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Kedar Sade E, Lantsberg D, Tagar Sar-El M, Gefen S, Gafner M, Katorza E. Identifying causes and associated factors of stillbirths using autopsy of the fetus and placenta. Arch Gynecol Obstet 2024:10.1007/s00404-024-07522-1. [PMID: 38691157 DOI: 10.1007/s00404-024-07522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE The study aimed to evaluate the causes of death and associated factors in cases of stillbirth, using post-mortem examination and applying a rigorous, evidence-based holistic approach. METHODS Our retrospective observational study included cases of autopsy following stillbirth that occurred at our tertiary medical center during a period of 8 years. Detailed up-to-date criteria that incorporate clinical reports, medical history, prenatal imaging, and histopathological findings were used to evaluate the cause of death and associated factors. RESULTS After applying our proposed methodology, 138 cases of stillbirth were classified into eight categories based on the causes of death. A definitive cause of death was observed in 100 (72%) cases, while 38 (28%) cases were considered unexplained. The leading cause of death was placental lesions (n = 39, 28%) with maternal vascular malperfusion (MVM) lesions being the most common (54%). Ascending infection was the second most common cause of fetal death (n = 24, 17%) and was often seen in the setting of preterm labor and cervical insufficiency. CONCLUSION The largest category of cause of death was attributed to placental pathology. Using rigorous detailed up-to-date criteria that incorporate pathological and clinical factors may help in objectively classifying the cause of death.
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Affiliation(s)
- Eliel Kedar Sade
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon, Affiliated With the Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
| | - Daniel Lantsberg
- Department of Obstetrics and Gynecology, The Royal Women's Hospital, Melbourne, Australia
| | | | - Sheizaf Gefen
- Department of Internal Medicine 'E', Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Gafner
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Faculty of Medical and Health Sciences, Tel-Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat-Gan, Israel
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Kedar Sade E, Lantsberg D, Tagar Sar-El M, Gefen S, Katorza E. Disparities Between Prenatal Ultrasound and Autopsy Findings in Pregnancies Resulting in Fetal Loss. J Ultrasound Med 2024; 43:455-465. [PMID: 37994216 DOI: 10.1002/jum.16376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES This retrospective study aimed to assess disparities between prenatal ultrasound and autopsy findings in pregnancies that resulted in fetal loss, and to evaluate the diagnostic performance of prenatal ultrasound using postmortem examinations as a gold standard. METHODS Our study included 136 autopsy cases following a fetal loss that occurred at our tertiary medical center for 8 years. A comparison between the prenatal ultrasound and autopsy findings was made, and all cases were classified according to the degree of agreement. The diagnostic performance of prenatal ultrasound was calculated at the level of organ system and specific malformations. RESULTS The primary sonographic diagnosis was confirmed in 91.9% of the cases (n = 125). General agreement was highest among central nervous system (CNS), cardiovascular and musculoskeletal systems (85.7%, n = 36, 18, and 12, respectively) and lowest among facial, multiple anomalies, genitourinary and gastrointestinal systems (50.0%, 74.3%, 78.6%, and 80.0%, n = 2, 26, 11, and 4, respectively). The sensitivity of ultrasound was highest in the CNS (93.2%) and musculoskeletal (87.0%) and lowest in the facial (32.3%) and pulmonary (13.0%) systems. Specifically, low diagnostic rates were noted in detecting ventriculomegaly, valvular anomalies, renal dysplasia, spleen and adrenal anomalies, and digital and facial defects. CONCLUSIONS Our study observed an overall high agreement between prenatal ultrasound and autopsy while contributing to our comprehensive understanding of its strengths and limitations across various types of organ systems and specific malformations.
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Affiliation(s)
- Eliel Kedar Sade
- Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Sheizaf Gefen
- Department of Internal Medicine "E", Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Gertner Institute for Epidemiology & Health Policy, Sheba Medical Center, Ramat-Gan, Israel
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Lim C, Wu W, La J, Chan V, Schubach KM, Duns G, Lantsberg D, Katz DJ. Direct-to-Consumer Telemedicine Practices in the Health and Fertility of Men: A Systematic Review of the Literature. World J Mens Health 2024; 42:148-156. [PMID: 37652657 PMCID: PMC10782129 DOI: 10.5534/wjmh.230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/11/2023] [Accepted: 04/16/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE Men are increasingly turning toward online direct-to-consumer (DTC) men's health platforms to fulfill their health needs. Research surrounding these platforms is lacking and the motivations and predictors underlying this online health-seeking behavior is largely unknown. This review scopes the existing literature concerning DTC men's health and identifies factors influencing engagement, as well as health outcomes of this platform. MATERIALS AND METHODS A structured search was performed following PRISMA guidelines. CINAHL via EBSCO, Embase, MEDLINE via Ovid, PsycINFO, PubMed and Web of Science were searched. RESULTS Peer-reviewed quantitative and qualitative studies with a focus on demographics and characteristics of those using DTC men's health platforms, as well as studies related to patient outcomes using such platforms, were included. Ten of the 3,003 studies identified met the inclusion and exclusion criteria. Four cross-sectional descriptive studies evaluated the motivations behind men's engagement with DTC platforms. Convenience, embarrassment and health motivation were identified as predominant factors associated with DTC platform use. The review identified a lack of qualitative studies, and major limitations were noted in the quantitative studies that impacted the accuracy of findings. Six further quantitative studies explored the quality of care provided by DTC platforms. DTC platforms were found to have a varying level of adherence to established clinical guidelines, but appeared to provide satisfactory patient outcomes with low levels of patient-reported side effects and adverse events. CONCLUSIONS There is a lack of research within the DTC men's health space given the infancy of the field. Important predictors and motivations underlying men's choices in accessing these platforms have been noted across several studies. However, further studies need to be conducted to investigate the psychosocial underpinnings of this behavior. Studies across a wider variety of male health conditions treated by these platforms will also help to provide insights to guide patient-centered care within the DTC landscape.
