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Johnston M, Fuscaldo G, Sutton E, Hunt S, Zander-Fox D, Rombauts L, Mills C. Storage trends, usage and disposition outcomes following egg freezing. Reprod Biomed Online 2024; 48:103728. [PMID: 38330858 DOI: 10.1016/j.rbmo.2023.103728] [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: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 02/10/2024]
Abstract
RESEARCH QUESTION What happens to eggs after egg freezing? DESIGN A retrospective cohort study was performed spanning 2012-2022. Data were obtained from seven assisted reproductive technology clinics in Victoria, Australia. Aggregated, de-identified data were collected on cycles that resulted in egg freezing and the following outcomes, including treatment involving thawed eggs and disposition outcomes of surplus eggs. RESULTS The number of patients with eggs in storage grew rapidly from 144 in 2012 to 2015 in 2022. In 2022, 73% of patients had stored their eggs for <5 years, 25% for 5-10 years, and 2% for ≥10 years. Most thaw cycles (600/645, 93%) involved eggs that had been frozen for <5 years, of which 47% had been frozen for <6 months. Overall, the live birth rate per initiated thaw cycle was 12%. Across the study period, 2800 eggs from 286 patients were either discarded, donated or exported. Of the 128 patients who discarded their eggs, 32% had stored their eggs for <5 years, 32% for 5-10 years and 36% for >10 years. Of the 23 patients who donated their eggs to someone else, all but four had stored their eggs for <5 years. No eggs were donated to research over the study period. CONCLUSIONS This study shows that very few patients have made the decision to use or relinquish their eggs. Strategies may be needed to address the prolonged storage of surplus eggs, and ensure that patients are supported to make decisions regarding the fate of their eggs which align with their preferences and values.
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Affiliation(s)
- Molly Johnston
- Monash Bioethics Centre, Monash University, Clayton, Australia.
| | | | | | - Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash IVF, Clayton, Australia
| | - Deirdre Zander-Fox
- Monash IVF, Clayton, Australia; Biomedicine Discovery Institute, Monash University, Clayton, Australia; School of Biomedicine, University of Adelaide, Adelaide, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia; Monash IVF, Clayton, Australia
| | - Catherine Mills
- Monash Bioethics Centre, Monash University, Clayton, Australia
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Lin T, Allaire C, As-Sanie S, Stratton P, Vincent K, Adamson GD, Arendt-Nielsen L, Bush D, Jansen F, Longpre J, Rombauts L, Shah J, Toussaint A, Hummelshoj L, Missmer SA, Yong PJ. World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonization Project: V. physical examination standards in endometriosis research. Fertil Steril 2024:S0015-0282(24)00178-X. [PMID: 38508508 DOI: 10.1016/j.fertnstert.2024.03.007] [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: 03/06/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The World Endometriosis Research Foundation (WERF) established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, four data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies. DESIGN An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards that underwent multiple rounds of iterations and revisions. SUBJECTS N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect physical examination (EPHect-PE) tool provides standardised assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of a) back and pelvic girdle; b) abdomen including allodynia and trigger points; c) vulva including provoked vestibulodynia; d) pelvic floor muscle tone and tenderness; e) tenderness on unidigital pelvic exam; f) presence of pelvic nodularity; g) uterine size and mobility; h) presence of adnexal masses; i) presence of incisional masses; j) speculum examination; k) tenderness and allodynia at an extra-pelvic site (e.g. forearm); and l) recording of anthropometrics. CONCLUSION(S) The EPHect physical examination standards (EPHect-PE) will facilitate the standardised documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain.
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Affiliation(s)
- Tinya Lin
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - G David Adamson
- World Endometriosis Research Foundation (WERF); Stanford University, Palo Alto, California, USA
| | - Lars Arendt-Nielsen
- Aalborg University, Aalborg, Denmark; Aalborg University Hospital, Mech-Sense, Aalborg, Denmark
| | | | - Femke Jansen
- World Endometriosis Organisations (WEO); EndoHome, Belgium
| | | | - Luk Rombauts
- World Endometriosis Research Foundation (WERF); Monash University, Clayton, Victoria, Australia
| | - Jay Shah
- National Institutes of Health, Bethesda, Maryland, USA
| | - Abeesha Toussaint
- World Endometriosis Organisations (WEO); Trinidad and Tobago Endometriosis Association, Trinidad and Tobago
| | | | - Stacy A Missmer
- World Endometriosis Research Foundation (WERF); Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA; Michigan State University, Grand Rapids, Michigan, USA
| | - Paul J Yong
- University of British Columbia, Vancouver, British Columbia, Canada.
