe maternal ICU admissions at a quaternary care hospital in Montreal, Canada, and evaluate the association between maternal age and composite of: need for invasive interventions, ICU stay > 48 h, or maternal death. Methods Chart review of ICU admissions during pregnancy/postpartum (2006-2016); logistic regressions to evaluate the impact of age on outcomes. Results With 5.1 ICU admissions per 1000 deliveries, we included 187 women (mean age 32 ± 6.3 years; 20 (10.7%) ≥ 40 years). The composite outcome occurred in 105 (56.2%) patients; there were two maternal deaths. Age ≥ 40 years increased the odds of invasive interventions (OR 4.03; 95% confidence interval [CI] 1.15-14.1) but not of the composite outcome (OR 2.30; 95% CI 0.66-8.02). Conclusion Peripartum women aged ≥ 40 years had worse outcomes in ICU, with an increased need for invasive interventions.
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Affiliation(s)
- Maria Agustina Lopez Laporte
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Jason Shahin
- Division of Respirology and Critical Care Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Andrea Blotsky
- Division of Respirology and Critical Care Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Isabelle Malhamé
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Natalie Dayan
- Division of General Internal Medicine and Critical Care Medicine, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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Alorf F, Alani S, Steiner N, Dahan MH. How successful is intrauterine insemination after failed IVF? A study of 551 women. Reprod Biomed Online 2024; 48:103684. [PMID: 38271821 DOI: 10.1016/j.rbmo.2023.103684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Abstract
RESEARCH QUESTION What is the success rate of intrauterine insemination (IUI) after failing IVF? DESIGN This retrospective cohort study evaluated the pregnancy outcomes of 551 patients who underwent a total of 992 IUI cycles at an academic fertility centre between October 2008 and April 2018. RESULTS The study participants (n = 551) had previously failed one to three fresh IVF cycles and any resultant embryo transfers, and subsequently underwent a total of 992 IUI cycles. When comparing demographics, women with ongoing pregnancies, clinical pregnancies and positive pregnancies were significantly younger (P = 0.037, P = 0.025 and P = 0.049, respectively) compared with women who did not conceive. The cumulative ongoing pregnancy rate for all IUI cycles was 7.44% per patient (41 pregnancies in 551 patients), and the ongoing pregnancy rate after the first IUI cycle was 4.72%. In single women who had previously failed six IUI cycles before undergoing IVF cycles with donor sperm, the cumulative ongoing pregnancy rate was 15.8% in donor sperm IUI cycles compared with 5.1% in women who used their partner's sperm for both IVF and IUI cycles, with an adjusted odds ratio of 6.1. Patient age, number of previous pregnancies, daily gonadotrophin dose for IVF, number of mature follicles at trigger, and number of failed IVF cycles failed to predict pregnancy outcomes. CONCLUSION Ongoing pregnancy following IUI after failed IVF occurs at a rate of approximately 5% per cycle, and this rate is higher if donor sperm is used for both IVF and IUI cycles. This can be considered with proper counselling in women aged <40 years, and may be discouraged in women aged ≥43 years.
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Affiliation(s)
- Faisel Alorf
- Obstetrics and Gynecology Department, McGill University, Montreal, Quebec, Canada.
| | - Sanah Alani
- Obstetrics and Gynecology Department, McGill University, Montreal, Quebec, Canada
| | - Naama Steiner
- Obstetrics and Gynaecology Department, Soroka Medical Centre, Beersheba, Israel
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Quebec, Canada
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Dason ES, Maxim M, Gesink D, Yee M, Chan C, Baxter NN, Shapiro H, Simpson AN. Medical Students' Perspectives on Family Planning and Impact on Specialty Choice. JAMA Surg 2024; 159:170-178. [PMID: 38090998 PMCID: PMC10719828 DOI: 10.1001/jamasurg.2023.6392] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 12/17/2023]
Abstract
Importance Physicians are known to delay childbearing compared with nonphysicians and to experience higher rates of age-related pregnancy complications. Delay of childbearing is more pronounced in surgical specialties, and family planning and building goals may influence specialty choice. Objective To assess medical students' perspectives on the development of family planning goals and the timing of family building within a medical career to elucidate how these perceptions impact their choice of specialty. Design, Setting, and Participants This qualitative study included fourth-year medical students at the University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada, and was conducted between May and August 2021. Participants were purposively sampled to maximize diversity of gender and specialty choice. Interviews were conducted via videoconferencing software that were recorded, transcribed verbatim, and verified for accuracy. Thematic analysis was completed independently by 2 researchers and consensus on final themes was reached through discussion among study investigators. Data were analyzed between September and December 2021. Main Outcomes and Measures Participants were asked to share their perceptions of personal family planning goals, support currently in place, family planning education in medicine and factors contributing to their choice of specialty and program. Thematic analysis was completed. Results A total of 34 fourth-year medical students (median [range] age, 26 [24-33] years; 23 females [67.6%]) were interviewed. Four main themes were identified: (1) there is no ideal time to family build in a medical career, (2) family planning is a taboo topic, (3) surgical specialties offer less support for family building, and (4) residents who have children are perceived to place a burden on their colleagues. Medical students considered their family planning while deliberating among specialty choices and their experiences were highly influential in shaping their specialty selection. Conclusions and Relevance Results of this qualitative study suggest that medical students perceive that family building during training may have unfavorable implications for team dynamics and relationships with colleagues, and these perceptions may affect specialty choice and family planning goals. Integration of family planning discussions and support for family building into medical curricula is needed along with efforts to improve culture by supporting team dynamics and workload when students take parental leave.
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Affiliation(s)
- Ebernella Shirin Dason
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Madalina Maxim
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynecology, McGill University, Montréal, Québec, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Yee
- Department of Emergency Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Crystal Chan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Li Ka Shing Knowledge Institute, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Heather Shapiro
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N. Simpson
- Li Ka Shing Knowledge Institute, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, St Michael’s Hospital/Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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Lee CE, Allaire C, Williams C, Bedaiwy MA, Noga H, Hanley GE, Lisonkova S, Albert A, Yong PJ. Outcomes After Surgery at an Interdisciplinary Centre of Expertise for Endometriosis and Pelvic Pain in Canada: A Prospective Cohort Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102246. [PMID: 38442956 DOI: 10.1016/j.jogc.2023.102246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVES To prospectively evaluate pain-related quality-of-life (Endometriosis Health Profile-30 [EHP-30] pain subscale) after surgery at an interdisciplinary centre of expertise for endometriosis and pelvic pain. METHODS A prospective cohort study was completed of persons undergoing surgical management for pelvic pain between December 2013 and July 2016 at an interdisciplinary tertiary referral centre for pelvic pain and endometriosis. We compared the change in EHP-30 scores for the following scenarios: (1) type of surgery (conservative surgery vs. hysterectomy), (2) stage of endometriosis (stage I/II vs. III/IV), and (3) age (age <40 vs. age ≥40 years). We used mixed-effects models to evaluate changes in pain during follow-up after surgery. RESULTS Overall, 595 individuals met our inclusion criteria; the follow-up rate was 65.9% (392/595). In total, 436 (73.3%) underwent conservative surgery, while 159 (26.7%) underwent hysterectomy. Improvements in pain-related quality-of-life were seen for both conservative surgery and hysterectomy but greater improvements were seen with hysterectomy (P < 0.001). For conservative surgery, similar improvements in quality-of-life were observed regardless of endometriosis stage (I/II vs. III/IV) (P = 0.84) or age (<40 or ≥40 years old) (P = 0.87). We also observed similar improvements in quality-of-life regardless of stage (P = 0.24) or age (P = 0.71) after hysterectomy. CONCLUSIONS At an interdisciplinary centre of expertise, there were significant improvements in quality-of-life after endometriosis surgery. These improvements were seen for both conservative surgery and hysterectomy (although greater improvement with the latter), for early and advanced stage disease, and younger and older patients.