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Affiliation(s)
- Christopher Lim
- Department of Urology, Western Health, St Albans, Australia.
| | - Winston Wu
- Department of Urology, Western Health, St Albans, Australia
| | - Justin La
- Department of Urology, Kaiser Permanente San Rafael Medical Center, San Rafael, CA, USA
| | | | | | - Glenn Duns
- Men's Health Melbourne, Melbourne, Australia
| | - Daniel Lantsberg
- Men's Health Melbourne, Melbourne, Australia
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Australia
- Melbourne IVF, East Melbourne, Australia
| | - Darren J Katz
- Department of Urology, Western Health, St Albans, Australia
- Men's Health Melbourne, Melbourne, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Parkville, Australia
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Barda S, Amir H, Mizrachi Y, Dviri M, Yaish I, Greenman Y, Sofer Y, Azem F, Hauser R, Lantsberg D. Sperm parameters in Israeli transgender women before and after cryopreservation. Andrology 2023; 11:1050-1056. [PMID: 36542410 DOI: 10.1111/andr.13369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-non-conforming individuals undergoing therapy for gender compatibility. OBJECTIVES To examine semen quality and survival in transgender women pursuing semen cryopreservation in the presence or absence of gender-affirming hormonal medication. MATERIALS AND METHODS In this retrospective cohort study, we reviewed data of 74 consecutive transgender women presenting for semen cryopreservation at a single center between 2000 and 2019. Semen parameters before and after cryopreservation were compared to a control group composed of 100 consecutive sperm bank donor candidates. A subgroup analysis of subjects who had used gender-affirming hormonal treatment was also performed. RESULTS Compared to the control group, transgender women had lower total sperm count (144.0 vs. 54.5 million, respectively, p < 0.001), lower sperm motility percentage (65.0% vs. 51.0%, respectively, p < 0.001), and lower total motile sperm count (94.0 vs. 27.0 million, respectively, p < 0.001). Values were further decreased in transgender women who had received hormonal treatment before sperm cryopreservation. Post-thawing motility rate remained lower in the transgender group compared to the control group (20.0% vs. 45.0%, respectively, p < 0.001), and the total motile count remained lower as well (2.7 vs. 9.0 million, respectively, p < 0.001). Following sperm cryopreservation, the post-thaw decreases in total motile sperm count were higher in the transgender group compared with the control group (91.5% vs. 90.0%). Further subdivision in the transgender group showed that the decrease in total motile sperm count was lower for transgender women who did not use gender-affirming hormonal treatment compared to those who did (-89.7% vs. -92.6%, respectively, p < 0.01). DISCUSSION AND CONCLUSION Sperm parameters in transgender women are poor compared to candidates for sperm donation representing the general population. Specimens collected after discontinuation of gender-affirming hormone treatments were further impaired. Moreover, post-thawing sperm total motile count, motility, and overall sperm survival were reduced in transgender women.
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Affiliation(s)
- Shimi Barda
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Israel Academic College, Ramat Gan, Israel
| | - Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Mizrachi
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Michal Dviri
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iris Yaish
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yona Greenman
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Sofer
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Hauser
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Slonim M, Peate M, Merigan K, Lantsberg D, Anderson RA, Stern K, Gook D, Jayasinghe Y. Ovarian stimulation and oocyte cryopreservation in females and transgender males aged 18 years or less: a systematic review. Front Endocrinol (Lausanne) 2023; 14:1146476. [PMID: 37404308 PMCID: PMC10315913 DOI: 10.3389/fendo.2023.1146476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Background Fertility preservation is an important healthcare focus in the paediatric and adolescent population when gonadotoxic treatments are required. Ovarian stimulation (OS) resulting in oocyte cryopreservation is a well-established fertility preservation option in the adult population. It's utility, however, is little known in young patients. The purpose of this review was to synthesise the available literature on OS in patients ≤18 years old, to identify gaps in current research and provide suggestions for future research directions. Methods Using PRISMA guidelines, a systematic review of the literature was performed for all relevant full-text articles published in English in Medline, Embase, the Cochrane Library and Google Scholar databases. The search strategy used a combination of subject headings and generic terms related to the study topic and population. Two reviewers independently screened studies for eligibility, extracted data and assessed the risk of bias. Characteristics of the studies, objectives and key findings were extracted and summarised in a narrative synthesis. Results Database search and manual review identified 922 studies, 899 were eliminated based on defined exclusion criteria. Twenty-three studies were included and comprised 468 participants aged ≤18 years who underwent OS (median 15.2, range 7-18 years old). Only three patients were premenarchal, and four patients were on treatment to suppress puberty. Patients had OS for a broad range of indications including oncology treatment, transgender care and Turner syndrome. A total of 488 cycles of OS were completed, with all but 18 of these cycles (96.3%) successfully resulting in cryopreserved mature oocytes (median 10 oocytes, range 0-35). Fifty-three cycles (9.8%) were cancelled. Complications were rare (<1%). One pregnancy was reported from a female who had OS aged 17 years old. Conclusion This systematic review demonstrates that OS and oocyte cryopreservation is achievable in young females however there are only a few cases in the literature describing OS in premenarcheal children or those who have suppressed puberty. There is little proof that OS can lead to pregnancy in adolescents, and no proof that this can be achieved in premenarchal girls. Therefore it should be regarded as an innovative procedure for adolescents and experimental for premenarcheal girls. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=265705, identifier CRD42021265705.