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Gallagher S, Attinger S, Sassano A, Sutton E, Kerridge I, Newson A, Farsides B, Hammarberg K, Hart R, Jackson E, Ledger W, Mayes C, Mills C, Norcross S, Norman RJ, Rombauts L, Waldby C, Yazdani A, Lipworth W. Medicine in the marketplace: clinician and patient views on commercial influences on assisted reproductive technology. Reprod Biomed Online 2024; 48:103850. [PMID: 38582042 DOI: 10.1016/j.rbmo.2024.103850] [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: 07/20/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 04/08/2024]
Abstract
RESEARCH QUESTION What are the views and experiences of patient and expert stakeholders on the positive and negative impacts of commercial influences on the provision of assisted reproductive technology (ART) services, and what are their suggestions for governance reforms? DESIGN Semi-structured interviews were conducted with 31 ART industry experts from across Australia and New Zealand and 25 patients undergoing ART from metropolitan and regional Australia, between September 2020 and September 2021. Data were analysed using thematic analysis. RESULTS Expert and patient participants considered that commercial forces influence the provision of ART in a number of positive ways - increasing sustainability, ensuring consistency in standards and providing patients with greater choice. Participants also considered commercial forces to have a number of negative impacts, including increased costs to government and patients; the excessive use of interventions that lack sufficient evidence to be considered part of standard care; inadequately informed consent (particularly with regard to financial information); and threats to patient-provider relationships and patient-centred care. Participants varied in whether they believed that professional self-regulation is sufficient. While recognizing the benefits of commercial investment in healthcare, many considered that regulatory reforms, as well as organizational cultural initiatives, are needed as means to ensure the primacy of patient well-being. CONCLUSIONS The views expressed in this study should be systematically and critically examined to derive insights into how best to govern ART. These insights may also inform the design and delivery of other types of healthcare that are provided in the private sector.
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Affiliation(s)
- Siun Gallagher
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Sara Attinger
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Elizabeth Sutton
- Monash Bioethics Centre, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia
| | - Ian Kerridge
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Haematology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ainsley Newson
- Sydney Health Ethics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Bobbie Farsides
- Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, UK
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Roger Hart
- Obstetrics and Gynaecology, UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | | | - William Ledger
- School of Women's and Children's Health, University of New South Wales, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Christopher Mayes
- Alfred Deakin Institute of Citizenship and Globalisation, Deakin University, Waurn Ponds, Victoria, Australia
| | - Catherine Mills
- Monash Bioethics Centre, School of Philosophical, Historical and International Studies, Monash University, Clayton, Victoria, Australia
| | | | - Robert J Norman
- The Robinson Research Institute, School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Catherine Waldby
- Research School of Social Sciences, ANU College of Arts and Social Sciences, Canberra, Australian Capital Territory, Australia
| | - Anusch Yazdani
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Wendy Lipworth
- Department of Philosophy, Macquarie University, Sydney, New South Wales, Australia
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4
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Zander-Fox D, Green M, Watson K, Turner R, Bakos HW, Foo J, Pacella-Ince L, Caddy M, McPherson NO, Rombauts L. Improved fertilization, degeneration, and embryo quality rates with PIEZO-intracytoplasmic sperm injection compared with conventional intracytoplasmic sperm injection: a sibling oocyte split multicenter trial. Fertil Steril 2024:S0015-0282(24)00031-1. [PMID: 38272382 DOI: 10.1016/j.fertnstert.2024.01.028] [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: 08/15/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To investigate whether PIEZO-intracytoplasmic sperm injection (PIEZO-ICSI) increases the fertilization rate, decreases the degeneration rate, and increases the utilization rate per oocyte injected compared with conventional intracytoplasmic sperm injection (ICSI). DESIGN Sibling oocyte split multicenter trial. SETTING Fertility clinics. PATIENTS Women with a diagnosis of infertility who used ICSI as their method of insemination and had ≥6 mature oocytes for injection. INTERVENTIONS Participants had their mature oocyte cohort divided, where half were injected using conventional ICSI and the other half were injected using PIEZO-ICSI. For patients with an uneven oocyte number, the extra oocyte was injected using conventional ICSI. The injection technique used first was also randomized to ensure that there was no bias due to order of injection. MAIN OUTCOME MEASURE The primary outcome measure was the fertilization rate after injection. RESULTS A total of 108 patients underwent a sibling split use of conventional ICSI and PIEZO-ICSI. The fertilization rate was 71.6% in PIEZO-ICSI, which significantly increased compared with that in conventional ICSI 65.6%. In addition, the oocyte degeneration rate decreased in PIEZO-ICSI compared with that in conventional ICSI (6.3% vs. 12.1% respectively), and the blastocyst quality increased, as measured by the number of grade A and B quality blastocysts present on day 5 of development (33.3% vs. 27.5%). No significant differences in the aneuploidy or utilization rate, clinical pregnancy, or live birth outcome after single embryo transfer were noted between the two injection techniques. CONCLUSIONS This trial supports the possibility that PIEZO-ICSI increases the fertilization rates, decreases the oocyte degeneration rates, and increases the blastocyst quality compared with conventional ICSI; however, it does not appear to influence the clinical pregnancy or live birth rate per transfer. CLINICIAN TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry ACTRN12620000407998.