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Affiliation(s)
- Caroline E Lee
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Catherine Allaire
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Christina Williams
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Mohamed A Bedaiwy
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Heather Noga
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Gillian E Hanley
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Arianne Albert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Paul J Yong
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
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Coban O, Serdarogullari M, Pervaiz R, Soykok A, Yarkiner Z, Bankeroglu H. Effect of paternal age on assisted reproductive outcomes in ICSI donor cycles. Andrology 2023; 11:515-522. [PMID: 36482823 DOI: 10.1111/andr.13363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite growing evidence suggesting age-related molecular changes in gametes, the impact of paternal age on clinical outcomes during infertility treatments has not been adequately assessed. OBJECTIVES This study aims to assess the correlation of paternal age to clinical pregnancy and live birth rates in egg donation cycles undergoing intracytoplasmic sperm injection. MATERIALS AND METHODS This retrospective cohort study includes 4930 fresh oocyte donation cycles from 3995 couples between April 2005 and February 2020 in a private IVF hospital. Clinical pregnancy and live birth rates were the primary outcome measures. The results were also assessed according to the paternal age groups, donor characteristics, semen parameters, fertilization rate, and quality of the transferred embryos. RESULTS The age and body mass index of the donors, oocyte maturation, fertilization rates, and the mean number of transferred embryo quality were comparable on day-3 but not on day-5 embryo transfers between paternal age groups (p > 0.05). Paternal age was found to be negatively correlated to the number of oocytes utilized, normal semen parameters, fertilization, clinical pregnancy, and live birth rates (p < 0.05). In day-5 embryo transfer cycles, only the rate of cycles with normal spermatozoa, number of allocated oocytes, and pregnancy were found to be statistically significant. DISCUSSION AND CONCLUSION Paternal age may influence reproductive outcomes and should be considered during infertility evaluations in intracytoplasmic sperm injection donor cycles. Further research is needed to confirm these findings.
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Affiliation(s)
- Onder Coban
- Department of Embryology, British Cyprus IVF Hospital, Nicosia, Cyprus
| | - Munevver Serdarogullari
- Department of Histology and Embryology, Faculty of Medicine, Cyprus International University, Nicosia, Cyprus
| | - Ruqiya Pervaiz
- Department of Zoology, Faculty of Chemical and Life Sciences, Abdul Wali Khan University, Mardan, Pakistan
| | - Afet Soykok
- Department of Embryology, British Cyprus IVF Hospital, Nicosia, Cyprus
| | - Zalihe Yarkiner
- Department of Basic Sciences and Humanities, Faculty of Arts and Sciences, Cyprus International University, Nicosia, Cyprus
| | - Hasan Bankeroglu
- Department of Obstetrics & Gynecology, British Cyprus IVF Hospital, Nicosia, Cyprus
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Temmesen CG, Faber Frandsen T, Svarre-Nielsen H, Petersen KB, Clemensen J, Andersen HLM. Women's reflections on timing of motherhood: a meta-synthesis of qualitative evidence. Reprod Health 2023; 20:30. [PMID: 36755286 PMCID: PMC9909900 DOI: 10.1186/s12978-022-01548-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 12/11/2022] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Fertility declines with increasing age, especially in women. In recent decades women's age at the birth of their first child has risen markedly in many countries, and an increasing number of women do not establish a family until their late-twenties to mid-thirties. Although there can be various reasons that couples experience fertility problems, advanced maternal age is the most frequent cause for difficulties with achieving pregnancy. OBJECTIVE In this meta-synthesis, we investigated reflections on timing of motherhood in women who have not yet had children. METHODS A systematic literature search of six electronic databases and manual searches of reference lists identified eight qualitative studies published between 2011 and 2018 that focused on women's reflections on timing of motherhood. The studies were assessed with the Critical Assessment Skills Programme (CASP) quality appraisal tool. The results were synthesized using Noblit and Hare's meta-ethnographic approach as described by Malterud. FINDINGS An overall theme of 'Timing of motherhood' and four overlapping subthemes were identified: Making a life-changing decision, The right time, Fear of regret, and Plan B. The dilemmas associated with timing of motherhood leave women of reproductive age balancing their priorities and values against a biological deadline for having children naturally or through assisted reproductive technology. CONCLUSIONS Women of reproductive age are aware that they must make a life-changing decision as to if or when to have children, but they consider having children at 'the right time' to be important. Simultaneously, while some women are reluctant to have children for various reasons, they express fear that waiting too long could result in their regretting not having children later in life. Although women of reproductive age express concern about their ability to achieve pregnancy, they have limited focus on the medical risks associated with postponing motherhood. There is a need to establish preventive health initiatives to support women of reproductive age in their considerations regarding timing of motherhood. TRIAL REGISTRATION NUMBER PROSPERO: CRD42020175151.
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Affiliation(s)
- Camilla Gry Temmesen
- Department of Nutrition, Rehabilitation and Midwifery, University College Absalon, Sdr. Stationsvej 30, 4200, Slagelse, Denmark. .,Clinical Institute, University of Southern Denmark, Odense, Denmark.
| | - Tove Faber Frandsen
- grid.10825.3e0000 0001 0728 0170Department of Design and Communication, University of Southern Denmark, Kolding, Denmark
| | - Henriette Svarre-Nielsen
- grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark ,grid.411905.80000 0004 0646 8202Department of Obstetrics and Gynecology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | | | - Jane Clemensen
- grid.10825.3e0000 0001 0728 0170Department of Children, Hans Christian Andersen Children’s Hospital, University of Southern Denmark, Odense, Denmark
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Cantor A, Meng L, Lanes A, Greenblatt EM. The effect of the Ontario Fertility Program on IVF utilization and outcomes in women of advanced reproductive age. Reprod Biomed Online 2023; 46:410-416. [PMID: 36336568 DOI: 10.1016/j.rbmo.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/12/2022] [Accepted: 05/21/2022] [Indexed: 02/07/2023]
Abstract
RESEARCH QUESTION Are the demographics and clinical outcomes similar for patients aged ≥40 but <43 years seeking IVF in Ontario, Canada, before and after implementation of the Ontario Fertility Program (OFP), which supports public funding of IVF up to age 43? DESIGN Retrospective database review using the Canadian Assisted Reproductive Technologies Registry Plus (CARTR Plus) and Better Outcomes Registry & Network (BORN) Ontario databases. Cycles from women who underwent autologous IVF and who were aged ≥40 and <43 years were analysed during a 2-year period prior to (2014-2015) and after (2016-2017) introduction of publicly funded IVF through the OFP. RESULTS There was an almost doubling of treatment cycles in women aged 40-42 in Ontario after the OFP launch. Clinical pregnancy rate per cycle start (17.0% versus 13.3%, P < 0.001) and cumulative clinical pregnancy rate per stimulation cycle (20.5% versus 16.8%, P < 0.001) were statistically higher in women before OFP implementation. While cumulative live birth rate per cycle start was statistically lower after funding was introduced (12.5% versus 10.5%, P = 0.027), the clinical importance of this difference appears small. Outcomes were above the 10% live birth per cycle threshold recommended by the Advisory Process for Infertility Services panel, commissioned by the Ministry of Health, to determine access to publicly funded IVF. CONCLUSIONS Use of IVF in women over age 40 doubled with access to OFP funding; however, eligibility criteria based on age still meet the target of achieving a cumulative live birth rate of at least 10%.
