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Qi J, Su Y, Zhang H, Ren Y. Association between dietary inflammation index and female infertility from National Health and Nutrition Examination Survey: 2013-2018. Front Endocrinol (Lausanne) 2024; 15:1309492. [PMID: 38757001 PMCID: PMC11096589 DOI: 10.3389/fendo.2024.1309492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To investigate the relationship between dietary inflammatory index (DII) scores and infertility in US adults aged 18 to 45. Methods Data were gathered from the 2013-2018 National Health and Nutrition Examination Survey (NHANES). In total, 3496 women were included in the study. To examine the relationship between DII, EDII and infertility, a weighted multivariable logistic regression analysis using continuous factors or categorical variables grouped by quartiles was conducted. Using subgroup analysis stratified based on DII and infertility features, the association between DII and infertility has been further studied. In order to determine whether there was a nonlinear relationship between DII and infertility, restricted cubic spline (RCS) analysis was carried out. Results For statistical analysis, a total of 3496 individuals - 367 patients with infertility and 3129 persons without infertility - were included. A multivariable logistic regression study revealed a positive relationship between DII and infertility. A significant difference in subgroup analysis was shown in age group and race, although RCS analysis demonstrated nonlinear relationship between the DII and infertility. Conclusion For participants aged 18-45 years, higher DII scores were positively correlated with infertility. In addition, anti-inflammatory diets might improve infertility outcomes.
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Affiliation(s)
- Jie Qi
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
| | - Yujie Su
- Department of Gynecology, Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, Shandong, China
| | - Huanhuan Zhang
- Department of Anesthesiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yanan Ren
- Department of Gynecology, Hebei General Hospital, Shijiazhuang, China
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Cai J, Jiang X, Liu L, Liu Z, Chen J, Chen K, Yang X, Ren J. Pretreatment prediction for IVF outcomes: generalized applicable model or centre-specific model? Hum Reprod 2024; 39:364-373. [PMID: 37995380 PMCID: PMC10833083 DOI: 10.1093/humrep/dead242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
STUDY QUESTION What was the performance of different pretreatment prediction models for IVF, which were developed based on UK/US population (McLernon 2016 model, Luke model, Dhillon model, and McLernon 2022 model), in wider populations? SUMMARY ANSWER For a patient in China, the published pretreatment prediction models based on the UK/US population provide similar discriminatory power with reasonable AUCs and underestimated predictions. WHAT IS KNOWN ALREADY Several pretreatment prediction models for IVF allow patients and clinicians to estimate the cumulative probability of live birth in a cycle before the treatment, but they are mostly based on the population of Europe or the USA, and their performance and applicability in the countries and regions beyond these regions are largely unknown. STUDY DESIGN, SIZE, DURATION A total of 26 382 Chinese patients underwent oocyte pick-up cycles between January 2013 and December 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS UK/US model performance was externally validated according to the coefficients and intercepts they provided. Centre-specific models were established with XGboost, Lasso, and generalized linear model algorithms. Discriminatory power and calibration of the models were compared as the forms of the AUC of the Receiver Operator Characteristic and calibration curves. MAIN RESULTS AND THE ROLE OF CHANCE The AUCs for McLernon 2016 model, Luke model, Dhillon model, and McLernon 2022 model were 0.69 (95% CI 0.68-0.69), 0.67 (95% CI 0.67-0.68), 0.69 (95% CI 0.68-0.69), and 0.67 (95% CI 0.67-0.68), respectively. The centre-specific yielded an AUC of 0.71 (95% CI 0.71-0.72) with key predictors including age, duration of infertility, and endocrine parameters. All external models suggested underestimation. Among the external models, the rescaled McLernon 2022 model demonstrated the best calibration (Slope 1.12, intercept 0.06). LIMITATIONS, REASONS FOR CAUTION The study is limited by its single-centre design and may not be representative elsewhere. Only per-complete cycle validation was carried out to provide a similar framework to compare different models in the sample population. Newer predictors, such as AMH, were not used. WIDER IMPLICATIONS OF THE FINDINGS Existing pretreatment prediction models for IVF may be used to provide useful discriminatory power in populations different from those on which they were developed. However, models based on newer more relevant datasets may provide better calibrations. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the National Natural Science Foundation of China [grant number 22176159], the Xiamen Medical Advantage Subspecialty Construction Project [grant number 2018296], and the Special Fund for Clinical and Scientific Research of Chinese Medical Association [grant number 18010360765]. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Jiali Cai
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiaoming Jiang
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Lanlan Liu
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zhenfang Liu
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jinghua Chen
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Kaijie Chen
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Xiaolian Yang
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
| | - Jianzhi Ren
- Reproductive Medicine Centre, The Affiliated Chenggong Hospital of Xiamen University, Xiamen, Fujian, China
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The Influence of Metabolic Factors and Diet on Fertility. Nutrients 2023; 15:nu15051180. [PMID: 36904180 PMCID: PMC10005661 DOI: 10.3390/nu15051180] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Infertility is a disease globally affecting 20-30% of the reproductive age female population. However, in up to 50% on recorded cases, problems with infertility are ascribed to men; therefore, it is important to popularize healthy eating also in this group. During the last decade, it has been observed that society's lifestyle changed drastically: reduced energy expenditure in physical activity per day, increased consumption of hypercaloric and high-glycemic-index foods with high content of trans fats, and reduced consumption of dietary fiber, which negatively affects fertility. Increasing evidence points to a link between diet and fertility. It is becoming clear that well-planned nutrition can also contribute to the effectiveness of ART. The low-GI plant-based diet appears to have a positive effect, especially when it is based on Mediterranean dietary patterns: rich in antioxidants, vegetable protein, fiber, MUFA fatty acids, omega-3, vitamins, and minerals. Importantly, this diet has been shown to protect against chronic diseases associated with oxidative stress, which also translates into pregnancy success. As lifestyle and nutrition seem to be important factors affecting fertility, it is worth expanding knowledge in this regard among couples trying to conceive a child.
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Li Piani L, Vigano' P, Somigliana E. Epigenetic clocks and female fertility timeline: A new approach to an old issue? Front Cell Dev Biol 2023; 11:1121231. [PMID: 37025178 PMCID: PMC10070683 DOI: 10.3389/fcell.2023.1121231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Worldwide increase in life expectancy has boosted research on aging. Overcoming the concept of chronological age, higher attention has been addressed to biological age, which reflects a person's real health state, and which may be the resulting combination of both intrinsic and environmental factors. As epigenetics may exert a pivotal role in the biological aging, epigenetic clocks were developed. They are based on mathematical models aimed at identifying DNA methylation patterns that can define the biological age and that can be adopted for different clinical scopes (i.e., estimation of the risks of developing age-related disorders or predicting lifespan). Recently, epigenetic clocks have gained a peculiar attention in the fertility research field, in particular in the female counterpart. The insight into the possible relations between epigenetic aging and women's infertility might glean additional information about certain conditions that are still not completely understood. Moreover, they could disclose significant implications for health promotion programs in infertile women. Of relevance here is that the impact of biological age and epigenetics may not be limited to fertility status but could translate into pregnancy issues. Indeed, epigenetic alterations of the mother may transfer into the offspring, and pregnancy itself as well as related complications could contribute to epigenetic modifications in both the mother and newborn. However, even if the growing interest has culminated in the conspicuous production of studies on these topics, a global overview and the availability of validated instruments for diagnosis is still missing. The present narrative review aims to explore the possible bonds between epigenetic aging and fertility timeline. In the "infertility" section, we will discuss the advances on epigenetic clocks focusing on the different tissues examined (endometrium, peripheral blood, ovaries). In the "pregnancy" section, we will discuss the results obtained from placenta, umbilical cord and peripheral blood. The possible role of epigenetic aging on infertility mechanisms and pregnancy outcomes represents a question that may configure epigenetic clock as a bond between two apparently opposite worlds: infertility and pregnancy.
