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Valdeyron C, Soubrier M, Pereira B, Constantin A, Morel J, Gaudin P, Combe B, Gremeau AS, Dejou-Bouillet L, Pouly JL, Sapin V, Oris C, Brugnon F. Impact of disease activity and treatments on ovarian reserve in patients with rheumatoid arthritis in the ESPOIR cohort. Rheumatology (Oxford) 2021; 60:1863-1870. [PMID: 33147613 DOI: 10.1093/rheumatology/keaa535] [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: 04/14/2020] [Revised: 06/10/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Patients with RA have a higher prevalence of infertility than the general population. This study sought to examine the impact of RA disease activity and treatments on ovarian reserve measured by serum anti-Müllerian hormone (AMH) levels in the ESPOIR cohort. We sought to better define the indications for fertility preservation. METHODS Patients and serum analysis data were derived from the French national cohort ESPOIR. Enrolled patients (n = 102; 18-37-year-olds) fulfilled ACR/EULAR 2010 criteria for RA. Serum AMH levels were measured at T0, T6, T12, T24 and T36 months post-diagnosis. The impacts of RA activity (DAS28 and CRP level) and treatments (MTX only or with other medications) were evaluated at each study visit. RESULTS A gradual decrease in patients' serum AMH levels was observed over time, in line with the descending curve described for healthy women. Serum AMH levels of RA patients in comparison with the values considered normal for age did not reveal any significant differences (P > 0.05). We did not observe any impact of RA treatments. We demonstrated an inverse correlation between AMH variation and disease activity (DAS28: r = -0.27, P = 0.003; CRP: r = -0.16, P = 0.06). CONCLUSION This is the first study to determine serum AMH levels of a large cohort of RA patients over 36 months. Rapid disease activity control appears to be required to limit changes in the ovarian reserve. Fertility preservation is not likely to be necessary if inflammation is promptly controlled. CLINICALTRIALS.GOV IDENTIFIER NCT03666091.
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Affiliation(s)
- Camille Valdeyron
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Martin Soubrier
- Rheumatology, CHU Gabriel-Montpied, Clermont-Ferrand University, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, France
| | | | - Jacques Morel
- Rheumatology, CHU Montpellier, Montpellier University, France
| | - Philippe Gaudin
- Rheumatology, Sud Echirolles Hospital, CHU Grenoble Alpes, France
| | - Bernard Combe
- Rheumatology, CHU Montpellier, Montpellier University, France
| | - Anne Sophie Gremeau
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Lydie Dejou-Bouillet
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Jean Luc Pouly
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic, CHU Clermont-Ferrand, France
| | - Charlotte Oris
- Biochemistry and Molecular Genetic, CHU Clermont-Ferrand, France
| | - Florence Brugnon
- Assistance Medicale à la Procréation, CECOS, CHU Estaing, Clermont-Ferrand University, France.,UCA, IMoST - INSERM 1240, Faculty of Medicine, Clermont-Ferrand University, France
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Esteves SC, Lombardo F, Garrido N, Alvarez J, Zini A, Colpi GM, Kirkman-Brown J, Lewis SEM, Björndahl L, Majzoub A, Cho CL, Vendeira P, Hallak J, Amar E, Cocuzza M, Bento FC, Figueira RC, Sciorio R, Laursen RJ, Metwalley AM, Jindal SK, Parekattil S, Ramasamy R, Alviggi C, Humaidan P, Yovich JL, Agarwal A. SARS-CoV-2 pandemic and repercussions for male infertility patients: A proposal for the individualized provision of andrological services. Andrology 2020; 9:10-18. [PMID: 32357288 PMCID: PMC7267121 DOI: 10.1111/andr.12809] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
The prolonged lockdown of health facilities providing non‐urgent gamete cryopreservation—as currently recommended by many reproductive medicine entities and regulatory authorities due to the SARS‐CoV‐2 pandemic will be detrimental for subgroups of male infertility patients. We believe the existing recommendations should be promptly modified and propose that the same permissive approach for sperm banking granted for men with cancer is expanded to other groups of vulnerable patients. These groups include infertility patients (eg, azoospermic and cryptozoospermic) undergoing medical or surgical treatment to improve sperm quantity and quality, as well as males of reproductive age affected by inflammatory and systemic auto‐immune diseases who are about to start treatment with gonadotoxic drugs or who are under remission. In both scenarios, the “fertility window” may be transitory; postponing diagnostic semen analysis and sperm banking in these men could compromise the prospects of biological parenthood. Moreover, we provide recommendations on how to continue the provision of andrological services in a considered manner and a safe environment. Our opinion is timely and relevant given the fact that fertility services are currently rated as of low priority in most countries.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil.,Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Francesco Lombardo