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Affiliation(s)
- Marnie Slonim
- Oncofertility Program and Department of Gynaecology, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Kira Merigan
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Melbourne, VIC, Australia
| | | | - Richard A. Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Kate Stern
- Department of Obstetrics and Gynaecology, Royal Women’s Hospital, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Debra Gook
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Yasmin Jayasinghe
- Oncofertility Program and Department of Gynaecology, Royal Children’s Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Melbourne, VIC, Australia
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Kieu V, Polyakov A, Rozen G, Lantsberg D, Stern C, Tinn Teh W. Live birth rates in day 5 fresh versus vitrified single blastocyst transfer cycles: A cross-sectional analysis. Int J Reprod Biomed 2023; 21:245-254. [PMID: 37122887 PMCID: PMC10133739 DOI: 10.18502/ijrm.v21i3.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/01/2022] [Accepted: 02/14/2023] [Indexed: 05/02/2023] Open
Abstract
Background The use of frozen embryo transfers (FET) in assisted reproduction has increased worldwide. Controlled ovarian hyperstimulation in a fresh transfer may impair endometrial-embryo synchronicity. However, there is conflicting evidence on live birth rates (LBR) and clinical pregnancy rates (CPR). Objective To compare LBRs and CPRs between single autologous day 5 fresh vs. vitrified blastocyst transfer cycles, to investigate the impact of controlled ovarian hyperstimulation on embryo-endometrium asynchrony. Materials and Methods A large cross-sectional analysis of 6002 embryo transfers (ET) comprised 3774 fresh and 2228 FET cycles from 2016 to 2019. Multivariate and subgroup analysis were performed for high responders ( > 20 oocytes). Results Univariate analysis showed no difference in LBR (28.3% vs. 27.4%, p = 0.43) and CPR (32.2% vs. 30.9%, p = 0.30); however, multivariate analysis demonstrated significantly lower LBR (OR 0.864, p = 0.046, 95% CI 0.749-0.997) and CPR (OR 0.852, p = 0.024, 95% CI 0.742-0.979) in FET compared to fresh ETs. Younger participant age, previous in vitro fertilization pregnancy, advanced blastocyst expansion, higher trophectoderm quality, and lower cumulative number of ETs all improved the odds of LBR and CPR. Conventional in vitro fertilization, rather than intracytoplasmic sperm injection, improved CPR but not LBR. Body mass index affected neither LBR nor CPR. In the subgroup, multivariate analysis of high responders showed no difference in LBR or CPR. Conclusion This study demonstrates relatively higher LBR and CPR of nearly 14% for fresh ETs compared to FETs, in multivariate analysis. A universal freeze-all strategy, without appropriate indication, may lead to suboptimal outcomes. In high responders, freeze-all cycles may be beneficial, as outcomes appear similar.
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Affiliation(s)
- Violet Kieu
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Alex Polyakov
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Genia Rozen
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Daniel Lantsberg
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Catharyn Stern
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
| | - Wan Tinn Teh
- Reproductive Services Unit, Royal Women's Hospital, Melbourne, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
- Melbourne IVF, Melbourne, VIC, Australia
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Wu W, La J, Schubach KM, Lantsberg D, Katz DJ. Psychological, social, and sexual challenges affecting men receiving male infertility treatment: a systematic review and implications for clinical care. Asian J Androl 2023; 25:448-453. [PMID: 36412462 PMCID: PMC10411259 DOI: 10.4103/aja202282] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, social research surrounding the consequences of infertility has increasingly focused on the male perspective; however, a gap exists in the understanding of men's experiences of male infertility treatment. This review aims to synthesize the existing evidence concerning the psychological, social, and sexual burden of male infertility treatment on men, as well as patient needs during clinical care. A systematic search identified 12 studies that are diverse in design, setting, and methods. Psychological evaluations have found that urological surgery may have a lasting impact on infertility-specific stress, and treatment failure can lead to feelings of depression, grief, and inadequacy. Men tended to have an avoidant coping mechanism throughout fertility treatment, and their self-esteem, relationship quality, and sexual functions can be tied to outcomes of treatment. Partner bonds can be strengthened by mutual support and enhanced communication; couple separation, however, has been noted as a predominant reason for discontinuing male infertility treatment and may be associated with difficult circumstances surrounding severe male infertility. Surgical treatments can affect the sexual functioning of infertile men; however, the impact of testicular sperm extraction outcomes appears to be psychologically driven whereas the improvements after microsurgical varicocelectomy are only evident in hypogonadal men. Clinically, there is a need for better inclusion, communication, education, and resource provision, to address reported issues of marginalization and uncertainty in men. Routine psychosocial screening in cases of severe male infertility and follow-up in cases of surgical treatment failure are likely beneficial.
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Affiliation(s)
- Winston Wu
- Department of Urology, Western Health, St Albans, VIC 3021, Australia
| | - Justin La
- Department of Urology, Kaiser Permanente San Rafael Medical Center, San Rafael, CA 94903, USA
| | | | - Daniel Lantsberg
- Men’s Health Melbourne, Melbourne, VIC 3000, Australia
- Reproductive Services Unit, The Royal Women’s Hospital, Parkville, VIC 3052, Australia
- Melbourne IVF, East Melbourne, VIC 3002, Australia
| | - Darren J Katz
- Department of Urology, Western Health, St Albans, VIC 3021, Australia
- Men’s Health Melbourne, Melbourne, VIC 3000, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Parkville, VIC 3010, Australia
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Lensen S, Lantsberg D, Gardner DK, Sophian AD, Wandafiana N, Kamath MS. The role of timing in frozen embryo transfer. Fertil Steril 2022; 118:832-838. [PMID: 36150920 DOI: 10.1016/j.fertnstert.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/13/2023]
Abstract
The process of implantation is characterized by a complex cross-talk between the endometrium and the blastocyst, with the endometrium only being receptive to implantation during a transient window of implantation of approximately 2-3 days during the midsecretory phase. The timing of embryo transfer, including frozen embryo transfer, is therefore critical to the success of implantation. In this article, we discuss various elements that may guide the timing of frozen embryo transfer, including the role of endometrial characteristics such as thickness, days postovulation or length of progesterone administration, stage of the embryo, and the application of endometrial receptivity tests to guide personalized embryo transfer.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Australia.