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Affiliation(s)
- Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
- *Correspondence: Letizia Li Piani,
| | - Paola Vigano'
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Bonanni V, Reschini M, La Vecchia I, Castiglioni M, Muzii L, Vercellini P, Somigliana E. The impact of small and asymptomatic intramural and subserosal fibroids on female fertility: a case-control study. Hum Reprod Open 2022; 2023:hoac056. [PMID: 36579123 PMCID: PMC9782921 DOI: 10.1093/hropen/hoac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/02/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Do small and asymptomatic intramural and subserosal uterine fibroids affect female fertility? SUMMARY ANSWER Small and asymptomatic fibroids that do not encroach the endometrial cavity appear to not markedly affect female fertility. WHAT IS KNOWN ALREADY The available evidence on uterine fibroids and fertility is limited. Most information has been obtained in IVF settings by comparing the success in women affected and not affected by fibroids. These studies have shown a detrimental effect of submucosal and possibly intramural fibroids. However, this study design provides information only on embryo implantation, not on female fertility in general. STUDY DESIGN SIZE DURATION A retrospective observational case-control study on 200 women whose partner was diagnosed with severe male infertility and 200 women with unexplained infertility was conducted. If the null hypothesis (that fibroids do not affect fertility) is valid, one would expect a similar prevalence of fibroids in the two study groups. Conversely, if fibroids do impact fertility, one would expect a higher prevalence among women with unexplained infertility. The study was carried out at the Infertility Unit of the Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico covering a 5-year period between January 2014 and June 2020. PARTICIPANTS/MATERIALS SETTING METHODS We retrospectively recruited women seeking pregnancy whose partner was repeatedly documented to have a sperm concentration below 1 million/ml and matched them by age and study period to a group of women with unexplained infertility. The latter group of women was considered as a case group (infertile subjects), while the former group of women was considered as a control group (reflecting the general female population). Women with fibroids could be included in both study groups; only those with submucosal lesions were excluded. MAIN RESULTS AND THE ROLE OF CHANCE Fibroids were diagnosed in 31 women (16%) with unexplained infertility and in 32 women (16%) with severe male factor infertility. The adjusted odds ratio of carrying fibroids in women with unexplained infertility was 0.91 (95% CI: 0.52-1.58). Subgroup analyses according to number, dimension and location of fibroids failed to highlight an increased risk of infertility in any group. LIMITATIONS REASONS FOR CAUTION This is a retrospective study and some inaccuracies in fibroids detection cannot be ruled out. Moreover, the relatively small sample size hampers robust subgroup analyses. Even though we excluded women with patent causes of infertility, some women with specific causes of infertility could have been included among controls (yet are expected to account for <10% of the group). WIDER IMPLICATIONS OF THE FINDINGS This study suggests that small fibroids that do not encroach the endometrial cavity do not markedly affect female fertility. This information is clinically relevant when counseling infertile women with small fibroids and an otherwise unremarkable diagnostic work-up. Surgery may still be considered but only in selected cases. STUDY FUNDING/COMPETING INTERESTS This study was partially funded by Italian Ministry of Health: current research IRCCS. E.S. reports grants from Ferring, grants and personal fees from Merck, and grants and personal fees from Theramex outside the submitted work. All the other authors do not have any competing interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Valentina Bonanni
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Marco Reschini
- Correspondence address. Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy. Tel: +39-02-55034303; Fax: +39-02-55036581; E-mail:
| | - Irene La Vecchia
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marta Castiglioni
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Ludovico Muzii
- Department of Gynecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy
| | - Paolo Vercellini
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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Iktidar MA, Chowdhury S, Roy S, Islam AMK, Islam M, Chowdhury T, Tabassum MN, Ali TS, Akash A, Ahmed M, Zafar FA, Hawlader MDH. Knowledge, attitude and perception among medical students and healthcare professionals regarding male infertility: a cross-sectional survey from Bangladesh. BMJ Open 2022; 12:e062251. [PMID: 36356990 PMCID: PMC9660710 DOI: 10.1136/bmjopen-2022-062251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to explore the knowledge, attitude and behaviour regarding male infertility among medical students and healthcare workers in Bangladesh. DESIGN This was a cross-sectional study. SETTING This study covered eight divisions of Bangladesh. PARTICIPANTS The participants were medical students or healthcare professionals of Bangladesh who were surveyed anonymously on their knowledge, attitude and perception regarding male infertility. PRIMARY OUTCOME MEASURES The level of knowledge, attitude and perception regarding male infertility. ANALYSIS The mean knowledge and attitude scores were then correlated with sociodemographic factors using χ2 and two-independent sample t-tests. Finally, we performed binary logistic regression to explore predictors of good knowledge and positive attitude. RESULT Among 556 participants, 49.82% did not have good male infertility knowledge, and nearly 60.79% had negative attitudes regarding male infertility. Young (23-26 years) healthcare professionals and medical students were more likely to have good knowledge than others (OR: 1.81; 95% CI 1.099 to 2.988). Surprisingly, women were more likely to have a positive attitude (OR=1.48; 95% CI 1.002 to 2.19, p=0.049) than men. Among all the professions, Bachelor of Medicine and Surgery doctors were most likely to have good knowledge and a positive attitude regarding male infertility. Good knowledge of male infertility predicted a positive attitude (OR=1.61; 95% CI 1.105 to 2.346, p=0.013) and vice versa. CONCLUSION Our research found that healthcare professionals and medical students in Bangladesh had inadequate knowledge and negative attitudes regarding male infertility despite favourable opinions. This emphasises the need for interdisciplinary training programmes, standardisation of healthcare worker guidelines and curricular adjustments for medical students.
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Affiliation(s)
- Mohammad Azmain Iktidar
- Department of Public Health, North South University, Dhaka, Bangladesh
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
- School of Research, Chattogram, Bangladesh
| | - Sreshtha Chowdhury
- Department of Public Health, North South University, Dhaka, Bangladesh
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
- School of Research, Chattogram, Bangladesh
| | - Simanta Roy
- Department of Public Health, North South University, Dhaka, Bangladesh
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
- School of Research, Chattogram, Bangladesh
| | - A M Khairul Islam
- Department of Public Health, North South University, Dhaka, Bangladesh
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
| | - Mahzabeen Islam
- School of Research, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chittagong, Chittagong, Bangladesh
| | - Tonmoy Chowdhury
- School of Research, Chattogram, Bangladesh
- Department of Medicine, Rangamati Medical College, Chittagong, Bangladesh
| | - Mustari Nailah Tabassum
- School of Research, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chittagong, Chittagong, Bangladesh
| | - Tahsin Sumat Ali
- School of Research, Chattogram, Bangladesh
- Department of Medicine, Comilla Medical College, Comilla, Comilla, Bangladesh
| | - Atandra Akash
- School of Research, Chattogram, Bangladesh
- Department of Medicine, Chittagong Medical College, Chittagong, Chittagong, Bangladesh
| | - Mashrur Ahmed
- Department of Public Health, North South University, Dhaka, Bangladesh
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
- School of Research, Chattogram, Bangladesh
| | - Faraz Al Zafar
- Department of Public Health, North South University, Dhaka, Bangladesh
- Public Health Professional Development Society (PPDS), Dhaka, Bangladesh
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Shingshetty L, Maheshwari A, McLernon DJ, Bhattacharya S. Should we adopt a prognosis-based approach to unexplained infertility? Hum Reprod Open 2022; 2022:hoac046. [PMID: 36382011 PMCID: PMC9662706 DOI: 10.1093/hropen/hoac046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/09/2022] [Indexed: 08/27/2023] Open
Abstract
The treatment of unexplained infertility is a contentious topic that continues to attract a great deal of interest amongst clinicians, patients and policy makers. The inability to identify an underlying pathology makes it difficult to devise effective treatments for this condition. Couples with unexplained infertility can conceive on their own and any proposed intervention needs to offer a better chance of having a baby. Over the years, several prognostic and prediction models based on routinely collected clinical data have been developed, but these are not widely used by clinicians and patients. In this opinion paper, we propose a prognosis-based approach such that a decision to access treatment is based on the estimated chances of natural and treatment-related conception, which, in the same couple, can change over time. This approach avoids treating all couples as a homogeneous group and minimizes unnecessary treatment whilst ensuring access to those who need it early.