- Department of Medical Physiopathology, University of Rome "La Sapienza", Rome, Italy
| | - Nicolás Garrido
- IVI Foundation, Health Research Institute La Fe, Valencia, Spain
| | | | - Armand Zini
- Division of Urology, Department of Surgery, St. Mary's Hospital, McGill University, Montreal, QC, Canada
| | - Giovanni M Colpi
- Andrology Service, Procrea Swiss Fertility Center, Lugano, Switzerland.,Andrology and IVF Department, San Carlo Cinic, Paderno Dugnano/Milano, Italy
| | - Jackson Kirkman-Brown
- Centre for Human Reproductive Science, IMSR, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Birmingham Women's Fertility Centre, Birmingham Women's & Children's NHS Foundation Trust, Birmingham, UK
| | - Sheena E M Lewis
- Queens University Belfast, Belfast, UK.,Examenlab Ltd., Belfast, UK
| | - Lars Björndahl
- ANOVA, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Chak-Lam Cho
- Department of Surgery, Union Hospital, Hong Kong, Hong Kong.,S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Pedro Vendeira
- Urology/Andrology Unit, Saúde Atlântica, Clínica do Dragão, Porto, Portugal
| | - Jorge Hallak
- Androscience, Science and Innovation Center in Andrology and High-Complex Clinical and Andrology Laboratory, São Paulo, Brazil.,Division of Urology, University of São Paulo, São Paulo, Brazil.,Men's Health Study Group, Institute for Advanced Studies, University of São Paulo, São Paulo, Brazil.,Reproductive Toxicology Unit, Department of Pathology, University of São Paulo, São Paulo, Brazil
| | - Edouard Amar
- Cabinet D'Andrologie Victor Hugo, American Hospital of Paris Reproductive Center, Paris, France
| | - Marcello Cocuzza
- Human Reproduction Center, Division of Urology, University of São Paulo, São Paulo, Brazil
| | - Fabiola C Bento
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Rita C Figueira
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rita J Laursen
- Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - Ahmad M Metwalley
- IVF Laboratory, Al Saad Specialist Hospitals, Jeddah, Saudi Arabia.,Reproductive Medicine and Genetic Unit, GEBRI, Sadat City, Egypt
| | - Sunil K Jindal
- Division of Reproductive Medicine and Andrology, Jindal Hospital, Meerut, India
| | - Sijo Parekattil
- PUR Clinic and University of Central Florida, Clermont, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic Skive, Skive Regional Hospital, Skive, Denmark
| | - John L Yovich
- PIVET Medical Centre, Perth, WA, Australia.,Curtin University, Perth, WA, Australia.,Cairns Fertility Centre, Cairns, QLD, Australia
| | - Ashok Agarwal
- Andrology Center, Department of Urology, Cleveland Clinic, Cleveland, OH, USA
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Giudice MG, Del Vento F, Wyns C. Male fertility preservation in DSD, XXY, pre-gonadotoxic treatments - Update, methods, ethical issues, current outcomes, future directions. Best Pract Res Clin Endocrinol Metab 2019; 33:101261. [PMID: 30718080 DOI: 10.1016/j.beem.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper aims at reviewing the fertility preservation strategies that could be considered in several conditions at risk of spermatogonial depletion such as 46,XY disorders of sexual development, Klinefelter syndrome and after gonadotoxic treatment in males highlighting current knowledge on diseases and processes involved in infertility as well as future directions along with their specific ethical issues. While sperm cryopreservation after puberty is the only validated technique for fertility preservation, for prepubertal boys facing gonadotoxic therapies or at risk of testicular tissue degeneration where testicular sperm is not present, cryopreservation of spermatogonial cells may be an option to ensure future parenthood. Promising results with transplantation and in vitro maturation of spermatogonial cells were achieved in animals but so far none of the techniques was applied in humans.
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Affiliation(s)
- Maria Grazia Giudice
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium
| | - Federico Del Vento
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium
| | - Christine Wyns
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium.
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