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Affiliation(s)
- Arielle Cantor
- Mount Sinai Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Department of Obstetrics and Gynecology, 250 Dundas Street West, #700, Toronto Ontario M5T 2Z5, Canada.
| | - Lynn Meng
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa Ontario K1H 8L1, Canada
| | - Andrea Lanes
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa Ontario K1H 8L1, Canada
| | - Ellen M Greenblatt
- Mount Sinai Centre for Fertility and Reproductive Health, Mount Sinai Hospital, Department of Obstetrics and Gynecology, 250 Dundas Street West, #700, Toronto Ontario M5T 2Z5, Canada
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Weissert SJ, Mikkelsen EM, Jacobsen BH, Hatch EE, Wesselink AK, Wise LA, Rothman KJ, Sørensen HT, Laursen ASD. Organic food consumption and fecundability in a preconception cohort study of Danish couples trying to conceive. Paediatr Perinat Epidemiol 2023; 37:57-68. [PMID: 36071679 PMCID: PMC10087289 DOI: 10.1111/ppe.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/29/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about potential health effects of eating organic food in relation to reproduction. OBJECTIVE We examined associations between organic food consumption and fecundability. METHODS Data were derived from a preconception cohort study of Danish couples trying to conceive (SnartForaeldre.dk, SF). Participants completed a baseline questionnaire on socio-demographics, anthropometrics and lifestyle and a validated food-frequency questionnaire, which included questions on proportions of organic food consumed within six food groups. Participants were followed up with bimonthly questionnaires for up to 12 months or until pregnancy. Analyses were restricted to 2061 participants attempting pregnancy for ≤6 cycles at enrollment and 1303 with <3 cycles. Fecundability ratios (FRs) and 95% confidence intervals (CI) were estimated by proportional probabilities regression models adjusted for potential confounders including age, lifestyle and socioeconomic factors. Associations were examined for vegetables, fruits, cereals, dairy products, eggs and meat, separately, and for the overall pattern of organic food consumption (organic sum score). RESULTS The final analytic sample comprised 2069 participants. In the full cohort, organic food consumption was not meaningfully associated with fecundability. Among participants <3 cycles of pregnancy attempt at study entry (n = 1303), the FR was 1.11 (95% CI 0.93, 1.33) for the category 'less than half', for 'more than half' the FR was 1.17 (95% CI 0.99, 1.38) and for 'almost everything' the FR was 1.12 (95% CI 0.97, 1.28). CONCLUSION Higher consumption of organic foods was not meaningfully associated with fecundability, although slightly greater fecundability was seen among participants with <3 cycles of pregnancy attempt time.
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Affiliation(s)
- Sissel Jessen Weissert
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen Margrethe Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Bjarke H Jacobsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amelia K Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Anne Sofie Dam Laursen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Zhang Y, Qiao Y, Li L, Gao DD, Song JY, Sun ZG. Efficacy of Qizi Yusi Pill on Pregnancy Outcomes in Women of Advanced Reproductive Age: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Chin J Integr Med 2022; 28:675-682. [PMID: 35648305 DOI: 10.1007/s11655-022-3515-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evalvate efficacy of Qizi Yusi Pills (QYP), a Chinese medicine compound preparation, on in vitro fertilization-embryo transfer (IVF-ET) in women of advanced reproductive age. METHODS This multicenter, randomized, double-blind, placebo-controlled trial was conducted from June 2018 to October 2019. A total of 124 patients were randomly allocated to either the QYP group or the placebo group using a stratified block randomization design, with 62 patients in each group. All patients completed controlled ovarian stimulation using a standard gonadotropin-releasing hormone agonist (GnRH-a) long protocol. As the QYP group, QYP was administered while the control group received placebo. QYP and placebo were administered for a total of 24 to 30 days from the day of GnRH-a pituitary downregulation to transvaginal oocyte retrieval. Both medications were taken orally at doses of 10 g three times each day. The primary outcome was cumulative pregnancy rate, and the secondary outcomes were periodic medication, follicular status, serum hormone and endometrial receptivity. Follow-up continued until 4 weeks after delivery. Maternal and neonatal complications, such as gestational diabetes, were also observed. RESULTS Overall, 119 patients completed the study, 60 in the QYP group and 59 in the placebo group. Per protocol (PP) analysis revealed that 6-month cumulative pregnancy rate in the QYP group was significantly higher than that in the placebo group [43.33% (26/60) vs. 25.42% (15/59), P=0.040). Additionally, more oocytes were retrieved from the QYP group than those from the placebo group (8.95 ± 3.12 vs. 7.85 ± 1.91, P=0.022). Moreover, the endometrial thickness of HCG day in the QYP group was significantly higher than that in the placebo group (11.78 ± 2.27 mm vs. 10.68 ± 2.07 mm, P=0.012). Maternal and neonatal complications between the two groups were not significantly different (P>0.05). Intention-to-treat analysis was in line with PP results. CONCLUSIONS QYP can enhance ovarian reserve capacity and ovarian response, and possibly promote endometrial receptivity. QYP effectively improves cumulative pregnancy rates in older patients (⩾35 years) undergoing IVF-ET. (Registration No. ChiCTR1800014427).
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Affiliation(s)
- Yi Zhang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Yan Qiao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Li Li
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Dan-Dan Gao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, 250355, China
| | - Jing-Yan Song
- The First Clinical College, Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Zhen-Gao Sun
- Reproductive and Genetic Center of Integrated Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250011, China.
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Richmond E, Ray JG, Pudwell J, Djerboua M, Gaudet L, Walker M, Smith GN, Velez MP. Caesarean birth in women with infertility: population-based cohort study. BJOG 2022; 129:908-916. [PMID: 34797929 PMCID: PMC9300122 DOI: 10.1111/1471-0528.17019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Caesarean section (CS) is more common following infertility treatment (IT) but the reasons why remain unclear and confounded. The Robson 10-Group Classification System (TGCS) may further explain variation in CS rates. We assessed the association between mode of conception and CS across Robson groups. DESIGN Population-based cohort study. SETTING Ontario, Canada, in a public healthcare system. POPULATION 921 023 births, 2006-2014. METHODS Modified Poisson regression produced relative risks (RR) and 95% confidence intervals, comparing the risk of CS among women with (1) subfertility without IT, (2) non-invasive IT (OI, IUI) or (3) invasive IT (IVF)-each relative to (4) spontaneous conception (SC). MAIN OUTCOME MEASURES CS rate according to one of four modes of conception, overall and stratified by each of the TGCS groups. RESULTS Relative to SC (26.9%), the risk of CS increased in those with subfertility without IT (RR 1.17, 95% CI 1.16-1.18), non-invasive IT (RR 1.21, 95% CI 1.18-1.24) and invasive IT (RR 1.39, 95% CI 1.36-1.42). Within each Robson group, similar patterns of RRs were seen, but with markedly differing rates. For example, in Group 1 (nulliparous, singleton, cephalic at ≥37 weeks, with spontaneous labour), the respective rates were 15.0, 19.4, 18.7 and 21.9%; in Group 2 (nulliparous, singleton, cephalic at ≥37 weeks, without spontaneous labour), the rates were 35.9, 44.4, 43.2 and 54.1%; and in Group 8 (multiple pregnancy), they were 55.9, 67.5, 65.0 and 69.3%, respectively. CONCLUSIONS CS is relatively more common in women with subfertility and those receiving IT, an effect that persists across Robson groups. TWEETABLE ABSTRACT Caesarean delivery is more common in women with infertility independent of demographics and prenatal conditions.