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Affiliation(s)
- Laxmi Shingshetty
- Aberdeen Centre for Reproductive Medicine, NHS Grampian, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Centre for Reproductive Medicine, NHS Grampian, Aberdeen, UK
| | - David J McLernon
- Medical Statistics Team, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Zhu C, Yan L, He C, Wang Y, Wu J, Chen L, Zhang J. Incidence and risk factors of infertility among couples who desire a first and second child in Shanghai, China: a facility-based prospective cohort study. Reprod Health 2022; 19:155. [PMID: 35804377 PMCID: PMC9270756 DOI: 10.1186/s12978-022-01459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background With the implementation of the two-child policy in China, more couples have expressed the desire to have another child. We conducted this study to evaluate the incidence of infertility and risk factors in couples intending to have a first and second child. Methods From 2013 to 2017, a prospective cohort study was conducted at the pre-pregnancy center of the International Peace Maternal and Child Health Hospital. The participants were selected by screening and random sampling couples who came to the pre-pregnancy center. Data regarding patient sociodemographic characteristics, reproductive and gynecological history, male disease history, and laboratory and imaging examination results were collected. Couples were followed up every 3 months until pregnancy or for 12 months, whichever came first. Multi-factor logistic regression was used to analyze risk factors for infertility. Adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors. Results The overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338), respectively. This study found great differences in both infertility rate (P < 0.001) and risk factors between the two groups. Risk factors for “first child intention” infertility included advanced age (> 35 years) (aOR = 1.70, 95% CI 1.27–2.28), abnormal body mass index (BMI) (aOR = 1.58, 95% CI 1.31–6.26), longer menstrual periods (aOR = 4.47, 95% CI 2.25–8.88), endometrial polyps (aOR = 2.52, 95% CI 1.28–4.97), polycystic ovarian syndrome (PCOS) (aOR = 6.72, 95% CI 1.79–7.39), salpingostomy (aOR = 3.44, 95% CI 1.68–7.07), and history of mycoplasma (aOR = 1.54, 95% CI 1.09–2.40). However, in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma (aOR = 5.60, 95% CI 1.06–29.76), and higher age (> 40 years) (aOR = 7.36, 95% CI 1.01–53.84). Conclusion The overall infertility rate in Shanghai is similar to that of other large cities in China. Marriage at advanced ages has become increasingly common. As such, the government must consider subsidies to encourage childbirth at childbearing ages, which can improve fertility levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01459-x. Infertility is defined as pregnancy failure after at least 12 months of regular unprotected sexual intercourse. Few researchers have investigated the infertility rate in Shanghai in the past 15 years, and little attention has been paid to the infertility of couples hoping to have a second child. We conducted a prospective cohort study in Shanghai to evaluate infertility incidence and risk factors in couples intending to have a first or second child. The investigators administered a questionnaire survey to the participants and followed them for 1 year. Finally, 1839 couples intending to have a first child and 338 couples intending to have a second child were included in this study. The overall infertility incidence was 16.95% (369/2177). However, the infertility incidence of the “first child intention” and “second child intention” groups was 19.30% (355/1839) and 4.14% (14/338), respectively. Risk factors for “first child intention” infertility included advanced age (> 35 years), abnormal body mass index (BMI), longer menstrual periods, endometrial polyps, polycystic ovarian syndrome (PCOS), salpingostomy, and history of mycoplasma; in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma and advanced age (> 40 years). Since studies have shown large differences in infertility risk factors between the two groups, early and targeted intervention for couples in different high-risk groups can help reduce infertility.
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Affiliation(s)
- Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Pre-Pregnancy center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Li Yan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Jiahao Wu
- Pre-Pregnancy center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Luting Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, China.
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, China.
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Expectant Management Before In vitro Fertilization in Women Aged 39 or Above and Unexplained Infertility Does Not Decrease Live Birth Rates Compared to Immediate Treatment. Reprod Sci 2021; 29:1232-1240. [PMID: 34724170 PMCID: PMC8559689 DOI: 10.1007/s43032-021-00767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/05/2021] [Indexed: 11/04/2022]
Abstract
Unexplained infertile couples can have further expectant management before starting assisted reproductive treatments. However, ovarian reserve and in vitro fertilization (IVF) outcomes rapidly decline after 39 years or more. It is thus important to clarify whether a waiting policy is also appropriate for women of advanced age. Couples who had access to a waiting list for approximately 1 year before receiving reimbursed public IVF were compared with those paying for access to immediate treatment. To allow for comparisons between these two strategies, we followed up couples who opted to pay for 1 year after the last embryo transfer from their first cycle. We calculated the proportion of live births in both groups and compared these using logistic regression models and a two-sample Z test for equality of proportions. Six hundred thirty-five couples were evaluated. Out of 359 couples in the immediate group, 70 (19.5%) had a live birth of which 11 after natural conception and 59 after IVF. Out of 276 couples in the waiting group, 57 (20.7%) had a live birth of which 37 after natural conception and 20 after IVF. There was no statistically significant difference between the two strategies in terms of the crude cumulative live birth rate (cLBR). The adjusted odds ratio of 0.69 (95%CI:0.39–1.22) did not change this conclusion as our sensitivity analyses. The cLBR for the ‘waiting before IVF’ and the ‘immediate’ strategies were similar. Further studies are needed to better characterize couples affected by unexplained infertility in order to individualize treatment strategies.
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Figoli CB, Garcea M, Bisioli C, Tafintseva V, Shapaval V, Gómez Peña M, Gibbons L, Althabe F, Yantorno OM, Horton M, Schmitt J, Lasch P, Kohler A, Bosch A. A robust metabolomics approach for the evaluation of human embryos from in vitro fertilization. Analyst 2021; 146:6156-6169. [PMID: 34515271 DOI: 10.1039/d1an01191j] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The identification of the most competent embryos for transfer to the uterus constitutes the main challenge of in vitro fertilization (IVF). We established a metabolomic-based approach by applying Fourier transform infrared (FTIR) spectroscopy on 130 samples of 3-day embryo culture supernatants from 26 embryos that implanted and 104 embryos that failed. On examining the internal structure of the data by unsupervised multivariate analysis, we found that the supernatant spectra of nonimplanted embryos constituted a highly heterogeneous group. Whereas ∼40% of these supernatants were spectroscopically indistinguishable from those of successfully implanted embryos, ∼60% exhibited diverse, heterogeneous metabolic fingerprints. This observation proved to be the direct result of pregnancy's multifactorial nature, involving both intrinsic embryonic traits and external characteristics. Our data analysis strategy thus involved one-class modelling techniques employing soft independent modelling of class analogy that identified deviant fingerprints as unsuitable for implantation. From these findings, we could develop a noninvasive Fourier-transform-infrared-spectroscopy-based approach that represents a shift in the fundamental paradigm for data modelling applied in assisted-fertilization technologies.
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Affiliation(s)
- Cecilia Beatriz Figoli
- Laboratorio de Bioespectrosocpia, CINDEFI-CONICET, CCT La Plata, Facultad de Ciencias Exactas, UNLP, 1900 La Plata, Argentina.
| | - Marcelo Garcea
- PREGNA Medicina Reproductiva, C1425 AYV Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudio Bisioli
- PREGNA Medicina Reproductiva, C1425 AYV Ciudad Autónoma de Buenos Aires, Argentina
| | - Valeria Tafintseva
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norway.
| | - Volha Shapaval
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norway.
| | - Mariana Gómez Peña
- PREGNA Medicina Reproductiva, C1425 AYV Ciudad Autónoma de Buenos Aires, Argentina
| | - Luz Gibbons
- IECS, Instituto de Efectividad Clínica y Sanitaria, C1414 Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Althabe
- IECS, Instituto de Efectividad Clínica y Sanitaria, C1414 Ciudad Autónoma de Buenos Aires, Argentina
| | - Osvaldo Miguel Yantorno
- Laboratorio de Bioespectrosocpia, CINDEFI-CONICET, CCT La Plata, Facultad de Ciencias Exactas, UNLP, 1900 La Plata, Argentina.
| | - Marcos Horton
- PREGNA Medicina Reproductiva, C1425 AYV Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Peter Lasch
- Centre for Biological Threats and Special Pathogens (ZBS) Proteomics and Spectroscopy Unit, Robert Koch-Institut, 13353 Berlin, Germany
| | - Achim Kohler
- Faculty of Science and Technology, Norwegian University of Life Sciences, 1432 Ås, Norway.
| | - Alejandra Bosch
- Laboratorio de Bioespectrosocpia, CINDEFI-CONICET, CCT La Plata, Facultad de Ciencias Exactas, UNLP, 1900 La Plata, Argentina.