| | - Daniel Lantsberg
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Australia; Reproductive Services, Royal Women's Hospital, Melbourne, Australia
| | - David K Gardner
- School of BioSciences, University of Melbourne, Parkville, Victoria, Australia and Melbourne IVF, East Melbourne, Victoria, Australia
| | | | | | - Mohan S Kamath
- Department of Reproductive Medicine and Surgery, Christian Medical College, Vellore, India
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Horta F, Fernando D, Lantsberg D, Holden S, Katz DJ, Green MP, McLachlan R, Zander-Fox D, Rombauts L. Are Clinical Outcomes of Micro-TESE in Non-obstructive Azoospermic Men Affected by the Use of Fresh or Frozen Gametes? FandR 2022. [DOI: 10.1142/s2661318222500086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: The combination of microsurgical testicular sperm extraction (mTESE) and intracytoplasmic sperm injection (ICSI) has become a common management option, with sperm motility being positively associated with successful outcomes. However, few studies have investigated whether the use of fresh or thawed gamete combinations affect clinical outcomes. Objectives: To determine whether the clinical outcomes of ICSI cycles using mTESE recovered testicular sperm of non-obstructive azoospermia (NOA) patients are affected by using fresh or thawed gametes. Material and Methods: A retrospective study was conducted of NOA patients who underwent mTESE between 2017 and 2020 at Monash IVF assisted reproductive clinics in Melbourne, Australia. The impact of gamete fresh/frozen status and sperm motility was investigated on clinical outcomes such as fertilization, blastocyst formation, clinical pregnancy, and live birth rates (LBRs). Results:A total of 103 NOA patients underwent mTESE, with a 65.1% successful surgical-sperm-retrieval. In total 56 patients contributed to 68 ICSI cycles, with a 35.1% fertilization rate and 25% LBR per embryo transfer. Compared with fresh testicular sperm, thawed testicular sperm did not affect clinical outcomes, including LBRs [16.7% vs 12.0%; odds ratio (OR) 0.68 (0.18–2.70)]. However, the use of thawed oocytes had a negative effect on fertilization rates [fresh-oocytes, 37.8%; vitrified-oocytes, 34.5%; OR 0.86 (0.02–0.48)]. Cycles using only motile sperm had a greater fertilization rate than those using a combination of motile and non-motile sperm (49.6% vs 37.2%, p ¡ 0.05). Importantly, when exclusively non-motile sperm were available (n = 26 cycles) their injection resulted in a very low fertilization rate (2.7%) and no live births were recorded. Conclusion: Micro-TESE is an effective treatment for NOA patients, with no clear advantage of using fresh over thawed sperm, however, the use of vitrified compared with fresh oocytes requires further investigation. Importantly, patients should be informed of the poor outcomes with the use of non-motile sperm in mTESE ICSI cycles.
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Affiliation(s)
- Fabrizzio Horta
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash University, Clayton, Victoria 3168, Australia
| | - Dhanushi Fernando
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash Health, Clayton, Victoria 3168, Australia
| | - Daniel Lantsberg
- Men’s Heath Melbourne, Melbourne, Australia
- The Royal Women’s Hospital, Melbourne 3052, Australia
- University of Melbourne, Melbourne 3010, Australia
| | | | - Darren J. Katz
- Men’s Heath Melbourne, Melbourne, Australia
- University of Melbourne, Melbourne 3010, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Mark P. Green
- Monash IVF, Clayton, Victoria 3168, Australia
- University of Melbourne, Melbourne 3010, Australia
| | - Robert McLachlan
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash Health, Clayton, Victoria 3168, Australia
- Hudson Institute of Medical Research, Monash University, Clayton, Victoria 3168, Australia
| | - Deirdre Zander-Fox
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash University, Clayton, Victoria 3168, Australia
- University of Adelaide, Adelaide, South Australia 5000, Australia
- University of South Australia, Adelaide, South Australia 5095, Australia
| | - Luk Rombauts
- Monash IVF, Clayton, Victoria 3168, Australia
- Monash University, Clayton, Victoria 3168, Australia
- Monash Health, Clayton, Victoria 3168, Australia
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10
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Lantsberg D, Mizrachi Y, Katz DJ. Micro-testicular sperm extraction outcomes for non-obstructive azoospermia in a single large clinic in Victoria. Aust N Z J Obstet Gynaecol 2022; 62:300-305. [PMID: 35112341 DOI: 10.1111/ajo.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the results of microdissection testicular sperm extraction (micro-TESE) and intracytoplasmic sperm injection (ICSI) for treatment of non-obstructive azoospermia (NOA). MATERIALS AND METHODS We retrospectively analysed data of 88 consecutive patients with clinical NOA who were treated with micro-TESE by a single surgeon, between August 2014 and September 2020, in Melbourne, Victoria. Upon a successful sperm retrieval, sperm was either used fresh for ICSI, frozen for future use or both. The outcome measures were sperm retrieval rate (SRR), and in vitro fertilisation (IVF)/ICSI results. Furthermore, SRR was calculated for the predominant causes and histopathological patterns. RESULTS The overall SRR was 61.2%. It was significantly higher in patients with a history of cryptorchidism and other childhood diseases (100%) than in the other NOA groups (P < 0.05). Patients with Klinefelter syndrome had a 75% SRR. Among the different types of testicular histology, the highest SRR were noted in patients with complete hyalinisation (100%) and hypospermatogenesis (92.9%), and low with Sertoli cell-only syndrome (46.3%). The SRR has significantly increased from 33.3% in 2015-2016 to 73.6% in 2019-2020 (P = 0.009). Of the 52 patients with SSR, 47 underwent IVF/ICSI. Fertilisation rate was 42.4%. Twenty-nine couples achieved at least one good-quality embryo and had embryo transfer. Nineteen achieved pregnancy (40.4%), and in three patients a miscarriage resulted. CONCLUSIONS This is the first report from Australia showing that micro-TESE is an effective treatment for NOA with high SRR. The increasing success rates over several years indicate the importance of surgical skill and laboratory staff experience.