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Affiliation(s)
- E Richmond
- Department of Obstetrics & GynaecologyKingston General HospitalQueen’s UniversityKingstonONCanada
| | - JG Ray
- ICESTorontoONCanada
- Department of MedicineSt. Michael’s HospitalUniversity of TorontoTorontoONCanada
| | - J Pudwell
- Department of Obstetrics & GynaecologyKingston General HospitalQueen’s UniversityKingstonONCanada
| | | | - L Gaudet
- Department of Obstetrics & GynaecologyKingston General HospitalQueen’s UniversityKingstonONCanada
| | - M Walker
- Department of Obstetrics, Gynaecology & Newborn CareUniversity of OttawaOttawaONCanada
| | - GN Smith
- Department of Obstetrics & GynaecologyKingston General HospitalQueen’s UniversityKingstonONCanada
| | - MP Velez
- Department of Obstetrics & GynaecologyKingston General HospitalQueen’s UniversityKingstonONCanada
- ICESTorontoONCanada
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12
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Pregnancy After 40: Recommendations for Counseling, Evaluation, and Management From Preconception to Delivery. Obstet Gynecol Surv 2022; 77:111-121. [DOI: 10.1097/ogx.0000000000000967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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13
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Wilson RD. Every Mother and Every Fetus Matters: A Positive Pregnant Test = Multiple Offerings of Reproductive Risk Screening for personal, family, and specific obstetrical-fetal conditions. Int J Gynaecol Obstet 2021; 159:65-78. [PMID: 34927726 DOI: 10.1002/ijgo.14074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022]
Abstract
Structured OBJECTIVE: The requirement and need for a focused 'pregnant person -centered' antenatal care process with time for informed consent and shared decision making are important for optimal antenatal care. This commentary focuses on the evidenced -based screening test options and timing as part of the overall 'pregnant person-centered' preconception and antenatal care journey. METHODS A structured quality improvement (QI) review (Squire 2.0) was undertaken to examine the appropriate reproductive screening process in the periods of preconception and during pregnancy. RESULTS First, evaluated the broader antenatal care structure which, second, enabled the directed reproductive risk screening processes to be offered within an informed consent process. Four international pre-conception and antenatal evidenced-based consensus would routinely offer specific gestational age reproductive risk screening elements: totaling 21 screening elements (preconception 3; 1st trimester 9; 2nd trimester 3; 3rd trimester 4; intrapartum 1; postpartum 1). CONCLUSION The best evidenced-based opportunity for comprehensive and collaborative antenatal care with appropriate screening elements requires: single national access healthcare system; expert evidenced-based guideline creation; collaborative maternity care providers based for risk assessment, triage, and management; pregnant person (women) centered care model of maternity care; clearly identified evidenced-based gestational age directed screening elements; international pre-conception and antenatal guideline consensus.
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Affiliation(s)
- R Douglas Wilson
- Professor Emeritus / Department of Obstetrics and Gynecology, Cumming School of Medicine University of Calgary, Calgary Alberta, Canada
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14
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Zhang Y, Yan Z, Liu H, Li L, Yuan C, Qin L, Cai L, Liu J, Hu Y, Cui Y. Sorbitol accumulation decreases oocyte quality in aged mice by altering the intracellular redox balance. Aging (Albany NY) 2021; 13:25291-25303. [PMID: 34897034 PMCID: PMC8714154 DOI: 10.18632/aging.203747] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022]
Abstract
Sorbitol is a product of glucose metabolism through the polyol pathway. Many studies have demonstrated that excessive sorbitol can disrupt the intracellular redox balance. However, we still know very little about the impact of excessive intracellular sorbitol on oocyte quality, oocyte maturation, and embryo developmental potential. This study explored whether intracellular sorbitol accumulates in the oocytes of aged mice during in vitro maturation (IVM) and what roles sorbitol plays in oocyte development and maturation. Our results showed that sorbitol levels were significantly higher in in vitro-matured oocytes from aged mice than in oocytes from young mice (14.08 ± 3.78 vs. 0.23 ± 0.04 ng/oocyte). The expression of aldose reductase (AR) mRNA was significantly higher in the in vitro-cultured oocytes from 9-month-old mice than prior to culture. To decrease the excessive intracellular sorbitol in oocytes from aged mice, sorbinil, a specific inhibitor of aldose reductase, was supplemented in IVM medium, and the sorbitol level was significantly decreased (14.08 ± 3.78 vs. 0.48 ± 0.19 ng/oocyte). Our results indicated that the percentage of oocytes with first polar body extrusion (PBE) was significantly higher in the sorbinil group than in the aged group (82.4% ± 7.2% vs. 66.1% ± 6.9%), and the content of sorbitol was drastically increased in the aged group. The ROS fluorescence intensity in the sorbinil group was drastically lower than that in the aged group, while the GSH fluorescence intensity was significantly higher. Interestingly, SOD1 was upregulated in the sorbinil group. The present study suggests that excessive sorbitol accumulation is induced during IVM in aged mouse oocytes, which negatively influences oocyte quality by altering the intracellular redox balance. Inhibition of sorbitol accumulation may be a potential method to improve the nuclear maturation of aged oocytes.
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Affiliation(s)
- Yuexin Zhang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhengjie Yan
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Hanwen Liu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Lingjun Li
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Chun Yuan
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Lianju Qin
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Lingbo Cai
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Yanqiu Hu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Yugui Cui
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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15
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Marrus N, Turner TN, Forsen E, Bolster D, Marvin A, Whitehouse A, Klinger L, Gurnett CA, Constantino JN. Genetic counseling as preventive intervention: toward individual specification of transgenerational autism risk. J Neurodev Disord 2021; 13:39. [PMID: 34530736 PMCID: PMC8447585 DOI: 10.1186/s11689-021-09389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although autism spectrum disorders (ASD) are among the most heritable of all neuropsychiatric syndromes, most affected children are born to unaffected parents. Recently, we reported an average increase of 3-5% over general population risk of ASD among offspring of adults who have first-degree relatives with ASD in a large epidemiologic family sample. A next essential step is to investigate whether there are measurable characteristics of individual parents placing them at higher or lower recurrence risk, as this information could allow more personalized genetic counseling. METHODS We assembled what is to our knowledge the largest collection of data on the ability of four measurable characteristics of unaffected prospective parents to specify risk for autism among their offspring: (1) sub clinical autistic trait burden, (2) parental history of a sibling with ASD, (3) transmitted autosomal molecular genetic abnormalities, and (4) parental age. Leveraging phenotypic and genetic data in curated family cohorts, we evaluate the respective associations between these factors and child outcome when autism is present in the family in the parental generation. RESULTS All four characteristics were associated with elevation in offspring risk; however, the magnitude of their predictive power-with the exception of isolated rare inherited pathogenic variants -does not yet reach a threshold that would typically be considered actionable for reproductive decision-making. CONCLUSIONS Individual specification of risk to offspring of adults in ASD-affected families is not straightforwardly improved by ascertainment of parental phenotype, and it is not yet clear whether genomic screening of prospective parents in families affected by idiopathic ASD is warranted as a clinical standard. Systematic screening of affected family members for heritable pathogenic variants, including rare sex-linked mutations, will identify a subset of families with substantially elevated transmission risk. Polygenic risk scores are only weakly predictive at this time but steadily improving and ultimately may enable more robust prediction either singly or when combined with the risk variables examined in this study.