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11
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Downregulation of KIF2C and TEKT2 is associated with male infertility and testicular carcinoma. Aging (Albany NY) 2021; 13:22898-22911. [PMID: 34591790 PMCID: PMC8544317 DOI: 10.18632/aging.203583] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/03/2021] [Indexed: 12/12/2022]
Abstract
Background: Genetic factors are important in spermatogenesis and fertility maintenance, and are potentially significant biomarkers for the early detection of infertility. However, further understanding of these biological processes is required. Methods: In the present study, we sought to identify associated genes by reanalyzing separate studies from Gene Expression Omnibus datasets (GSE45885, GSE45887 and GSE9210) and validation datasets (GSE4797, 145467, 108886, 6872). The differential genes were used the limma package in R language. Gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed by the clusterprofier package. The protein-protein interaction network was constructed by the STRING database. The interaction between mRNA and TF was predicted by miRWalk web. At last, The Cancer Genome Atlas data were used to identify hub gene expression levels in GEPIA web. Results: The results showed that 27 shared genes associated with spermatogenesis. We effectively screen out two genes (KIF2C and TEKT2) and both validated by GSE4797, 145467, 108886 and 6872. Among 27 shared genes, KIF2C and TEKT2 both down-regulated in spermatogenesis. The network of TF-miRNA-target gene was established, we found KIF2C-miRNAs (has-miR-3154, 6075, 6760-5p, 1251-5p, 186-sp)-TFs (EP300, SP1) might work in spermatogenesis. Conclusions: Our study might help to improve our understanding of the mechanisms in spermatogenesis and provide diagnostic biomarkers and therapeutics targets.
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12
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Karanges EA, Nangla C, Parker L, Fabbri A, Farquhar C, Bero L. Pharmaceutical industry payments and assisted reproduction in Australia: a retrospective observational study. BMJ Open 2021; 11:e049710. [PMID: 34465582 PMCID: PMC8413968 DOI: 10.1136/bmjopen-2021-049710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate the extent and nature of pharmaceutical industry payments related to fertility and assisted reproduction in Australia. DESIGN AND SETTING This retrospective observational study employed four databases compiled from publicly available pharmaceutical industry transparency reports on educational event sponsorship (October 2011-April 2018), payments to healthcare professionals (October 2015-April 2018) and patient group support (January 2013-December 2017). Analyses were restricted to fertility-related payments by two major manufacturers of fertility medicines in Australia: Merck Serono and Merck, Sharp and Dohme (MSD). PRIMARY AND SECONDARY OUTCOME MEASURES Descriptive statistics on fertility-related payments and other transfers of value (counts, total and median costs in Australian dollars) for educational events and to healthcare professionals and patient groups. RESULTS Between October 2011 and April 2018, Merck Serono and MSD spent $A4 522 263 on 970 fertility-related events for healthcare professionals, including doctors, nurses and fertility scientists. 56.8% (551/970) events were held by fertility clinics and 29.3% (284/970) by professional medical associations. Between October 2015 and April 2018, Merck Serono spent $A403 800 across 177 payments to 118 fertility healthcare professionals, predominantly for educational event attendance. Recipients included obstetricians and gynaecologists (76.3% of payments, 135/177), nurses (11.3%, 20/177) and embryologists/fertility scientists (9.6%, 17/117). The highest paid healthcare professionals held leadership positions in major fertility clinics. Merck Serono provided $A662 850 to fertility-related patient groups for advocacy and education (January 2013-December 2017). CONCLUSIONS The pharmaceutical industry sponsored a broad range of fertility clinicians and organisations, including doctors, nurses, embryologists, professional medical organisations, fertility clinics and patient groups. This sponsorship may contribute to the overuse of fertility services.
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Affiliation(s)
- Emily Aspasia Karanges
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Conrad Nangla
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Parker
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alice Fabbri
- Department for Health, University of Bath, Bath, UK
- Centre for Evidence-Based Medicine Odense (CEBMO), Department for Health, University of Southern Denmark, Odense, Denmark
| | - Cynthia Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Lisa Bero
- Schools of Medicine and Public Health, The University of Colorado Anschutz Medical Center, Denver, Colorado, USA
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13
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Ramírez N, Estofán G, Tissera A, Molina R, Luque EM, Torres PJ, Mangeaud A, Martini AC. Do aging, drinking, and having unhealthy weight have a synergistic impact on semen quality? J Assist Reprod Genet 2021; 38:2985-2994. [PMID: 34327599 DOI: 10.1007/s10815-021-02274-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/07/2021] [Indexed: 03/18/2023] Open
Abstract
PURPOSE To evaluate if age, alcohol consumption, and body mass index (BMI) have synergistic effects on seminal quality, and to rank these factors based on their impact on semen. METHODS Retrospective study of 9464 patients attending an andrology laboratory. Data on patients' age and daily alcohol intake were provided by the patients. BMI was recorded in the laboratory. Seminal parameters evaluated were volume, sperm concentration and total count, motility, morphology, viability, nuclear maturity, and membrane functional integrity. RESULTS All the seminal parameters evaluated were affected by the synergistic interaction Age x BMI, suggesting that this combination is more potent in affecting semen quality. The variables sperm morphology and nuclear maturity seemed to be especially susceptible since they were affected by the three synergistic interactions. In the logistic regression analysis, age was the most powerful factor since it impacted first on five of the nine parameters, impacting mainly on sperm motility, viability, and morphology, with no effects on sperm count. On the contrary, BMI impacted first in sperm concentration and total sperm count; which was confirmed also by the logistic predictions analysis. Alcohol consumption impacted first on membrane functional integrity and nuclear maturity. A J-shaped association between BMI or alcohol consumption with semen quality was found in the multivariate analysis. CONCLUSION The factors considered in this study showed a synergistic negative impact on semen quality, being age and unhealthy weight the most important ones. Reducing the exposure to lifestyle risk factors may be promising for improving sperm quality in infertile patients.
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Affiliation(s)
- Nicolás Ramírez
- Instituto de Fisiología, Facultad de Ciencias Médicas (FCM), Universidad Nacional de Córdoba and Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)-FCM, Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Gustavo Estofán
- Centro Integral de Ginecología, Obstetricia y Reproducción (CIGOR), Chacabuco 1123, X5000IIL, Córdoba, Argentina
| | - Andrea Tissera
- Laboratorio de Andrología y Reproducción (LAR), Chacabuco 1089, X5000IIK, Córdoba, Argentina
| | - Rosa Molina
- Laboratorio de Andrología y Reproducción (LAR), Chacabuco 1089, X5000IIK, Córdoba, Argentina
| | - Eugenia Mercedes Luque
- Instituto de Fisiología, Facultad de Ciencias Médicas (FCM), Universidad Nacional de Córdoba and Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)-FCM, Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Pedro Javier Torres
- Instituto de Fisiología, Facultad de Ciencias Médicas (FCM), Universidad Nacional de Córdoba and Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)-FCM, Santa Rosa 1085, X5000ESU, Córdoba, Argentina
| | - Arnaldo Mangeaud
- Cátedra de Bioestadística, Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Vélez Sarsfield 299, 5000, Córdoba, Argentina
| | - Ana Carolina Martini
- Instituto de Fisiología, Facultad de Ciencias Médicas (FCM), Universidad Nacional de Córdoba and Instituto de Investigaciones en Ciencias de la Salud (INICSA), Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)-FCM, Santa Rosa 1085, X5000ESU, Córdoba, Argentina.