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Affiliation(s)
- Daniel Lantsberg
- Reproductive Services Unit, Reproductive Services Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Lis Maternity Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Men's Health Melbourne, Melbourne, Victoria, Australia
| | - Yossi Mizrachi
- Reproductive Services Unit, Reproductive Services Unit, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Darren J Katz
- Men's Health Melbourne, Melbourne, Victoria, Australia.,Department of Surgery, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, Western Health, Melbourne, Victoria, Australia
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11
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Allen M, Hale L, Lantsberg D, Kieu V, Stevens J, Stern C, Gardner DK, Mizrachi Y. Post-warming embryo morphology is associated with live birth: a cohort study of single vitrified-warmed blastocyst transfer cycles. J Assist Reprod Genet 2022; 39:417-425. [PMID: 35043277 PMCID: PMC8956752 DOI: 10.1007/s10815-021-02390-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose This study aims to examine whether blastocyst morphology post-warming correlates with live birth. Methods In this cohort study, morphological characteristics post-warming were reviewed in all single vitrified-warmed blastocyst transfer cycles performed between November 2016 and May 2017. Immediately before transfer, the degree of blastocoel re-expansion was graded as A, fully expanded; B, partially expanded ≥ 50%; C, partially expanded < 50%; and D, collapsed. The degree of post-warming cell survival was graded on a scale of 50 to 100% and was then classified into 4 groups: very low 50–70%, low 71–80%, moderate 81–90%, and high 91–100%. Results Overall, 612 cycles were reviewed, of which 196 included PGT-A tested embryos. The live birth rate (LBR) increased from 11.4% in the collapsed blastocysts group to 38.9% in the post-warming full re-expansion group (p < 0.001) and from 6.5% for blastocysts with a very low cell survival rate to 34.7% for blastocysts with high cell survival rate (p = 0.001). LBR was 6.7% for blastocysts with the worst post-warming morphological characteristics, namely, collapsed with very low cell survival rate. On multivariate analyses, partial blastocyst re-expansion ≥ 50%, full re-expansion, and high cell survival rate remained significantly associated with live birth, after controlling for female age, pre-vitrification morphological grading, and PGT-A. A sub-analysis of cycles using PGT-A tested embryos showed similar results. Conclusion Post-warming re-expansion and high cell survival rate are associated with higher LBR in euploid and untested blastocysts. However, embryos with poor post-warming morphology still demonstrate a considerable probability of live birth, and they should not be discarded. Supplementary Information The online version contains supplementary material available at 10.1007/s10815-021-02390-z.
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Affiliation(s)
| | | | - Daniel Lantsberg
- Reproductive Services Unit, The Royal Women's Hospital, Melbourne, VIC, Australia
| | - Violet Kieu
- Reproductive Services Unit, The Royal Women's Hospital, Melbourne, VIC, Australia
| | | | - Catharyn Stern
- Melbourne IVF, Melbourne, VIC, Australia.,Reproductive Services Unit, The Royal Women's Hospital, Melbourne, VIC, Australia
| | | | - Yossi Mizrachi
- Reproductive Services Unit, The Royal Women's Hospital, Melbourne, VIC, Australia.
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12
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Kieu V, Lantsberg D, Mizrachi Y, Stern C, Polyakov A, Teh WT. A survey study of endometrial receptivity tests and immunological treatments in in vitro fertilisation (IVF). Aust N Z J Obstet Gynaecol 2021; 62:306-311. [PMID: 34862795 DOI: 10.1111/ajo.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Suboptimal endometrial receptivity is a key factor behind in vitro fertilisation (IVF) implantation failure. Direct clinical tests of the endometrium of natural killer (NK) cells and endometrial receptivity analysis (ERA) are controversial. AIMS To examine the current practice of endometrial receptivity tests (NK cells and ERA) and immunological treatments (corticosteroids, anticoagulants, antiplatelets, intravenous immunoglobulin, Intralipid, other) among fertility specialists in Australia and New Zealand. METHODS A prospective 23-item web-based survey was distributed by email via the Fertility Society of Australia and New Zealand, between August and October 2020. Data were collected and analysed using Qualtrics. RESULTS Of 238 fertility specialists, 90 completed the survey (response rate 37.8%). ERA (48/90, 53.3%) was most commonly ordered, followed by uterine NK (uNK) (36/90, 40.0%) and peripheral blood NK (pNK) (12/90, 13.3%). For all tests, the most common indication was recurrent implantation failure (RIF) (41/48, 22/36, 6/12; 85.4%, 61.1%, and 50.0%, respectively for ERA, uNK and pNK). Of those that did not offer these tests, the main reason cited was insufficient evidence (30/42, 47/54, 68/78; 71.4%, 87.0%, and 87.0%). A third of specialists offered empirical immunological treatment for RIF (30/90, 33.3%): anticoagulants (28/30, 93.3%), antiplatelets (27/30, 90.0%), and corticosteroids (25/30; 83.3%). The majority of specialists (56/90, 62.2%) stated they had refused a patient request for endometrial testing or treatment. CONCLUSIONS Tests for presumed endometrial receptivity pathology are often used in Australia and New Zealand. Immunological treatments for RIF are commonly employed empirically, without strong evidence of their effectiveness or safety. Further studies should focus on education and clinical adherence to evidence-based guidelines.
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Affiliation(s)
- Violet Kieu
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Daniel Lantsberg
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Yossi Mizrachi
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Catharyn Stern
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Alex Polyakov
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
| | - Wan Tinn Teh
- Reproductive Services Unit, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics & Gynaecology, School of Medicine, The University of Melbourne, Parkville, Victoria, Australia.,Melbourne IVF, East Melbourne, Victoria, Australia
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13
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Amir H, Perl L, Barda S, Lantsberg D, Sege. Becker A, Israeli G, Azem F, Oren A. P–441 Semen quality and cryopreservation in adolescent transgender females. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
What are the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment?
Summary answer
Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI).