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Affiliation(s)
- Natasha Marrus
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave; Box 8504, St. Louis, MO, 63110, USA.
| | - Tychele N Turner
- Department of Genetics, Washington University School of Medicine, 660 S. Euclid Ave; Box 8108, St. Louis, MO, 63110, USA
| | - Elizabeth Forsen
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave; Box 8504, St. Louis, MO, 63110, USA
| | - Drew Bolster
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave; Box 8504, St. Louis, MO, 63110, USA
| | - Alison Marvin
- Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, PACT Building/Office 121B; 7000 Tudsbury Road, Baltimore, MD, 21244, USA
| | - Andrew Whitehouse
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Campus Box #7180, Chapel Hill, NC, 27599-7180, USA
| | - Christina A Gurnett
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Ave; Box 8111, St. Louis, MO, 63110, USA
| | - J N Constantino
- Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave; Box 8504, St. Louis, MO, 63110, USA
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16
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Wang Y, Shi H, Chen L, Zheng D, Long X, Zhang Y, Wang H, Shi Y, Zhao Y, Wei Y, Qiao J. Absolute Risk of Adverse Obstetric Outcomes Among Twin Pregnancies After In Vitro Fertilization by Maternal Age. JAMA Netw Open 2021; 4:e2123634. [PMID: 34505887 PMCID: PMC8433605 DOI: 10.1001/jamanetworkopen.2021.23634] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Twin pregnancy is a common occurrence in pregnancies conceived with in vitro fertilization (IVF), but the absolute risk of adverse obstetric outcomes stratified by IVF, twin or singleton pregnancy, and maternal age are unknown. OBJECTIVE To estimate the absolute risk of adverse obstetric outcomes at each maternal age among twin pregnancies conceived with IVF. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included pregnant women with infants born from January 1, 2013, to December 31, 2018, based on the Hospital Quality Monitoring System in China. Data were analyzed from September 1, 2020, to June 30, 2021. EXPOSURES Twin pregnancy with IVF (IVF-T), singleton pregnancy with IVF (IVF-S), twin pregnancy with non-IVF (nIVF-T), and singleton pregnancy with non-IVF (nIVF-S). MAIN OUTCOMES AND MEASURES Sixteen obstetric outcomes, including 10 maternal complications (gestational hypertension, eclampsia and preeclampsia, gestational diabetes, placenta previa, placental abruption, placenta accreta, preterm birth, dystocia, cesarean delivery, and postpartum hemorrhage) and 6 neonatal complications (fetal growth restriction, low birth weight, very low birth weight, macrosomia, malformation, and stillbirth). RESULTS Among 16 879 728 pregnant women aged 20 to 49 years (mean [SD] age, 29.2 [4.7] years), the twin-pregnancy rates were 32.1% in the IVF group and 1.5% in the non-IVF group (relative risk, 20.8; 95% CI, 20.6-20.9). The most common adverse obstetric outcomes after pregnancy conceived with IVF were cesarean delivery (88.8%), low birth weight (43.8%), preterm birth (39.6%), gestational diabetes (20.5%), gestational hypertension and preeclampsia and eclampsia (17.5%), dystocia (16.8%), and postpartum hemorrhage (11.9%). The absolute risk of most adverse obstetric outcomes in each subgroup presented in 2 dominant patterns: Pattern A indicated the absolute risk ranging from IVF-T to nIVF-T to IVF-S to nIVF-S, and pattern B indicated the absolute risk ranging from IVF-T to IVF-S to nIVF-T to nIVF-S. Both patterns showed an elevated obstetric risk with increasing maternal age in each subgroup. CONCLUSIONS AND RELEVANCE In this cohort study, twin pregnancy, IVF, and advanced maternal age were independently associated with adverse obstetric outcomes. Given these findings, promotion of the elective single embryo transfer strategy is needed to reduce multiple pregnancies following IVF technologies. Unnecessary cesarean delivery shouldh be avoided in all pregnant women.
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Affiliation(s)
- Yuanyuan Wang
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
| | - Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Lian Chen
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Danni Zheng
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
| | - Xiaoyu Long
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
| | - Yunjun Zhang
- Department of Biostatistics, Peking University School of Public Health, Beijing, China
| | - Haibo Wang
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Centre for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, China
| | - Yangyu Zhao
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
| | - Jie Qiao
- Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrical and Gynecology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing, China
- National Center for Healthcare Quality Management in Obstetrics, Beijing, China
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17
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Parental age and preterm birth: a population-based cohort of nearly 3 million California livebirths from 2007 to 2012. J Perinatol 2021; 41:2156-2164. [PMID: 33293667 DOI: 10.1038/s41372-020-00894-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/15/2020] [Accepted: 11/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the relationships between parental ages and preterm birth subtypes. METHODS A population-based cohort analysis of California livebirths 2007-2012. Associations between maternal and paternal age with spontaneous and medically indicated preterm birth were estimated from Cox proportional hazard models. Parental age was modeled with restricted cubic splines to account for nonlinear relationships. RESULTS Young paternal age was associated with increased hazard ratios for spontaneous and medically indicated preterm birth. Older fathers showed elevated hazards for preterm birth in crude analysis but after adjustment the relationship was generally not observed. Aging mothers showed increased hazard ratios for both preterm birth phenotypes. CONCLUSIONS After adjusting for parental demographics, births to younger fathers and older mothers had the highest risks for spontaneous preterm birth. The paternal influence on preterm birth was observed to be independent of maternal factors.
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18
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Temmesen CG, Nielsen HS, Andersen HLM, Birch Petersen K, Clemensen J. Using Social Media for Qualitative Health Research in Danish Women of Reproductive Age: Online Focus Group Study on Facebook. JMIR Form Res 2021; 5:e24108. [PMID: 34057418 PMCID: PMC8204231 DOI: 10.2196/24108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/25/2021] [Accepted: 04/13/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Social media platforms provide new possibilities within health research. With Facebook being the largest social network in the world, it constitutes a potential platform for recruitment and data collection from women of reproductive age. Women in Denmark and in other Western countries postpone motherhood and risk infertility due to their advanced age when they try to conceive. To date, no study has explored Danish women's reflections on the timing of motherhood within a social media setting. OBJECTIVE The aim of this study was to explore the challenges and opportunities of using Facebook as a platform for qualitative health research in Danish women of reproductive age. METHODS This study was a qualitative study based on 3 online focus groups on Facebook with 26 Danish women of reproductive age discussing the timing of motherhood in January 2020. RESULTS Conducting online focus groups on Facebook was successful in this study as the web-based approach was found suitable for developing qualitative data with women of reproductive age and made recruitment easy and free of charge. All participants found participating in an online focus group to be a positive experience. More than half of the women participating in the online focus groups found it advantageous to meet on Facebook instead of meeting face-to-face. CONCLUSIONS Conducting online focus groups on Facebook is a suitable method to access qualitative data from women of reproductive age. Participants were positive toward being a part of an online focus group. Online focus groups on social media have the potential to give women of reproductive age a voice in the debate of motherhood.