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14
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Bosselut H, Paulmyer-Lacroix O, Gnisci A, Bretelle F, Perrin J, Courbiere B. [Prognostic factors of live-birth after in vitro fertilization for unexplained infertility: A cohort study]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:601-607. [PMID: 33434750 DOI: 10.1016/j.gofs.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES For 15 to 30% of infertile couples, no etiology can be found, leading to the diagnosis of "unexplained infertility". The aim of our study was to identify prognostic factors for live birth following in vitro fertilization (IVF) for these couples. METHODS A retrospective, monocentric study on a cohort of couples undergoing IVF for unexplained infertility with the woman aged≤40 years old. Primary analysis compared couples with a live birth following IVF versus childless couples following IVF. RESULTS Between January 2014 and December 2018, 104 couples were included, 196 transvaginal oocyte pickup were performed, followed by 234 embryo transfers (fresh or cryopreserved) which resulted in 43 deliveries. The cumulative live birth rate was 40.4% per couple. Before IVF attempts, no clinical or paraclinical prognostic factors between the two groups was observed. However, multivariate analysis showed several biological factors of good prognosis in course of treatment, such as a higher number of mature oocytes and better quality embryos in "live birth" group. CONCLUSIONS For a couple, the chances of having a child following IVF unexplained infertility are 40.4%. However, no clinical characteristic enabled us to identify favourable or unfavourable prognosis factors before starting ART. The prognostic factors identified during IVF cycle are interesting to advise or not to pursue IVF.
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Affiliation(s)
- H Bosselut
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - O Paulmyer-Lacroix
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, département d'histologie et embryologie, Marseille, France
| | - A Gnisci
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France
| | - F Bretelle
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, unité de recherche sur les maladies infectieuses tropicales et émergentes, UM 63, CNRS 7278, IRD 198, Inserm 1095, Marseille, France
| | - J Perrin
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
| | - B Courbiere
- Pôle femmes-parents-enfants, centre clinico-biologique d'AMP-CECOS, AP-HM La Conception, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille université, CNRS, IRD, Avignon université, IMBE, Marseille, France
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15
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Rozen G, Rogers P, Teh WT, Stern CJ, Polyakov A. An algorithm to personalise the diagnosis of recurrent implantation failure based on theoretical cumulative implantation rate. Hum Reprod 2021; 36:1463-1468. [PMID: 33904909 DOI: 10.1093/humrep/deab091] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Recurrent implantation failure (RIF) is an imprecisely defined disorder lacking a robust scientific basis. The incomplete understanding of RIF provides significant diagnostic and therapeutic challenges, and a better understanding of the underlying issues is necessary to improve outcomes. We propose a novel concept termed 'Theoretical Cumulative Implantation Rate', the calculation of which is based on objective data, to define whether a patient should be diagnosed with RIF. An updated definition to assist with patient counselling and planning research studies, which is more precise and standardised, is well overdue.
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Affiliation(s)
- Genia Rozen
- Reproductive Services, Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia.,Melbourne IVF, East Melbourne, VIC, Australia
| | - Peter Rogers
- Department of Obstetrics and Gynaecology, University of Melbourne, Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
| | - Wan Tinn Teh
- Reproductive Services, Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia.,Melbourne IVF, East Melbourne, VIC, Australia
| | - Catharyn J Stern
- Reproductive Services, Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia.,Melbourne IVF, East Melbourne, VIC, Australia
| | - Alex Polyakov
- Reproductive Services, Royal Women's Hospital, Parkville, VIC, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia.,Melbourne IVF, East Melbourne, VIC, Australia
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16
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Ombelet W, van Eekelen R, McNally A, Ledger W, Doody K, Farquhar C. Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in vitro fertilization as first-line treatment? Fertil Steril 2021; 114:1141-1148. [PMID: 33280720 DOI: 10.1016/j.fertnstert.2020.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Willem Ombelet
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Rik van Eekelen
- Centre for Reproductive Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Aine McNally
- Department of Clinical Reproductive Endocrinology and Infertility, St. George Hospital, Kogarah, Sydney, Australia
| | - William Ledger
- Department of Obstetrics and Gynecology and Reproductive Medicine, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, Australia
| | - Kevin Doody
- Center for Assisted Reproduction, Bedford, Texas
| | - Cynthia Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Fertility Plus, Auckland District Health Board, Auckland, New Zealand.
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17
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Kirkman-Brown JC, Martins MV. 'Genes versus children': if the goal is parenthood, are we using the optimal approach? Hum Reprod 2021; 35:5-11. [PMID: 31916579 PMCID: PMC6993870 DOI: 10.1093/humrep/dez256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 10/27/2019] [Indexed: 01/02/2023] Open
Abstract
First medical contact for couples trying for a child will usually emphasise the array of assistance available to ‘help them have their own child’, usually with options involving ART, after diagnosis. For many poorer prognosis couples, this means repetitive unsuccessful cycles of invasive and stressful treatment. What is sometimes lost at this stage is a reflection on the likelihood of success of different options, which may lead patients to focus on hoping for their own ‘genetic’ progeny, but failing to consider the alternative and potentially more successful other options, including donation and adoption, for achieving parenthood of a child. Factors not only such as female age but also advanced requirements such as preimplantation genetic testing or even mitochondrial replacement therapies all have reduced chances of success but further tend to reinforce the importance of a genetic link. The financial, physical and psychosocial burden associated with cumulative failure also lead to a higher probability of dropout and consequently an even higher probability of remaining in involuntary childlessness. We advocate formulation of a detailed roadmap for discussion of parenthood, with reference explanation to genetics and epigenetics, which gives due consideration to the psychological effects from the beginning to end of the treatment process, alongside a balanced consideration of the likelihood of treatment success and discussion of other options. Only when we provide patients with the service of a clear and transparent discussion of these matters, we will really realise the true potential of our field, which may then be better considered as assisted families.
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Affiliation(s)
- Jackson C Kirkman-Brown
- Centre for Human Reproductive Science, IMSR, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Birmingham Women's Fertility Centre, Birmingham Women's & Children's NHS Foundation Trust, Birmingham B15 2TG, UK
| | - Mariana V Martins
- Faculty of Psychology and Educational Sciences, University of Porto, Porto 4200-135, Portugal.,Centre for Psychology at University of Porto, Porto 4200-135, Portugal
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18
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Somigliana E, Reschini M, Bonanni V, Busnelli A, Li Piani L, Vercellini P. Fibroids and natural fertility: a systematic review and meta-analysis. Reprod Biomed Online 2021; 43:100-110. [PMID: 33903032 DOI: 10.1016/j.rbmo.2021.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
Available evidence from IVF studies supports a detrimental effect of submucosal and intramural fibroids on embryo implantation. It is misleading, however, to infer evidence obtained in IVF settings to natural fertility. Therefore, a systematic review and meta-analysis was conducted on the effect of fibroids on natural fertility. Studies comparing fertile and infertile women, and those investigating whether the presence of fibroids was a risk factor, were reviewed, as well as studies comparing women with and without fibroids. The aim was also to establish whether the frequency of infertility differed between the two groups. Seven out of 11 selected studies did not aim to establish whether fibroids caused infertility but, rather, whether a history of infertility could be a risk factor for fibroids. A meta-analysis of the four remaining studies that concomitantly evaluated the presence of fibroids and infertility studies highlighted a common odds ratio of fibroids in subfertile women of 3.54 (95% CI 1.55 to 8.11). When focusing on the two most informative studies, i.e. the studies comparing time to pregnancy in women with and without fibroids, the common OR was 1.93 (95% CI 0.89 to 4.18). In conclusion, the association between fibroids and infertility has been insufficiently investigated. Epidemiological studies suggest, but do not demonstrate, that fibroids may interfere with natural fertility. Given the high prevalence of these lesions in women seeking pregnancy, further evidence is urgently needed.
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Affiliation(s)
- Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, Milan 20122, Italy.
| | - Marco Reschini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, Milan 20122, Italy
| | - Valentina Bonanni
- Department of Gynecology, Obstetrics and Urology, 'Sapienza' University of Rome, Rome, Italy
| | - Andrea Busnelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele Milan, Italy; IRCCS Humanitas Research Hospital, Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Rozzano Milan, Italy
| | - Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, Milan 20122, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, Milan 20122, Italy
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19
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Garolla A, Pizzol D, Carosso AR, Borini A, Ubaldi FM, Calogero AE, Ferlin A, Lanzone A, Tomei F, Engl B, Rienzi L, De Santis L, Coticchio G, Smith L, Cannarella R, Anastasi A, Menegazzo M, Stuppia L, Corsini C, Foresta C. Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple. Front Endocrinol (Lausanne) 2021; 11:591837. [PMID: 33542705 PMCID: PMC7851076 DOI: 10.3389/fendo.2020.591837] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023] Open
Abstract
Capsule This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems. Background Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply. Objective The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems. Methods Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position. Outcomes Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures. Conclusions This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.
