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Zhang C, Garcia-Neuer M, Jogerst KM, Van Der Walt C, Chang Y, Nguyen MC. Reproductive planning and infertility: Training the next generation of surgeons. Am J Surg 2024; 238:115886. [PMID: 39128441 DOI: 10.1016/j.amjsurg.2024.115886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Female surgeons face increased rates of fertility challenges compared to the general population. We aim to understand surgical trainees' understanding and perspectives on family planning. METHODS A 35-question survey was emailed to program directors at all US surgical residency programs for distribution to residents. Descriptive analyses were performed to evaluate resident understanding and perspectives on family planning and fertility treatments. RESULTS A total of 121 residents responded to the survey. Most were female (n = 78; 65 %). Responders indicated the need to postpone pregnancy during training (female: n = 48, 64 % vs male n = 18, 45 %; p = 0.09). Potential negative career consequences (n = 50; 42 %), limited leave benefits (n = 47; 39 %), and lack of childcare (n = 45; 38 %) were primary reasons for postponing pregnancy. Only nine responders (8 %) received fertility-preservation education. CONCLUSION Surgical trainees delay pregnancy for career and social support concerns and are interested in reproductive preservation. Fertility education could provide needed support for trainees.
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Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
| | | | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Charles Van Der Walt
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - YuHui Chang
- Department of Quantitative Health Sciences, Mayo Clinic Arizona, Phoenix, AZ, USA
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Zhang L, Sun X, Wang R, Ma F. Effect of COVID-19 vaccination on the outcome of in vitro fertilization: A systematic review and meta-analysis. Front Public Health 2023; 11:1151999. [PMID: 37077193 PMCID: PMC10106637 DOI: 10.3389/fpubh.2023.1151999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundUniversal COVID-19 vaccination programs are now recommended in several countries and represent the most effective preventive measure against COVID-19. However, some reports suggest that vaccination may cause infertility or have adverse effects on pregnancy. Conflicting reports have led to vaccine hesitancy in women planning pregnancy.PurposeTo determine whether vaccination against COVID-19 affects in vitro fertilization (IVF) outcomes, we conducted a meta-analysis.MethodA systematic search was conducted using PubMed, Embase, MEDLINE, and Web of Science databases for all published literature on COVID-19 vaccines and outcomes of IVF. International Prospective Register of Systematic Reviews registration was completed on September 13, 2022 (CRD42022359771).ResultsWe analyzed 20 studies totaling 18,877 individual cases undergoing IVF. COVID-19 vaccination had significant effect on clinical and ongoing pregnancy rate (risk ratio (RR): 0.97; 95% confidence interval (CI): 0.94–0.99; RR: 0.93; 95% CI: 0.87–0.99). These outcomes did not differ between vaccinated and unvaccinated individuals: biochemical pregnancy rate (RR: 0.95; 95% CI: 0.88–1.03), implantation rate (RR: 1.02; 95%CI: 0.97–1.07; P = 0.41), the number of oocytes (mean difference (MD): 0.12; 95% CI: −0.65–0.88) and MII/mature oocytes recovered (MD: 0.27; 95% CI: −0.36–0.90), blastocysts rate (MD: 0.01; 95% CI: −0.04, 0.06), and fertilization rate (MD: 1.08; 95% CI: −0.57, 2.73).ConclusionOur findings suggest that vaccination against COVID-19 does not adversely affect the biochemical pregnancy rates; number of oocytes and MII/mature oocytes obtained; implantation, blastocysts; and fertilization rates in women undergoing IVF treatment. Subgroup analysis showed that the mRNA vaccine had no statistical significance on all indexes (clinical, biochemical, or ongoing pregnancy rates; implantation, blastocysts, or fertilization rates; and the number of oocytes and MII/mature oocytes). The findings of this meta-analysis are anticipated to increase the willingness of women planning IVF treatment to receive COVID-19 vaccination and provide evidence-based medical guidance for the development and implementation of guidelines.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022359771.