What is known already
The age of individuals seeking treatment for gender affirmation has fallen sharply in recent years and many of them are adolescents. Estrogen, the primary treatment for transgender women, is known to impair semen quality and fertility potential. Sperm cryopreservation enables young transgender females to circumvent GAH therapy-related fertility impairment and have genetically related children. There are recent data on semen quality among adult transgender women who preserve fertility before exposure to GAH therapy, but little is known about pubertal transgender female adolescents.
Study design, size, duration
This retrospective cohort study included 26 adolescent transgender females who underwent FP between June 2013 and October 2020.
Participants/materials, setting, methods
Before initiating gonadotropin-releasing hormone agonists solely or with GAH treatment, 25 adolescent transgender females were referred to FP in our Fertility Institute of a tertiary university-affiliated medical center. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of selected medical and lifestyle factors on the semen quality of our study participants.
Main results and the role of chance
The mean age at which adolescent transgender females underwent sperm cryopreservation was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data on semen quality in the general population of unscreened men, including volume (1.46 ml vs 3.2 ml, respectively, P = 0.001 ), sperm concertation (28*106/ml vs 64*106/ml, P < 0.001), total sperm number (28.2*106 vs 196*106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17*106 per vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. Attention-deficit/hyperactivity disorder (ADHD) diagnosis, history of depression/anxiety, medication for ADHD, and antidepressant drugs were found to correlate with hypospermia. No correlation was found between the time of FP, body mass index, autistic spectrum disorder diagnosis, cannabis use, testis tucking, or the levels of follicle-stimulating hormone, estradiol, and testosterone on the semen parameters.
Limitations, reasons for caution
Because no normal values of semen in adolescents are available and the absence of a matched control group, we used WHO 2010 semen data as reference values, and they may not be representative of the adolescent population.
Wider implications of the findings: Although adolescent transgender females have poor semen quality and limited stored semen samples suitable for advanced ART interventions, even before starting GAH therapy, we highly recommend sperm cryopreservation before initiating GAH treatment and thereby prevent further impairment of sperm quality associated with the hormonal treatment.
Trial registration number
Not applicable
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Affiliation(s)
- H Amir
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - L Perl
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - S Barda
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - D Lantsberg
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - A Sege. Becker
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - G Israeli
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - F Azem
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Racine IVF Unit- Fertility Institute- Lis Maternity Hospital, Tel Aviv, Israel
| | - A Oren
- Tel Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine- Tel Aviv University, Pediatric Endocrinology and Diabetes Unit- Dana-Dwek Children’s Hospital, Tel Aviv, Israel
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14
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Amir H, Perl L, Barda S, Lantsberg D, Becker AS, Israeli G, Azem F, Oren A. Adolescent Transgender Females Present Impaired Semen Quality That Is Suitable for Intracytoplasmic Sperm Injection Even Before Initiating Gender-Affirming Hormone Treatment. Reprod Sci 2021; 29:260-269. [PMID: 33788173 DOI: 10.1007/s43032-021-00561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
The present study aimed to determine the semen quality and cryopreservation outcomes among adolescent transgender females at the time of fertility preservation (FP) before initiating gender-affirming hormone (GAH) treatment. This retrospective cohort study included 26 adolescent transgender females who underwent FP in our Fertility Institute between 06/2013 and 10/2020. Pre-freezing semen parameters were compared to WHO 2010 reference values. Post-thaw semen parameters were used to determine the adequate assisted reproductive technology (ART). A multivariate linear regression analysis was performed to assess the impact of medical and lifestyle factors on semen quality. The mean age at which adolescent transgender females underwent FP was 16.2 ± 1.38 years. The median values of all semen parameters in our study group were significantly lower compared to the WHO data, including volume (1.46 mL vs 3.2 mL, respectively, P = 0.001 ), sperm concentration (28 × 106/mL vs 64 × 106/mL, P < 0.001), total sperm number (28.2 × 106 vs 196 × 106, P < 0.001), total motility (51.6% vs 62%, P < 0.001), and normal morphology (2% vs 14%, P < 0.001). The frequency of semen abnormalities was teratozoospermia 72%, hypospermia 52%, oligozoospermia 28%, and azoospermia 4%. The median post-thaw total motile count was 0.17 × 106/vial, and the quality was adequate only for ICSI in 87.7% of the thawed semen samples. No correlation was found between selected medical and lifestyle factors and poor semen parameters. Semen quality is strongly reduced among adolescent transgender females before hormone therapy and their stored sperm samples are suitable for intracytoplasmic sperm injection (ICSI) rather than conventional IVF/intrauterine insemination (IUI).
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Liat Perl
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Fertility Institute, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Oiknine-Djian E, Bar-On S, Laskov I, Lantsberg D, Haynes RK, Panet A, Wolf DG. Artemisone demonstrates synergistic antiviral activity in combination with approved and experimental drugs active against human cytomegalovirus. Antiviral Res 2019; 172:104639. [PMID: 31654672 DOI: 10.1016/j.antiviral.2019.104639] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 12/30/2022]
Abstract
We have recently shown that the artemisinin derivative artemisone, which was screened against malaria in human clinical studies, is a potent inhibitor of human cytomegalovirus (HCMV). Here we evaluated the antiviral effect of artemisone when employed in 2-drug combinations with approved and experimental anti-HCMV agents. Using the Chou-Talalay method, we found that in-vitro combination of artemisone with cidofovir, brincidofovir, or with the HCMV UL97 inhibitor maribavir resulted in antiviral synergism and the combination of artemisone with ganciclovir or with the viral terminase inhibitors letermovir and BDCRB resulted in moderate synergism. Importantly, the combination of artemisone with maribavir demonstrated synergistic antiviral activity ex-vivo, in a clinically-relevant multicellular model of human placental tissues maintained in organ culture. Our findings provide the basis for the use of artemisone in synergistically acting drug combinations, to enhance viral control and reduce antiviral drug toxicities.