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Affiliation(s)
- Deirdre Zander-Fox
- Monash IVF Group, Melbourne, Victoria, Australia; School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia.
| | - Mark Green
- Monash IVF Group, Melbourne, Victoria, Australia; School of BioSciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Watson
- Monash IVF Group, Melbourne, Victoria, Australia
| | - Ross Turner
- Monash IVF Group, Melbourne, Victoria, Australia
| | - Hassan W Bakos
- Monash IVF Group, Melbourne, Victoria, Australia; School of Environmental and Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Newcastle, New South Wales
| | - Jinny Foo
- Monash IVF Group, Melbourne, Victoria, Australia
| | - Leanne Pacella-Ince
- Monash IVF Group, Melbourne, Victoria, Australia; School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Nicole O McPherson
- Monash IVF Group, Melbourne, Victoria, Australia; School of Biomedicine, University of Adelaide, Adelaide, South Australia, Australia; Freemasons Centre for Male Health and Wellbeing, University of Adelaide, Adelaide, South Australia, Australia
| | - Luk Rombauts
- Monash IVF Group, Melbourne, Victoria, Australia; Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
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5
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Samarasekera T, Willats E, Green MP, Hardy T, Rombauts L, Zander-Fox D. Impact of male age on paternal aneuploidy: single-nucleotide polymorphism microarray outcomes following blastocyst biopsy. Reprod Biomed Online 2023; 47:103245. [PMID: 37619516 DOI: 10.1016/j.rbmo.2023.06.002] [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: 01/23/2023] [Revised: 04/20/2023] [Accepted: 06/06/2023] [Indexed: 08/26/2023]
Abstract
RESEARCH QUESTION Does advanced paternal age (APA; ≥40 years) contribute to a higher incidence of paternal origin aneuploidy in preimplantation embryos? DESIGN This was a multicentre retrospective study of single-nucleotide polymorphism (SNP) microarray (Natera and Karyomapping) preimplantation genetic testing (PGT) outcomes of blastocyst-stage embryos. Whole-chromosome aneuploidy analysis was performed on 2409 embryos from 389 male patients undertaking 681 assisted reproductive technology (ART) cycles between 2012-2021. Segmental aneuploidy analysis was performed on 867 embryos from 140 men undertaking 242 ART cycles between 2016-2021. Embryos were grouped based on paternal age at sperm collection: <35, 35-39 and ≥40 years. Paternal and maternal origin aneuploidy rates were compared between groups using chi-squared and/or Fisher's exact tests. RESULTS There was no significant difference across groups in paternal origin whole-chromosome aneuploidy rate, overall (P=0.7561) or when segregated by type (trisomy and monosomy: P=0.2235 and 0.8156) or complexity (single versus 2, 3 or ≥4 aneuploidies: P=0.9733, 0.7517, 0.669 and 0.1481). Conversely, maternal origin whole-chromosome aneuploidy rate differed across groups (P<0.0001) in alignment with differing mean maternal age (P<0.001). Paternal origin deletions were 2.9-fold higher than maternal origin deletions (P=0.0084), independent of age stratification. No significant difference in paternal origin deletions was observed with APA ≥40 compared with the younger age groups (4.8% versus 2.5% and 2.8%, P=0.5292). Individual chromosome aneuploidy rates were too low to perform statistical comparisons. CONCLUSIONS No significant association was found between APA and the incidence of paternal origin aneuploidy in preimplantation embryos, irrespective of type or complexity. Thus, APA may not be an indication for PGT.