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Affiliation(s)
- Andrea Garolla
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Damiano Pizzol
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
- Italian Agency for Development Cooperation, Public Health, Jerusalem, Israel
| | - Andrea Roberto Carosso
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Torino, Italy
| | - Andrea Borini
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | | | - Aldo Eugenio Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Lanzone
- Department of Woman’s Health Sciences of the Child and Public Health, Unit of Obstetrics Pathology, University Clinic Foundation “A Gemelli” IRCCS, Rome, Italy
- Clinic of Obstetrics and Gynecology, Catholic University Sacro Cuore, Rome, Italy
| | - Francesco Tomei
- Assisted Reproductive Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Bruno Engl
- Donna Salus, Center for Women’s Health and Fertility, Bolzano, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Lucia De Santis
- IVF Unit, Gynaecological-Obstetric Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
- Italian Society of Embryology, Reproduction and Research (SIERR), Giarre, Italy
| | - Giovanni Coticchio
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | - Lee Smith
- The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Attilio Anastasi
- Center for Physiopathology of Human Reproduction, Delta Hospital, Lagosanto, Italy
| | - Massimo Menegazzo
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Christian Corsini
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
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20
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Saadati N, Nikbakht R, Sattari A, Amininezhad FS. Spontaneous pregnancies and determinant factors in infertility: A cross-sectional study. Int J Reprod Biomed 2020; 18:905-910. [PMID: 33134803 PMCID: PMC7569715 DOI: 10.18502/ijrm.v13i10.7775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/14/2019] [Accepted: 05/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background The phenomenon of infertility may be derived from different factors - either in males or females or both genders, including few unexplained factors. It is generally managed by medical and surgical treatments. Objective To find a relation of occurrence of spontaneous pregnancy (SP) with effective factors in infertility. Materials and Methods This cross-sectional study was conducted at two referral infertility centers (university and privacy center) in the southwest of Iran from March 2015 and March 2016 on 655 infertile couples, who were divided in two groups of with (n = 31) and without (n = 624) SP. The variables included female and male age, male smoking, male job, the place of living, the causes of infertility, the type and duration of infertility, and the subgroups of infertility causes. Results Infertility may be caused due to both male- and female- related factors (47.5%). While female-related infertility was found in 31.5%, male-related infertility in 14.5%, and infertility due to unexplained factors in 6.6% of our patients. The rate of SP was 4.7%, which had a significant relation with the duration of infertility (p = 0.01), with women's age (p = 0.048), unexplained infertility (p = 0.001), and husband's job (p = 0.004). Conclusion The occurrence of SP in infertile couples was related to age of the female partner, the duration of unexplained infertility, and the male partner's job.
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Affiliation(s)
- Nasrin Saadati
- Department of Community Medicine, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Roshan Nikbakht
- Department of Obstetrics and Gynecology, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Alireza Sattari
- Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fatemeh Sadat Amininezhad
- Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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21
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IVF, from the past to the future: the inheritance of the Capri Workshop Group. Hum Reprod Open 2020; 2020:hoaa040. [PMID: 33005753 PMCID: PMC7508025 DOI: 10.1093/hropen/hoaa040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Indexed: 12/26/2022] Open
Abstract
Today IVF use is booming all over the world and has even started to play a role in demographic analyses. Prognosis-adjusted estimates suggest that up to two-thirds of couples could achieve a live birth. However, the scenario is less exciting in reality. Discontinuation during the cycles is common, and age and ovarian response continue to be crucial in modulating this rate of success. A growing interest is now given to the risk of abuses and in particular to overtreatment and to prescriptions of useless, if not harmful, expensive additional treatments (‘add-ons’). A more rational, evidence-based and wise approach is needed. From a scientific perspective, several obscure aspects remain and warrant future investigations. Of particular interest are the neglected role of sperm selection, the potential adult implications of early embryo life in vitro and the issue of sustainability.
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22
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Chua SJ, Danhof NA, Mochtar MH, van Wely M, McLernon DJ, Custers I, Lee E, Dreyer K, Cahill DJ, Gillett WR, Righarts A, Strandell A, Rantsi T, Schmidt L, Eijkemans MJC, Mol BWJ, van Eekelen R. Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis. Hum Reprod 2020; 35:1808-1820. [DOI: 10.1093/humrep/deaa129] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
STUDY QUESTION
What is the rate of natural conception leading to ongoing pregnancy or livebirth over 6–12 months for infertile women of age ≥35 years?
SUMMARY ANSWER
Natural conception rates were still clinically relevant in women aged 35 years and above and were significantly higher in women with unexplained infertility compared to those with other diagnoses.
WHAT IS KNOWN ALREADY
In recent years, increasing numbers of women have attempted to conceive at a later age, resulting in a commensurate increase in the need for ART. However, there is a lack of data on natural fertility outcomes (i.e. no interventions) in women with increasing age.
STUDY DESIGN, SIZE, DURATION
A systematic review with individual participant data (IPD) meta-analysis was carried out. PubMed, MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov were searched until 1 July 2018 including search terms ‘fertility service’, ‘waiting list’, ‘treatment-independent’ and ‘spontaneous conception’. Language restrictions were not imposed.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Inclusion criteria were studies (at least partly) reporting on infertile couples with female partner of age ≥35 years who attended fertility services, underwent fertility workup (e.g. history, semen analysis, tubal status and ovulation status) and were exposed to natural conception (e.g. independent of treatment such as IVF, ovulation induction and tubal surgery). Studies that exclusively studied only one infertility diagnosis, without including other women presenting to infertility services for other causes of infertility, were excluded. For studies that met the inclusion criteria, study authors were contacted to provide IPD, after which fertility outcomes for women of age ≥35 years were retrieved. Time to pregnancy or livebirth and the effect of increasing age on fertility outcomes after adjustment for other prognostic factors were analysed. Quality of studies was graded with the Newcastle–Ottawa Scale (non-randomised controlled trials (RCTs)) or the Cochrane Risk of Bias tool (for RCTs).
MAIN RESULTS AND THE ROLE OF CHANCE
We included nine studies (seven cohort studies and two RCTs) (n = 4379 women of at least age 35 years), with the observed composite primary outcome of ongoing pregnancy or livebirth occurring in 429 women (9.8%) over a median follow-up of 5 months (25th to 75th percentile: 2.5–8.5 months). Studies were of moderate to high quality. The probability of natural conception significantly decreased with any diagnosis of infertility, when compared with unexplained infertility. We found non-linear effects of female age and duration of infertility on ongoing pregnancy and tabulated the predicted probabilities for unexplained infertile women aged 35–42 years with either primary or secondary infertility and with a duration of infertility from 1 to 6 years. For a 35-year-old woman with 2 years of primary unexplained infertility, the predicted probability of natural conception leading to ongoing pregnancy or livebirth was 0.15 (95% CI 0.11–0.19) after 6 months and 0.24 (95% CI 0.17–0.30) after 12 months. For a 42-year-old woman, this decreased to 0.08 (95% CI 0.04–0.11) after 6 months and 0.13 (95% CI 0.07–0.18) after 12 months.
LIMITATIONS, REASONS FOR CAUTION
In the studies selected, there were different study designs, recruitment strategies in different centres, protocols and countries and different methods of assessment of infertility. Data were limited for women above the age of 40 years.
WIDER IMPLICATIONS OF THE FINDINGS
Women attending fertility services should be encouraged to pursue natural conception while waiting for treatment to commence and after treatment if it is unsuccessful. Our results may aid in counselling women, and, in particular, for those with unexplained infertility.
STUDY FUNDING/COMPETING INTEREST(S)
S.J.C. received funding from the University of Adelaide Summer Research Scholarship. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437), B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. B.W.M. reports research support by Merck and Guerbet.
PROSPERO REGISTRATION NUMBER
CRD42018096552.