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Affiliation(s)
- Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Department of Biochemistry and the Chanock Center for Virology, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel; The Lautenberg Center for General and Tumor Immunology, IMRIC, The Hebrew University, Israel
| | - Shikma Bar-On
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Laskov
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Richard K Haynes
- Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Amos Panet
- Department of Biochemistry and the Chanock Center for Virology, IMRIC, The Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel; The Lautenberg Center for General and Tumor Immunology, IMRIC, The Hebrew University, Israel.
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16
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Lantsberg D, Fernando S, Cohen Y, Rombauts L. The Role of Fertility Preservation in Women with Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2019; 27:362-372. [PMID: 31546067 DOI: 10.1016/j.jmig.2019.09.780] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/01/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To summarize the available evidence concerning fertility preservation techniques in the context of women with endometriosis. DATA SOURCES We searched for studies published between 1984 and 2019 on endometriosis and Assisted Reproductive Technology outcomes. We searched MEDLINE and PubMed and performed a manual search of reference lists within identified studies. METHODS OF STUDY SELECTION A total of 426 articles were identified, and 7 studies were eligible to be included for the systematic review. We included all published studies, excluding reviews, case reports, and animal studies. TABULATION, INTEGRATION, AND RESULTS Despite a significant increase in the number of studies addressing fertility preservation over the study period, we found a relative lack of evidence addressing the use of fertility preservation techniques in women with endometriosis. The studies identified included 2 case reports, 1 histological science study, and 4 retrospective cohort studies. CONCLUSION Women with endometriosis may benefit from fertility preservation techniques. However, there currently is a paucity of data in this population, especially when compared with other indications for fertility preservation. Although much knowledge can be translated from the oncofertility discipline, we have identified and discussed endometriosis-related changes to ovarian reserve and oocyte health that justify further well-designed research to confirm that fertility preservation outcomes are similar for women with endometriosis.
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Affiliation(s)
- Daniel Lantsberg
- Department of Obstetrics, Gynecology and Fertility, Lis Maternity Hospital (Drs. Lantsberg and Cohen); Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel.
| | - Shavi Fernando
- Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Women's Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia
| | - Yoni Cohen
- Sourasky Tel-Aviv Medical Center (Drs. Lantsberg and Cohen), and Sackler Faculty of Medicine (Drs. Lantsberg and Cohen), Tel-Aviv University, Israel
| | - Luk Rombauts
- Department of Obstetrics and Gynecology, Monash University, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Women's Health, Monash Health, Clayton (Prof. Rombauts and Dr. Fernando), Australia; Monash IVF Group, Richmond (Prof Rombauts), Australia
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17
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Lantsberg D, Farhi A, Zaslavsky-Paltiel I, Silverman BG, Lerner-Geva L, Orvieto R. Deliveries following fertility preservation by ovarian tissue cryopreservation without autotransplantation-what should be expected? J Assist Reprod Genet 2018; 36:335-340. [PMID: 30374733 DOI: 10.1007/s10815-018-1341-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/12/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the delivery rate and to characterize patients following ovarian tissue cryopreservation (OTCP) who did not undergo auto-transplantation. METHODS AND MATERIALS All consecutive cancer patients admitted to our IVF unit, from January 2004 to December 2015, who underwent OTCP for the purpose of fertility preservation without autotransplantation were analyzed. The cohort included 338 patients and was linked to the National Live Birth registry of the Israel Ministry of Health in order to determine whether the women delivered following the cancer diagnosis. MAIN OUTCOME MEASURES Delivery rate following OTCP without autotransplantation. RESULTS During 6.4 years of follow-up, 30% of the patients delivered, with no differences in gravity, age at first diagnosis of cancer, type of malignancy, or the prevalence of relapse of malignancy between those who delivered and those who did not. Moreover, in multivariate analysis, those undergoing OTCP before the age of 30 and those suffering from breast cancer had significantly higher odds to conceive and deliver following cancer treatment without the need of autotransplantation. CONCLUSIONS Further studies are required to elucidate the appropriate subgroup of patients with breast cancer under the age of 30 years, who will need OTCP. This information might aid both fertility specialists' counseling and their oncological patients in pursuing the appropriate fertility preservation strategy.
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Affiliation(s)
- Daniel Lantsberg
- IVF Unit, Obstetric and Gynecology Department, Sheba Medical Center, Tel Hashomer, Israel. .,Lis Maternity and Women's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adel Farhi
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research Ltd, Tel Hashomer, Israel
| | - Inna Zaslavsky-Paltiel
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research Ltd, Tel Hashomer, Israel
| | - Barbara G Silverman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel National Cancer Registry, Israel Ministry of Health, Tel Aviv, Israel
| | - Liat Lerner-Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Women and Children's Health Research Unit, Gertner Institute for Epidemiology & Health Policy Research Ltd, Tel Hashomer, Israel
| | - Raoul Orvieto
- IVF Unit, Obstetric and Gynecology Department, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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18
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Orvieto R, Feldman N, Lantsberg D, Manela D, Zilberberg E, Haas J. Natural cycle frozen-thawed embryo transfer-can we improve cycle outcome? J Assist Reprod Genet 2016; 33:611-615. [PMID: 26973337 DOI: 10.1007/s10815-016-0685-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Several replacement protocols for frozen-thawed ET (FET) exist, with no advantage of one protocol over the others. In the present study, we aim to evaluate the outcome of natural cycle FET with modified luteal support. METHODS All consecutive patients undergoing natural or artificial hormone replacement (AHR) day-2/3 FET cycles between May 2012 and June 2015 in our IVF unit were evaluated. While AHR FET cycles were consistent, those undergoing natural cycle FET received progesterone luteal support, and from June 2014, patients received two additional injections, one of recombinant hCG and the other of GnRH-agonist, on day of transfer and 4 days later, respectively (modified luteal support). RESULTS Patients' clinical characteristics and laboratory/embryological variables were comparable between those undergoing natural vs. AHR cycles, during the earlier as compared to the later period. Moreover, while implantation, clinical, and ongoing pregnancy rates were significantly higher during the later period in patients undergoing the natural cycle FET with the modified luteal support (31, 51, and 46 %, respectively), as compared to natural (17, 26, and 20 %, respectively), or AHR FET in the late study period (15, 22, and 17 %, respectively), the natural cycle FET without the additional two injections yielded the same results, as the AHR cycles. CONCLUSIONS We therefore suggest that in ovulatory patients undergoing FET, natural cycle FET with the modified luteal support should be the preparation protocol of choice. Further large prospective studies are needed to elucidate the aforementioned recommendation prior to its routine implementation.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Feldman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Manela
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Zilberberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Perri T, Lantsberg D, Ben-Baruch G, Beiner ME, Jakobson-Setton A, Korach J. Malignant Pericardial Effusion in Ovarian Malignancy: A Treatable Oncologic Emergency. J Emerg Med 2015; 49:281-3. [PMID: 26149806 DOI: 10.1016/j.jemermed.2015.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pericardial tamponade is a life-threatening condition that can occur, albeit rarely, in patients with ovarian cancer. Whether or not prolonged survival is possible after such an event is debatable. Our aim was to describe our experience with seven ovarian cancer patients who experienced malignant cardiac tamponade at tumor diagnosis or at recurrence. CASE REPORT Six patients were treated with pericardiocentesis and one with pericardial fenestration. Survival after tamponade ranged from 3 to 72 weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We suggest that when pericardial effusion occurs in patients with recurrent ovarian cancer, timely diagnosis and proper management might allow palliation and prolongation of life.