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Affiliation(s)
- Camilla Gry Temmesen
- HCA Research, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Department of Nursing, University College Absalon, Roskilde, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jane Clemensen
- HCA Research, Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Gu F, Ruan S, Luo C, Huang Y, Luo L, Xu Y, Zhou C. Can repeat IVF/ICSI cycles compensate for the natural decline in fertility with age? an estimate of cumulative live birth rates over multiple IVF/ICSI cycles in Chinese advanced-aged population. Aging (Albany NY) 2021; 13:14385-14398. [PMID: 34016792 PMCID: PMC8202897 DOI: 10.18632/aging.203055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/14/2021] [Indexed: 05/31/2023]
Abstract
In order to find out to what extent ovarian aging could be compensated by the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatments, a total of 4102 women above the age of 35 undergoing 6489 complete cycles from 2009 to 2015 with follow-up visits until 2017 were retrospectively analyzed. Cumulative live birth rates (CLBRs) across multiple IVF/ICSI cycles were compared in the study population stratified by age and ovarian reserve (classified by the POSEIDON criteria). Younger patients (aged between 35 and 40) could well benefit from repeat IVF treatments, with the optimal CLBRs ranging from 62%-72% for up to four complete cycles. However, the CLBRs sharply declined to 7.7%-40% in older patients (>40yrs). In light of ovarian reserve, the optimal-estimated-four-cycle CLBR of younger patients (35-40yrs) in POSEIDON group 2 could approached to those with normal ovarian response (non-POSEIDON), with 57.3%-70% versus 74.5%-81% respectively. However, the CLBR of older patients (>40yrs) in POSEIDON group 2 only reached 50% of their counterparts. Extending the number of IVF cycles beyond three or four is effective for advanced-aged women, especially in younger normal responders (non-POSEIDON) and unexpected poor/suboptimal responders (POSEIDON group 2). The real turning point at which female fecundity dropped after multiple IVF cycles is at the age of 40.
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Affiliation(s)
- Fang Gu
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Simin Ruan
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Chenxiang Luo
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Ying Huang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Lu Luo
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
| | - Yanwen Xu
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
- Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou 510080, China
| | - Canquan Zhou
- Department of Obstetrics and Gynecology, Reproductive Medical Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China
- Key Laboratory of Reproductive Medicine of Guangdong Province, Guangzhou 510080, China
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20
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Trawick E, Pecoriello J, Quinn G, Goldman KN. Guidelines informing counseling on female age-related fertility decline: a systematic review. J Assist Reprod Genet 2021; 38:41-53. [PMID: 33188440 PMCID: PMC7822973 DOI: 10.1007/s10815-020-01967-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/04/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To identify, appraise, and assess clinical practice guidelines informing patient counseling on female age-related fertility decline. METHODS Searched electronic database records from January 1, 2006, to September 10, 2018, and professional society websites. The search terms included iterations of "guideline," "counseling," "preconception," "age-related fertility decline," and "reproductive life planning." English-language professional organization guidelines addressing patient counseling on age-specific reproductive health topics were included. Assessed the methodological quality of included guidelines using the AGREE II instrument. Guidelines were categorized as high quality or low quality based on AGREE II scores. Extracted age-specific reproductive health recommendations of high-quality guidelines. RESULTS The search identified 2918 records. Nineteen records addressed counseling on age-related fertility decline; only 6 focused only on reproductive aging, with the remaining 13 covering related topics. Eleven met criteria for high quality. All high-quality guidelines had high "rigor of development" scores on AGREE II. Ten high-quality guidelines stated an age at which female fertility declines, ranging from 30 to "late 30s." One recommended a specific age at which patients should be counseled. Five of eleven high-quality guidelines did not discuss the obstetric and perinatal risks of advanced maternal age. CONCLUSIONS Few high-quality guidelines address counseling on female age-related fertility decline, and existing guidance on reproductive aging counseling is inconsistent and incomplete. Greater rigor of development and incorporation of age-specific counseling recommendations into clinical practice guidelines could lead to improved patient anticipatory guidance and more informed reproductive choices.
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Affiliation(s)
- Emma Trawick
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL, 60611, USA
| | - Jillian Pecoriello
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
| | - Gwendolyn Quinn
- Department of Obstetrics and Gynecology, NYU School of Medicine, 462 First Avenue, NBV 9N1-C, New York, NY, 10016, USA
| | - Kara N Goldman
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, 676 North Saint Clair Street, Suite 2300, Chicago, IL, 60611, USA.
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Abstract
An accurate understanding of reproductive facts is essential for appropriate decision making regarding whether, when, and how to conceive. The objective of this study was to investigate women’s knowledge of how age affects fertility and their knowledge about the effectiveness for assisted reproductive technologies for treating fertility. A cross-sectional study was conducted including women seeking fertility treatment at the University Medical Center, Nur-Sultan, Kazakhstan in 2018–2019. Patients were interviewed with a structured questionnaire. Socio-demographic, clinical characteristics, and knowledge and awareness about the implications of aging for fertility (advanced maternal age (AMA)) and pregnancy outcomes using fertility treatments (assisted reproductive technologies ((ART)) and the sum of both scores total knowledge score (TKS). TKS mean was 7.7 (SD = 2.1), AMA was 5.0 (SD = 1.5), and ART was 2.7 (SD = 1.5). No socio-demographic factors correlated with lower knowledge. Fertility knowledge was found to be low. No differences were found associated with socio-economic level, although they were identified in women with certain types of infertility and a history of gynecological problems. Delaying childbearing based on incorrect perceptions of female fertility could lead to involuntary childlessness. Health education regarding fertility has to be part of broader health promotion programs to enhance awareness of the effect of age on fertility.
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Sun X, Zhang Y, Hu Y, An J, Li L, Wang Y, Zhang X. Decreased expression of m 6A demethylase FTO in ovarian aging. Arch Gynecol Obstet 2020; 303:1363-1369. [PMID: 33221958 DOI: 10.1007/s00404-020-05895-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE N6-methyladenosine (m6A) and demethylase fat mass and obesity-associated protein (FTO) were reported to be associated with oocyte development and maturation. But the relationship between FTO and ovarian aging was still unclear. This study was aimed at investigating the FTO expression level and the m6A content during ovarian aging. METHODS The expression level of FTO and the content of m6A RNA methylation in human follicular fluid (FF), granulosa cells (GCs) and mouse ovary from different age groups were studied by ELISA, WB, qRT-PCR, IHC and m6A Colorimetric. RESULTS Human FF ELISA quantified that the level of FTO protein decreased with age (P = 0.025). QRT-PCR results showed that the relative expression of FTO in human GCs was lower in the elderly group than in the young group (P = 0.012). FTO mRNA and protein expression levels were lower in the ovary of 32-week-old mice than in 3- and 8-week-old mice (P < 0.05). Immunohistochemistry showed FTO was relatively decreased in 32-week-old mice (P < 0.05). The m6A content in total RNA from old human GCs and ovary from 32-week-old mice was significantly higher compared with the younger ones. CONCLUSIONS In human FF, GCs and mouse ovary, the expression of FTO decreased while the content of m6A increased with aging. However, the inner mechanism still needs further investigation.