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Affiliation(s)
- S J Chua
- University of Adelaide, Adelaide, South Australia 5000, Australia
| | - N A Danhof
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - M H Mochtar
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - D J McLernon
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - I Custers
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E Lee
- Western Ultrasound for Women, West Leederville, Western Australia 6007, Australia
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - D J Cahill
- Academic Unit of Obstetrics and Gynaecology, University of Bristol, St Michael’s Hospital, Bristol BS8 1TH, UK
| | - W R Gillett
- Women’s and Children’s Health, Dunedin School of Medicine, The University of Otago, Dunedin 9016, New Zealand
| | - A Righarts
- Women’s and Children’s Health, Dunedin School of Medicine, The University of Otago, Dunedin 9016, New Zealand
| | - A Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - T Rantsi
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, FI-00029 HUS, Helsinki, Finland
| | - L Schmidt
- Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| | - M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, 3584 CX Utrecht, The Netherlands
| | - B W J Mol
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, South Australia 5006, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton 3800, Victoria, Australia
| | - R van Eekelen
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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McLernon DJ, Lee AJ, Maheshwari A, van Eekelen R, van Geloven N, Putter H, Eijkemans MJ, van der Steeg JW, van der Veen F, Steyerberg EW, Mol BW, Bhattacharya S. Predicting the chances of having a baby with or without treatment at different time points in couples with unexplained subfertility. Hum Reprod 2020; 34:1126-1138. [PMID: 31119290 DOI: 10.1093/humrep/dez049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/17/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can we develop a prediction model that can estimate the chances of conception leading to live birth with and without treatment at different points in time in couples with unexplained subfertility? SUMMARY ANSWER Yes, a dynamic model was developed that predicted the probability of conceiving under expectant management and following active treatments (in vitro fertilisation (IVF), intrauterine insemination with ovarian stimulation (IUI + SO), clomiphene) at different points in time since diagnosis. WHAT IS KNOWN ALREADY Couples with no identified cause for their subfertility continue to have a realistic chance of conceiving naturally, which makes it difficult for clinicians to decide when to intervene. Previous fertility prediction models have attempted to address this by separately estimating either the chances of natural conception or the chances of conception following certain treatments. These models only make predictions at a single point in time and are therefore inadequate for informing continued decision-making at subsequent consultations. STUDY DESIGN, SIZE, DURATION A population-based study of 1316 couples with unexplained subfertility attending a regional clinic between 1998 and 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS A dynamic prediction model was developed that estimates the chances of conception within 6 months from the point when a diagnosis of unexplained subfertility was made. These predictions were recomputed each month to provide a dynamic assessment of the individualised chances of conception while taking account of treatment status in each month. Conception must have led to live birth and treatments included clomiphene, IUI + SO, and IVF. Predictions for natural conception were externally validated using a prospective cohort from The Netherlands. MAIN RESULTS AND THE ROLE OF CHANCE A total of 554 (42%) couples started fertility treatment within 2 years of their first fertility consultation. The natural conception leading to live birth rate was 0.24 natural conceptions per couple per year. Active treatment had a higher chance of conception compared to those who remained under expectant management. This association ranged from weak with clomiphene to strong with IVF [clomiphene, hazard ratio (HR) = 1.42 (95% confidence interval, 1.05 to 1.91); IUI + SO, HR = 2.90 (2.06 to 4.08); IVF, HR = 5.09 (4.04 to 6.40)]. Female age and duration of subfertility were significant predictors, without clear interaction with the relative effect of treatment. LIMITATIONS, REASONS FOR CAUTION We were unable to adjust for other potentially important predictors, e.g. measures of ovarian reserve, which were not available in the linked Grampian dataset that may have made predictions more specific. This study was conducted using single centre data meaning that it may not be generalizable to other centres. However, the model performed as well as previous models in reproductive medicine when externally validated using the Dutch cohort. WIDER IMPLICATIONS OF THE FINDINGS For the first time, it is possible to estimate the chances of conception following expectant management and different fertility treatments over time in couples with unexplained subfertility. This information will help inform couples and their clinicians of their likely chances of success, which may help manage expectations, not only at diagnostic workup completion but also throughout their fertility journey. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a Chief Scientist Office postdoctoral training fellowship in health services research and health of the public research (ref PDF/12/06). B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck, and Guerbet. None of the other authors declare any conflicts of interest.
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Affiliation(s)
- D J McLernon
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A Maheshwari
- Aberdeen Centre for Reproductive Medicine, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - R van Eekelen
- Centre for Reproductive Medicine, Academic Medical Centre, AZ Amsterdam, The Netherlands.,Department of Biostatistics and Research Support, University Medical Centre Utrecht-Julius Centre, GA Utrecht, The Netherlands
| | - N van Geloven
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - M J Eijkemans
- Department of Biostatistics and Research Support, University Medical Centre Utrecht-Julius Centre, GA Utrecht, The Netherlands
| | - J W van der Steeg
- Department for Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, GZ 's-Hertogenbosch, The Netherlands
| | - F van der Veen
- Centre for Reproductive Medicine, Academic Medical Centre, AZ Amsterdam, The Netherlands
| | - E W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, CN Rotterdam, The Netherlands
| | - B W Mol
- The Robinson Institute-School of Medicine, University of Adelaide, Adelaide, Australia
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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24
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Is early initiation of infertility treatment justified in women over the age of 35 years? Reprod Biomed Online 2020; 40:393-398. [DOI: 10.1016/j.rbmo.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/12/2019] [Accepted: 12/10/2019] [Indexed: 12/14/2022]
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25
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Babakhanzadeh E, Nazari M, Ghasemifar S, Khodadadian A. Some of the Factors Involved in Male Infertility: A Prospective Review. Int J Gen Med 2020; 13:29-41. [PMID: 32104049 PMCID: PMC7008178 DOI: 10.2147/ijgm.s241099] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 01/23/2020] [Indexed: 01/04/2023] Open
Abstract
Infertility is defined as the inability of couples to have a baby after one year of regular unprotected intercourse, affecting 10 to 15% of couples. According to the latest WHO statistics, approximately 50-80 million people worldwide sufer from infertility, and male factors are responsible for approximately 20-30% of all infertility cases. The diagnosis of infertility in men is mainly based on semen analysis. The main parameters of semen include: concentration, appearance and motility of sperm. Causes of infertility in men include a variety of things including hormonal disorders, physical problems, lifestyle problems, psychological issues, sex problems, chromosomal abnormalities and single-gene defects. Despite numerous efforts by researchers to identify the underlying causes of male infertility, about 70% of cases remain unknown. These statistics show a lack of understanding of the mechanisms involved in male infertility. This article focuses on the histology of testicular tissue samples, the male reproductive structure, factors affecting male infertility, strategies available to find genes involved in infertility, existing therapeutic methods for male infertility, and sperm recovery in infertile men.
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Affiliation(s)
- Emad Babakhanzadeh
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Majid Nazari
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sina Ghasemifar
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Khodadadian
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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26
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Wilkinson J, Malpas P, Hammarberg K, Mahoney Tsigdinos P, Lensen S, Jackson E, Harper J, Mol BW. Do à la carte menus serve infertility patients? The ethics and regulation of in vitro fertility add-ons. Fertil Steril 2019; 112:973-977. [PMID: 31703942 DOI: 10.1016/j.fertnstert.2019.09.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/18/2019] [Accepted: 09/20/2019] [Indexed: 01/08/2023]
Abstract
Add-on treatments are the new black. They are provided (most frequently, sold) to patients undergoing in vitro fertilization on the premise that they will improve the chances of having a baby. However, the regulation of add-ons is consistently minimal, meaning that they are introduced into routine practice before they have been shown to improve the live birth rate. Debate on the adequacy of this light-touch approach rages. Defenders argue that demands for a rigorous approval process are paternalistic, as this would delay access to promising treatments. Critics respond that promising treatments may turn out to have adverse effects on patients and their offspring, contradicting the clinician's responsibility to do no harm. Some add-ons, including earlier versions of preimplantation genetic testing for aneuploidy, might even reduce the live birth rate, raising the prospect of desperate patients paying more to worsen their chances. Informed consent represents a solution in principle, but in practice there is a clear tension between impartial information and direct-to-consumer advertising. Because the effects of a treatment cannot be known until it has been robustly evaluated, we argue that strong evidence should be required before add-ons are introduced to the clinic. In the meantime, there is an imperative to identify methods for communicating the associated risks and uncertainties of add-ons to prospective patients.