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Affiliation(s)
- Linyu Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinrui Sun
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruohan Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fang Ma
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Center for Translational Medicine, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Obstetrics and Gynecology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Fang Ma
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Lefebvre T, Fréour T, Duval G, Ploteau S, Marchand P, Le Bizec B, Antignac JP, Cano-Sancho G. Associations between internal concentrations of fluorinated and organochlorinated chemicals in women and in vitro fertilization outcomes: A multi-pollutant study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 313:120087. [PMID: 36087895 DOI: 10.1016/j.envpol.2022.120087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/12/2022] [Accepted: 08/29/2022] [Indexed: 06/15/2023]
Abstract
The impact of persistent organic pollutants (POPs) on reproductive health is still poorly understood, even though infertility management has high associated societal and economical costs. The aims of this study were to characterize the internal levels of polychlorinated biphenyls (PCBs), organochlorine pesticides (OCPs) and perfluoroalkylated substances (PFAS) in women undergoing in vitro fertilization (IVF); and evaluate their association with IVF outcomes, individually and as mixtures in a combined multipollutant approach. Thus, 136 women undergoing IVF treatment at Nantes University Hospital (France) were prospectively recruited between 2019 and 2020. Serum samples were analyzed using liquid chromatography with tandem-mass spectrometry for 14 PFAS. Follicular fluid was analyzed with gas chromatography coupled to high resolution mass spectrometry for 14 PCBs and 25 OCPs. Intermediate and clinical IVF outcomes were ascertained by embryologists and clinicians using standardized protocols. Multivariate Poisson regression models and Bayesian Kernel Machine Regressions (BKMR) were used to identify individual and joint associations between POPs and IVF outcomes adjusting for age, body mass index (BMI) and anti-Müllerian hormone. The results showed that most POPs were widely present in women, and globally not associated with clinically relevant IVF outcomes, like live birth rates. Nonetheless, negative associations between PCB138 and trans-nonachlor with useable blastocysts were identified, β -0.28 (95%CI [-0.52; -0.04] p = 0.02) and β -0.22 (95%CI [-0.40; -0.03] p = 0.02). Conversely, PCB28 showed positive associations with the number of useable blastocysts, pregnancy rate and live birth rate. The BKMR analysis suggested the lack of association of the mixture with intermediate and clinical outcomes. The study supports the need of conducting further studies in a larger population sample in order to ensure sufficient statistical power to identify modest effects and a robust stratification analysis to account for the large underlying disease heterogeneity.
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Affiliation(s)
- Tiphaine Lefebvre
- LABERCA, Oniris, INRAE, Nantes, France; CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France; Faculty of Medicine, Nantes Université, France
| | - Thomas Fréour
- CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France; Faculty of Medicine, Nantes Université, France; Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000, Nantes, France
| | - Gauthier Duval
- CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France
| | - Stéphane Ploteau
- CHU Nantes, Nantes Université, Service de Médecine et Biologie de La Reproduction, Gynécologie Médicale, 38 Bd Jean Monnet, Nantes, France; CHU Nantes, Department of Gynecology and Obstetrics, 38 Bd Jean Monnet, Nantes, France
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Actl7a deficiency in mice leads to male infertility and fertilization failure. Biochem Biophys Res Commun 2022; 623:154-161. [DOI: 10.1016/j.bbrc.2022.07.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
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Li Y, Cai X, Dong B, Wang Q, Yang X, Yu A, Wei H, Ke Z, Sun P, Zheng B, Sun Y. The Impact of Malignancy on Assisted Reproductive Outcomes for Cancer Survivors: A Retrospective Case–Control Study. Front Oncol 2022; 12:941797. [PMID: 36185197 PMCID: PMC9523265 DOI: 10.3389/fonc.2022.941797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundRelated studies have shown that it is safe for cancer patients to undergo assisted reproduction. However, studies on whether a history of cancer affects long-term reproductive outcomes in women who undergo assisted reproductive technology (ART) are scarce. In this study, we evaluated the long-term reproductive outcomes of patients with malignant tumors undergoing ART treatment and explored the impact of malignancy history on ART outcomes.MethodsThis retrospective study analyzed the clinical outcomes of patients with malignant tumors undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles compared with those of age-matched healthy infertile women at Fujian Maternity and Child Health Hospital between January 2003 and October 2020. We evaluated ovarian stimulation outcome, the pregnancy rate, the live birth rate, the risk of adverse obstetric outcomes and birth outcomes.ResultsThis study