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Affiliation(s)
- Xiaoyan Sun
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Yigan Zhang
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Yuping Hu
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Junxia An
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Lifei Li
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China.,The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Yiqing Wang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, 730000, China.,Gansu Key Laboratory of Reproductive Medicine and Embryology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xuehong Zhang
- The Reproductive Medicine Special Hospital of the First Hospital of Lanzhou University, Lanzhou, 730000, China. .,Gansu Key Laboratory of Reproductive Medicine and Embryology, The First Hospital of Lanzhou University, Lanzhou, China.
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23
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Zhang X, Bai L, Ren H, Liu X, Guo S, Xu P, Zheng J, Zheng L, Tan J. Perinatal and maternal outcomes after frozen versus fresh embryo transfer cycles in women of advanced maternal age. Eur J Obstet Gynecol Reprod Biol 2020; 257:133-137. [PMID: 33131929 DOI: 10.1016/j.ejogrb.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The delay of childbearing in women has become a worldwide issue in recent decades. The application of assisted reproductive technology in women of advanced maternal age (AMA) is increasing. Evidence on the safety and outcomes of frozen embryo transfer (FET) compared with fresh embryo transfer (ET) in AMA women is still lacking. Therefore, the objective of the present study was to compare perinatal and maternal outcomes after autologous FET and fresh ET cycles in women of AMA. STUDY DESIGN A retrospective study of 1663 FET and 3964 fresh ET cycles in reproductive medical centers from 2009 to 2014. Women who aged ≥35 years and had clinical pregnancies after autologous frozen or fresh ET were included. The main perinatal outcomes included birth weight, gestational age, rates of preterm birth, macrosomia, low birth weight (LBW), and very low birth weight. The main maternal outcomes included rates of hypertensive disorders of pregnancy, gestational diabetes mellitus, and preterm premature rupture of the membranes. RESULTS Women who underwent FET had an increased risk of hypertensive disorders of pregnancy [1.1 % vs. 0.4 %, adjusted OR (95 % CI): 2.76 (1.39-5.51); p = 0.004]. Singletons born after FET had significantly higher mean birth weight (3388.78 ± 538.47 vs. 3316.19 ± 549.08; p = 0.001). Furthermore, increased risk of macrosomia [13.5 % vs. 10.4 %, adjusted OR (95 % CI): 1.35 (1.07-1.71); p = 0.013] and decreased risk of LBW [3.6 % vs. 5.3 %, adjusted OR (95 % CI): 0.67 (0.45-1.00); p = 0.048] were found in singletons born after FET. CONCLUSIONS Perinatal risks of AMA patients are higher in FET than in fresh ET, including higher birth weight, risks of macrosomia in singleton births, and hypertensive disorders of pregnancy.
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Affiliation(s)
- Xinyi Zhang
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110022, Liaoning, China; Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, 110022, Liaoning, China.
| | - Lina Bai
- Jinghua Hospital, Shenyang Eastern Medical Group, Shenyang, 110005, Liaoning, China.
| | - Haiqin Ren
- Jinghua Hospital, Shenyang Eastern Medical Group, Shenyang, 110005, Liaoning, China.
| | - Xinyu Liu
- Shenyang 204 Hospital, Shenyang, 110043, Liaoning, China.
| | - Shuaishuai Guo
- Reproductive Medical Center, Shenyang Women's and Children's Hospital, Shenyang, 110011, Liaoning, China..
| | - Peng Xu
- Jinghua Hospital, Shenyang Eastern Medical Group, Shenyang, 110005, Liaoning, China.
| | - Jia Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China.
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning, China.
| | - Jichun Tan
- Center of Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, 110022, Liaoning, China; Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, 110022, Liaoning, China.
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24
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Wilson RD. Antenatal Fetal Assessment: 75 Years Later (1945-2019). JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 41 Suppl 2:S276-S280. [PMID: 31785673 DOI: 10.1016/j.jogc.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- R Douglas Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB
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25
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Maldonado-Cárceles AB, Mínguez-Alarcón L, Souter I, Gaskins AJ, Arvizu M, Williams PL, Ford JB, Chavarro JE. Dietary patterns and ovarian reserve among women attending a fertility clinic. Fertil Steril 2020; 114:610-617. [PMID: 32712021 DOI: 10.1016/j.fertnstert.2020.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the associations between dietary patterns and antral follicle count (AFC), a marker of ovarian reserve. DESIGN Prospective cohort study. SETTING Fertility center at an academic hospital. PATIENT(S) A total of 363 women seeking preconception evaluation and infertility care at the Massachusetts General Hospital who participated in the Environment and Reproductive Health Study. INTERVENTION(S) None. At enrollment, women reported diet through a food frequency questionnaire, from which we computed three dietary pattern adherence scores: the Mediterranean diet, the Fertility diet, and the Profertility diet. MAIN OUTCOME MEASURE(S) The AFC was assessed with a transvaginal ultrasound performed on the third day of an unstimulated menstrual cycle or on the third day of a P withdrawal bleed. RESULT(S) Higher adherence to the three dietary patterns examined were unrelated to AFC. The multivariable adjusted AFC means and 95% confidence intervals for women in the highest compared with the lowest quartile of adherence score were 13.9 (13.0-14.9) and 13.5 (12.6-14.4) for the Mediterranean diet, 14.0 (13.2-14.9) and 13.5 (12.7-14.3) for the Fertility diet, and 12.5 (11.6-13.5) and 13.3 (12.5-14.2) for the Profertility diet. CONCLUSION(S) Dietary patterns were unrelated to AFC among a cohort of women presenting at a fertility center. Due to the limited and heterogeneous current evidence, it is important to evaluate this association in further studies, and in particular among women from the general population.
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Affiliation(s)
- Ana B Maldonado-Cárceles
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Health and Social Sciences, Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Murcia, Spain.
| | - Lidia Mínguez-Alarcón
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Irene Souter
- Massachusetts General Hospital Fertility Center and Harvard Medical School, Boston, Massachusetts
| | - Audrey J Gaskins
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mariel Arvizu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Paige L Williams
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jorge E Chavarro
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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26
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Wilson RD. Évaluation fœtale prénatale : 75 ans plus tard (1945-2019). JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 2:S281-S286. [DOI: 10.1016/j.jogc.2019.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Beaujouan É, Reimondos A, Gray E, Evans A, Sobotka T. Declining realisation of reproductive intentions with age. Hum Reprod 2019; 34:1906-1914. [DOI: 10.1093/humrep/dez150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 05/28/2019] [Indexed: 12/15/2022] Open
Abstract
Abstract
STUDY QUESTION
What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age?
SUMMARY ANSWER
For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men.
WHAT IS KNOWN ALREADY
Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications.
STUDY DESIGN, SIZE, DURATION
This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18–45 and 528 women aged 18–41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised.
PARTICIPANTS/MATERIALS, SETTINGS, METHODS
Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions.
MAIN RESULTS AND THE ROLE OF CHANCE
Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38–41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child.
LIMITATIONS, REASONS FOR CAUTION
Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age.
WIDER IMPLICATIONS OF THE FINDINGS
Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages.