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Affiliation(s)
- Jack Wilkinson
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
| | - Phillipa Malpas
- Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Sarah Lensen
- Cochrane Gynecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - Emily Jackson
- Law Department, London School of Economics and Political Science, London, United Kingdom
| | - Joyce Harper
- Department of Reproductive Health, Institute for Women's Health, University College London, London, United Kingdom
| | - Ben W Mol
- Evidence-based Women's Health Care Research Group, Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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27
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Bhattacharya S, Evers JLH, Gameiro S, Negri E, Somigliana E, Vercellini P, Wellings K, Baird DT, Crosignani P, Glasier A, La Vecchia C. Towards a more pragmatic and wiser approach to infertility care. Hum Reprod 2019; 34:1165-1172. [DOI: 10.1093/humrep/dez101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022] Open
Abstract
Abstract
Infertility represents a very peculiar area of medicine. Contrary to other areas, where signs and symptoms lead to a diagnosis, which in turn leads to a specific treatment, in reproduction the lack of signs and symptoms for more than 12 months suggests the diagnosis of ‘unexplained subfertility’, and if this condition has lasted for some years, couples qualify for IVF. Diagnosis and treatments can extend over long periods of time (even years) and the accuracy of the diagnostic armamentarium is not optimal. Uncertainty about diagnosis and the need for significant perseverance is demanding on both couples and physicians, and actually constitute a very favourable situation for overdiagnosis (‘unexplained subfertility’) and overtreatment (IVF) on one hand, and, on the other, it may also affect compliance with treatments. To improve our capacity to properly handle this challenging situation, increased attention should be given to the duration of pregnancy seeking. Initiating treatments earlier in older women is unwise because this population has a lower fecundity and, therefore, duration of pregnancy seeking is even more important to achieve a reliable diagnosis of infertility. Moreover, if the infertility work-up is unremarkable, duration of pregnancy seeking should be extended up to more than 2 years prior to making a diagnosis of unexplained infertility regardless of age. An adequate period of pregnancy seeking is also required for couples who are diagnosed with conditions that can interfere with fertility to avoid overdiagnosis and overtreatment. Indeed, most causes of infertility will reduce but not impair natural conception. Within this sometimes long-term management, physicians should also pay attention to detrimental life habits in order to optimize the chances of both natural and assisted reproduction technology -mediated pregnancy. Even if interventional studies are not conclusive, it is advisable to address the problems of obesity and smoking. Focussing on frequency of sexual intercourse may be also beneficial for natural conception. Finally, there is the need for improving our capacity to handle compliance. Providing information on the importance of persevering at the start of treatment, promoting shared decision-making and tackling patient, clinic and treatment causes of drop-out can all improve the overall chances of parenthood. Thus, we plead for a wiser and more pragmatic approach to infertility, paying more attention to these neglected, but in our opinion essential, aspects of infertility care.
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Lower follicular n-3 polyunsaturated fatty acid levels are associated with a better response to ovarian stimulation. J Assist Reprod Genet 2018; 36:473-482. [PMID: 30547270 DOI: 10.1007/s10815-018-1384-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To analyze in detail the fatty acid (FA) composition of follicular fluid (FF) from two-sized follicles at oocyte retrieval and to determine associations of the FAs from large follicles with the woman's age and the response to ovarian stimulation. DESIGN Observational study. SETTING University and fertility clinic. PATIENTS Sixty-four women (age 19-46), consisting of unfertile patients and oocyte donors, undergoing controlled ovarian stimulation. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) FF from small (< 12 mm) and large (≥ 18 mm) follicles was collected at oocyte retrieval. FAs by gas chromatography-flame ionization detection. RESULT Thirty-two FAs with chain lengths ranging from 14 to 25 carbons were identified. There was a readjustment in FA distribution as follicle size increased, raising very long-chain saturated FAs, nervonic (24:1n-9), arachidonic (20:4n-6), and n-3 polyunsaturated FAs (PUFA, P < 0.001), the latter mainly due to an increase in docosahexaenoic acid (22:6n-3, DHA). In large follicles, double bond and peroxidizability indices and total n-3 PUFA, particularly DHA, correlated positively with the woman's age and negatively with the number of total and mature oocytes, total and top-quality embryos, and fertilization rate. CONCLUSIONS We have described 32 FAs in ovarian FF, of which 16 changed their distribution with follicle size. The results also indicate that lower n-3 PUFA levels in large follicles, which are associated with younger women, predict a better response to ovarian stimulation based on the recovery of total and mature oocytes, total and top-quality embryos, and fertilization rate per cycle. KEY MESSAGE The fatty acid profile of ovarian FF changes as the follicle grows and lower n-3 PUFA levels in large follicles, associated with younger women, predict a better response to ovarian stimulation.
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29
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Ovarian endometriosis and infertility: in vitro fertilization (IVF) or surgery as the first approach? Fertil Steril 2018; 110:1218-1226. [DOI: 10.1016/j.fertnstert.2018.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 01/01/2023]
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30
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Oliva A, Multigner L. Chronic epididymitis and Grade III varicocele and their associations with semen characteristics in men consulting for couple infertility. Asian J Androl 2018; 20:360-365. [PMID: 29516876 PMCID: PMC6038156 DOI: 10.4103/aja.aja_78_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/07/2017] [Indexed: 01/09/2023] Open
Abstract
Chronic epididymitis and varicocele are frequently observed genital disorders in men consulting for couple infertility, but their impact on semen characteristics at the time of infertility consultation is still a matter of debate. We investigated 652 male partners of couples who had their first infertility consultation between 1999 and 2015 in Argentina. Men with chronic epididymitis (n = 253), Grade III varicocele (n = 106), and both conditions (n = 125) were compared with a control group (n = 168) composed of men without these disorders or any other recognized causes of male infertility. We showed that men who presented isolated chronic epididymitis were more likely to have high percentages of low sperm motility and abnormal sperm morphology as well as a high number of white blood cells. Men with isolated Grade III varicocele had low sperm production and motility and an increased percentage of abnormal sperm morphology. Finally, men who simultaneously presented chronic epididymitis with Grade III varicocele had a low sperm motility and increased percentage of abnormal sperm morphology as well as a high number of white blood cells. Physical examination of the genital organs may identify common disorders, potentially involved as causal factors of patient's infertility. These disorders are associated with specific seminal profiles that should help in identifying the best treatment from the available therapeutic options, effectiveness, safety, and allowing as much as possible natural conception.
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Affiliation(s)
- Alejandro Oliva
- Center for Interdisciplinary Studies, National University of Rosario, Rosario 2000, Argentina
| | - Luc Multigner
- University of Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes F-35000, France
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The time dimension and the future of infertility treatments. J Assist Reprod Genet 2017; 34:965-966. [PMID: 28735460 DOI: 10.1007/s10815-017-0999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Amsiejiene A, Drasutiene G, Usoniene A, Tutkuviene J, Vilsinskaite S, Barskutyte L. The influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone level on clinical pregnancy rates in ART. Gynecol Endocrinol 2017; 33:41-43. [PMID: 29264991 DOI: 10.1080/09513590.2017.1399692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to estimate the influence of age, body mass index, waist-to-hip ratio and anti-Mullerian hormone levels on clinical pregnancies in assisted reproduction technologies (ART). We used the database of the fertility clinic both the in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) units. A total of 1134 treatment cycles from 2013 through 2015 were analyzed. We evaluated clinical pregnancy rate in terms of age, body mass index, waist-to-hip ratio, anti-Mullerian hormone level. The clinical pregnancy rate was 39.9%. The live birth rate was 25.5%. Women who conceived where statistically significantly younger and had lower body mass index. No statistical differences across pregnancy groups were found for waist-to-hip ratio, and anti-Mullerian hormone levels. Low AMH levels do not influence pregnancy rates in younger patients (<36 years).
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Affiliation(s)
- Andre Amsiejiene
- a Department of Clinics of Obstetrics and Gynecology , Faculty of Medicine Vilnius University , Vilnius , Lithuania
- b 'Vaisingumo Klinika' , Vilnius , Lithuania
| | - Grazina Drasutiene
- a Department of Clinics of Obstetrics and Gynecology , Faculty of Medicine Vilnius University , Vilnius , Lithuania
| | | | - Janina Tutkuviene
- c Department of Anatomy, Histology and Anthropology , Faculty of Medicine Vilnius University , Vilnius , Lithuania
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