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Affiliation(s)
- Tamar Perri
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Lantsberg
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Ben-Baruch
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario E Beiner
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariella Jakobson-Setton
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Korach
- Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Haas J, Lantsberg D, Feldman N, Manela D, Machtinger R, Dar S, Rabinovici J, Orvieto R. Modifying the luteal phase support in natural cycle frozen-thawed embryo transfer improves cycle outcome. Gynecol Endocrinol 2015; 31:891-3. [PMID: 26288149 DOI: 10.3109/09513590.2015.1075502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With the recent trend toward single embryo transfer (ET), cryopreservation of extraneous embryos is becoming increasingly prevalent. Several replacement protocols for frozen-thawed ET (FET) exist, with no advantage of one protocol over the others. All consecutive patients undergoing natural cycle Day-3 FET cycles between May 2012 and March 2015 in our IVF unit were evaluated. While following spontaneous ovulation, all patients received progesterone luteal support. Since June 2014, patients underwent the same aforementioned natural cycle FET cycles, with two additional injections, one of recombinant hCG (250 mcg) and the other of GnRH-agonist (triptorelin 0.1 mg), on the day of transfer and 4 d later, respectively. While the patients' clinical characteristics, the prevalence of embryos that survived the thawing process and the number of embryos transferred were comparable between the earlier as compared with the later period, implantation rate, positive β-hCG, clinical, and ongoing pregnancy rates were significantly higher during the later period. We, therefore, suggest that when natural cycle FET is offered, the addition of two injections of recombinant hCG and GnRH-agonist, on the day of transfer and 4 d later, respectively, might increase clinical pregancy rates. Further large prospective studies are needed to elucidate the aforementioned recommendation prior to its routine implementation.
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Affiliation(s)
- Jigal Haas
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Daniel Lantsberg
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Noa Feldman
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Daphna Manela
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Ronit Machtinger
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Shir Dar
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Jaron Rabinovici
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Raoul Orvieto
- a Department of Obstetrics and Gynecology , Chaim Sheba Medical Center (Tel Hashomer) , Ramat Gan , Israel and
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Lantsberg D, Yinon Y, Dulitzky M, Sivan E, Shif E, Mazaki-Tovi S. 458: Is there a disparity in the rate of pregnancy complications among patients diagnosed with cancers prevalent during child-bearing age? Evidence from a large population-based cohort study. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Orvieto R, Dratviman-Storobinsky O, Lantsberg D, Haas J, Mashiach R, Cohen Y. Interleukin-2 and SOCS-1 proteins involvement in the pathophysiology of severe ovarian hyperstimulation syndrome--a preliminary proof of concept. J Ovarian Res 2014; 7:106. [PMID: 25424734 PMCID: PMC4255649 DOI: 10.1186/s13048-014-0106-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/29/2014] [Indexed: 12/15/2022] Open
Abstract
Background Ovarian hyperstimulation syndrome (OHSS), is characterized by marked ovarian enlargement and acute third space fluid sequestration that almost always develops after hCG administration or in early pregnancy. OHSS is similar to vascular leak syndrome (VLS), which may be attributable to the massive increase in systemic inflammatory cytokines. In the present pilot exploratory case series, we sought to evaluate interleukin (IL)-2 and suppressor of cytokine signaling (SOCS)-1 expressions in the peripheral blood mononuclear cells (PBMCs) of patients suffering from severe ovarian hypertimulation syndrome (OHSS), and to examine whether their expressions differ when compared to PBMCs originated from normal early pregnant women (without OHSS). Methods Interleukin-2 and SOCS-1 mRNA expressions were examined in PBMCs of 5 women who were hospitalized due to severe OHSS (OHSS group) and 5 women with early IVF pregnancies and without OHSS (control group). Results Interleukin-2 mRNA levels in PBMCs were significantly higher in the OHSS as compared to the control groups. Moreover, while SOCS-1 mRNA levels were non-significantly lower, the ratio between IL-2 and SOCS-1 mRNA levels was significantly higher in the OHSS, as compared to the control group. Conclusions The inflammatory response to hCG, leading to dysregulation of Il-2 expression and SOCS activation, might be the culprit of OHSS. Additional large prospective studies are required to elucidate the effect of hCG on patients’ inherited inflammatory cascades, which may help discriminating those at risk to develop severe OHSS from those who are not.
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Affiliation(s)
- Raoul Orvieto
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Olga Dratviman-Storobinsky
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Daniel Lantsberg
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yoram Cohen
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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