STUDY FUNDING/COMPETING INTEREST(S)
This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan’s work was partly funded by the Austrian Science Fund (FWF) project ‘Later Fertility in Europe’ (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.
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Affiliation(s)
- Éva Beaujouan
- Vienna University of Economics and Business (Wittgenstein Centre for Demography and Global Human Capital), Vienna, Austria
| | - Anna Reimondos
- School of Demography, Australian National University, Canberra, Australia
| | - Edith Gray
- School of Demography, Australian National University, Canberra, Australia
| | - Ann Evans
- School of Demography, Australian National University, Canberra, Australia
| | - Tomáš Sobotka
- Vienna Institute of Demography (Austrian Academy of Sciences) (Wittgenstein Centre for Demography and Global Human Capital), Vienna, Austria
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Wiweko B, Satria ML, Mutia K, Iffanolida PA, Harzif AK, Pratama G, Muharam R, Hestiantoro A. Correlation between luteinizing hormone receptor gene expression in human granulosa cells with oocyte quality in poor responder patients undergoing in vitro fertilization: A cross-sectional study. F1000Res 2019; 8:16. [PMID: 31131092 PMCID: PMC6530604 DOI: 10.12688/f1000research.17036.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 02/03/2023] Open
Abstract
Background: This study was performed to evaluate the role of luteinizing hormone (LH) and granulosa cell LH receptor (LH-R) in poor responder patients who underwent controlled ovarian stimulation. Expression levels of LH-R mRNA in granulosa cells was investigated and compared with oocyte morphology, oocyte maturity and fertilization rate. Methods: Granulosa cells were obtained from 30 patients who underwent in vitro fertilization (IVF) at Dr. Cipto Mangunkusumo Hospital, Jakarta. The patients were divided into two groups: group I (n=10) poor responders; and group II (n=20) non-poor responders. After the extraction of total RNA from granulosa cells, semi-quantitative RT-PCR was performed and the amount of LH-R mRNA was quantified. The relative values were calculated as the ratio of LH-R mRNA and actin beta mRNA. Statistical analysis was performed using Mann-Whitney test and Spearman correlation. Results: The relative value of LH-R mRNA was higher in group I compared with group II (27.37[0.00-28939.37] vs 0.00[0.00-7196.12]). Oocyte maturity (r=0.267) and morphology (r=0.267) in group I consistently showed a positive correlation with LH-R mRNA; in group II a negative correlation with LH-R mRNA was shown for oocyte maturity (r= -0.552) and morphology (r= -0.164). Group I had a positive correlation between LH-R expression with fertilization rate (r=0.430), and group II showed a negative correlation (r=-0.340). Conclusions: The expression of LH-R mRNA has a positive correlation with oocyte quality in poor responder patients and a negative correlation in non-poor responders. Our study suggests an optimal expression of LH- R mRNA in granulosa cells during controlled ovarian stimulation to obtain good quality oocytes.
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Affiliation(s)
- Budi Wiweko
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
- Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - M. Luky Satria
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Kresna Mutia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Pritta Ameilia Iffanolida
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Achmad Kemal Harzif
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
- Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Gita Pratama
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
- Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - R. Muharam
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
- Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Andon Hestiantoro
- Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia, Jakarta, 10430, Indonesia
- Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta, 10430, Indonesia
- Human Reproductive, Infertility and Family Planning Research Center, Indonesia Medical Education and Research Institute(IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
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Wu Y, Chen Y, Shen M, Guo Y, Wen SW, Lanes A, White RR, Adanlawo A, Walker M, Hua X. Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study. BMC Pregnancy Childbirth 2019; 19:3. [PMID: 30606150 PMCID: PMC6318893 DOI: 10.1186/s12884-018-2147-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/12/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies. METHODS Data was obtained from a population-based retrospective cohort of women who delivered in Ontario, Canada, between April 1st, 2012 and March 31st, 2015. The adjusted relative risks (ARR) and 95% confidence intervals (CI) for adverse maternal and neonatal outcomes were estimated by using multivariate log-binomial regression models among age groups. All models were stratified by the utilization of ART (ART and spontaneous conceptions). RESULTS Women at vAMA had a higher risk of composite outcome comprised of preeclampsia, intrauterine growth retardation, stillbirth, and placental abruption than the younger counterparts (ARR = 1.38, 95% CI: 1.23-1.55 compared to mothers aged 20-34; ARR = 1.26, 95% CI: 1.12-1.42 compared to mothers aged 35-42). Increased risk of the primary outcome in ART compared to spontaneous conception was only observed in women aged 20-34 years (ARR = 1.24, 95% CI: 1.14-1.35). For women conceived with ART, the risk for the primary outcome significantly increased in women at vAMA (ARR = 1.29, 95% CI: 1.01-1.65 compared to mothers aged 20-34; ARR = 1.36, 95% CI: 1.06-1.74 compared to mothers aged 35-42). CONCLUSION Women at vAMA have higher risks of adverse maternal and neonatal outcomes. Although the utilization of ART may carry an independent role for adverse perinatal outcomes, it does not further enhance the adverse effect of vAMA.
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Affiliation(s)
- Yuelin Wu
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 China
| | - Yan Chen
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 China
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Minxue Shen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Yanfang Guo
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Shi Wu Wen
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Andrea Lanes
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada
| | - Ruth Rennicks White
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Adewumi Adanlawo
- Maternal-Fetal Medicine, Regina General Hospital, University of Saskatchewan, Reginal, Saskatchewan, Canada
| | - Mark Walker
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
- Better Outcomes Registry & Network Ontario, Ottawa, Ontario Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, OMNI Research Group, University of Ottawa, 501 Smyth Road, Ottawa, Ontario K1H8L6 Canada
| | - Xiaolin Hua
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092 China
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
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VEGFR2 Expression Is Differently Modulated by Parity and Nulliparity in Mouse Ovary. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6319414. [PMID: 30310818 PMCID: PMC6166384 DOI: 10.1155/2018/6319414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 11/18/2022]
Abstract
Parity and nulliparity exert opposite effects on women's health, as parity is considered a protective factor for several reproductive diseases. This study is aimed at determining if ovarian VEGF and VEGFR2 expression are differently modulated in the ovaries of parous and nulliparous mice. To this end primiparous and nulliparous fertile mice were sacrificed at postovulatory stage. Whole ovaries, corpus luteum, and residual stromal tissues were analyzed to assess VEGF/VEGFR2 expression levels. Ovarian mRNA amounts of Vegfa (120 and 164) and Vegfr2 were comparable between primiparous and nulliparous mice; both isoforms and receptor were accumulated mainly in corpus luteum tissues. VEGF 120 and 164 protein accumulation and distribution mirrored that of mRNA. Conversely, VEGFR2 protein content was significantly higher in ovaries of nulliparous mice and was more efficiently phosphorylated in ovaries of primiparous mice. In both groups, VEGFR2 was preferentially expressed in corpus luteum, while its phosphorylated form was equally distributed in two somatic compartments. We suggest that parity influences VEGFR2/phospho-VEGFR2 expression and tissue distribution. This difference could be part of a more complex mechanism that at least in mice is activated after the first pregnancy and likely aims to preserve female health.
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31
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Wilson RD. Woman's Pre-Conception Evaluation: Genetic and Fetal Risk Considerations for Counselling and Informed Choice. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:935-949. [DOI: 10.1016/j.jogc.2017.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 12/30/2022]
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