included 59 patients in the cancer group for data analysis who had a history of malignancy. By matching, a total of 118 healthy infertile women were included in the control group. No statistically significant association was found in terms of age, duration of infertility, BMI, or insemination type between the two groups of patients. Thyroid cancer(45.8%) and gynecologic malignancies (44.07%) were the major cancer types in this study. There were statistically significant differences in the antral follicle count (AFC) (12.00 ± 7.86 vs. 14.90 ± 8.71, P=0.033), length of ovarian stimulation (9.98 ± 2.68 vs. 11.42 ± 2.43, P=0.033) and endometrial thickness on the trigger day (10.16 ± 3.11 vs. 10.84 ± 2.17, P<0.001) between the two groups. The total gonadotropin dose, number of oocytes retrieved, fertilization rate, cleavage rate, high-quality embryo rate, blastocyst rate and first-time embryo-transfer (ET) implantation rate were nonsignificantly lower in the cancer group than in the control group (P>0.05). There were no significant differences in the clinical pregnancy rate per ET cycle (32% vs. 40.39%, P=0.156), live birth rate per ET cycle (27% vs. 35.96%, P=0.119), miscarriage rate per ET cycle (5% vs. 4.43%, P=0.779), or preterm delivery rate per ET cycle (11.11% vs. 17.80%, P=0.547) between the two groups. Additionally, regression analysis showed that a history of malignancy was not a risk factor for reproductive outcomes.ConclusionsOverall, it is feasible for women with a history of cancer to conceive using ART is feasible and their long-term reproductive outcomes are similar to these of healthy infertile women. A history of cancer does not decrease the number of retrieved oocytes, increase the risk of adverse obstetric outcomes or affect birth outcomes.
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Affiliation(s)
- Yuehong Li
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xuefen Cai
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Binhua Dong
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qi Wang
- Fujian Province Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Xiaohui Yang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Aili Yu
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Huijuan Wei
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zhanghong Ke
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Pengming Sun
- Laboratory of Gynecologic Oncology, Department of Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- *Correspondence: Pengming Sun, ; Beihong Zheng, ; Yan Sun,
| | - Beihong Zheng
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- *Correspondence: Pengming Sun, ; Beihong Zheng, ; Yan Sun,
| | - Yan Sun
- Center of Reproductive Medicine, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- *Correspondence: Pengming Sun, ; Beihong Zheng, ; Yan Sun,
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Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study. Healthcare (Basel) 2021; 9:healthcare9111552. [PMID: 34828600 PMCID: PMC8618283 DOI: 10.3390/healthcare9111552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 12/26/2022] Open
Abstract
Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.
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Cirillo M, Coccia ME, Fatini C. Lifestyle and Comorbidities: Do We Take Enough Care of Preconception Health in Assisted Reproduction? J Family Reprod Health 2020; 14:150-157. [PMID: 33603806 PMCID: PMC7868650 DOI: 10.18502/jfrh.v14i3.4667] [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] [Indexed: 12/19/2022] Open
Abstract
Objective: The preconception period is largely neglected, whereas it represents an opportunity to identify and modify clinical and behavioral risks, particularly in infertile women characterized by an unfavorable vascular burden. The present study was performed to strengthen previous findings and to increase the awareness of clinicians who should envision a broader preconception approach in infertile women, beyond their reproductive health. Materials and methods: In this cross-sectional study, we investigated 1003 Caucasian women, referred to the Internal Medicine Clinic at the Assisted Reproductive Technologies Center, Florence. Results: A high prevalence of dyslipidemia (57.4%), overweight/obesity (29.1%) and, smoking habit (26.6%) were found. We provided evidence of unhealthy lifestyle habits, represented by a closer adherence to the Mediterranean diet in the 9.5% only and by a sedentary behavior in 73%. A significant correlation between the Mediterranean Diet score and both anthropometric and metabolic parameters was found. We also observed a lower score adherence with both metabolic syndrome and diabetes (for both p=0.02), but not with hypertension. Conclusion: Before infertility treatment, the correction and the management of modifiable and non-modifiable cardiovascular risk factors are mandatory and represent the main goal for a safe pregnancy, and lifetime women's health.
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Affiliation(s)
- Michela Cirillo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Maria Elisabetta Coccia
- Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Cinzia Fatini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Center for Assisted Reproductive Technology, Division of Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
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