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Affiliation(s)
| | | | - Mark P Green
- Monash IVF, Melbourne, Australia.; School of Biosciences, Faculty of Science, University of Melbourne, Melbourne, Australia
| | | | - Luk Rombauts
- Monash IVF, Melbourne, Australia.; Monash Health, Melbourne, Australia.; Biomedicine Discovery Institute, Faculty of Biomedical Sciences, Monash University, Melbourne, Australia
| | - Deirdre Zander-Fox
- Monash IVF, Melbourne, Australia.; Biomedicine Discovery Institute, Faculty of Biomedical Sciences, Monash University, Melbourne, Australia.; School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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6
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Armour M, Ciccia D, Yazdani A, Rombauts L, Niekerk LV, Schubert R, Abbott J. Endometriosis research priorities in Australia. Aust N Z J Obstet Gynaecol 2023; 63:594-598. [PMID: 37226362 DOI: 10.1111/ajo.13699] [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: 01/16/2023] [Accepted: 05/03/2023] [Indexed: 05/26/2023]
Abstract
In Australia, endometriosis affects one in nine women and those assigned female at birth. Although endometriosis is more common than conditions such as diabetes, research funding for endometriosis research has historically been low in comparison. The National Action Plan for Endometriosis is an Australian Federal Government initiative designed to redress this imbalance, with a focus on research funding. Identification of research priorities, and subsequent funding allocation that is determined by consumer input is vital. An online survey focusing on Australia and New Zealand found that the highest general priorities were the treatment and management of endometriosis and its cause(s).
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Affiliation(s)
- Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Medical Research Institute of New Zealand (MRINZ), Wellington, New Zealand
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Donna Ciccia
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Endometriosis Australia, Sydney, New South Wales, Australia
| | - Anusch Yazdani
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Leesa Van Niekerk
- Senior Lecturer/Clinical Psychologist, School of Psychological Sciences, University of Tasmania, Hobart, Tasmania, Australia
| | - Ruth Schubert
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Abbott
- School of Clinical Medicine, Health and Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Gynaecological Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia
- Prince of Wales Private Hospital, New South Wales, Sydney, Australia
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7
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Caddy M, Popkiss S, Weston G, Vollenhoven B, Rombauts L, Green M, Zander-Fox D. PIEZO-ICSI increases fertilization rates compared with conventional ICSI in patients with poor prognosis. J Assist Reprod Genet 2023; 40:389-398. [PMID: 36586007 PMCID: PMC9935778 DOI: 10.1007/s10815-022-02701-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/17/2022] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Limited research has been published comparing PIEZO-ICSI with conventional ICSI. While positive effects have been documented in improving fertilization and degeneration, the outcomes in patients with previous poor results from conventional ICSI remain unclear. It is hypothesized that these patients may benefit the most from this form of insemination. METHODS This retrospective paired within-patient cohort study investigated patients (n=72) undertaking PIEZO-ICSI after a previous conventional ICSI cycle resulted in poor outcomes (including low fertilization (<50%), high degeneration (>15%), and/or poor embryo development and utilization). Patients required at least five oocytes collected in both cycles and a period of less than 2 years between the cycles. The outcomes of both cycles were compared in respect to fertilization, degeneration, embryo utilization, and pregnancy rates. Further analyses were applied to patients <38 and ≥38 years of age, with <50% or ≥50% fertilization with conventional ICSI and with <20% or ≥20% utilization with conventional ICSI. RESULTS PIEZO-ICSI resulted in significantly higher fertilization (61.9% vs 45.3%, P<0.0001) and lower degeneration (7.7% vs 18.2%, P=0.0001) when compared to the conventional ICSI cycles. The greatest benefit was seen in patients who had less than 50% fertilization or <20% utilization in their conventional ICSI cycle, with improvements in fertilization and degeneration rates resulting in a significantly higher number of embryos utilized (frozen or transferred) per cycle. CONCLUSIONS PIEZO-ICSI improved fertilization, degeneration, and utilization rates in patients with previous poor outcomes from conventional ICSI. The number of embryos available for use per cycle was also increased. Further significant improvements were achieved in patients who exhibited poor fertilization (<50%) or low utilization (<20%) from conventional ICSI.
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Affiliation(s)
- Melissa Caddy
- Monash IVF, Melbourne, Australia.
- Monash IVF Group, 252-256 Clayton Rd, Clayton, Victoria, 3168, Australia.
| | | | - Gareth Weston
- Monash IVF, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Beverley Vollenhoven
- Monash IVF, Melbourne, Australia
- Monash Health, Melbourne, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
| | - Luk Rombauts
- Monash IVF, Melbourne, Australia
- Monash Health, Melbourne, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
| | - Mark Green
- Monash IVF, Melbourne, Australia
- School of BioSciences, University of Melbourne, Melbourne, Australia
| | - Deirdre Zander-Fox
- Monash IVF, Melbourne, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Science, Monash University, Melbourne, Australia
- University of Adelaide, Adelaide, Australia
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Catford SR, Halliday J, Lewis S, O'Bryan MK, Handelsman DJ, Hart RJ, McBain J, Rombauts L, Amor DJ, Saffery R, McLachlan RI. The metabolic health of young men conceived using intracytoplasmic sperm injection. Hum Reprod 2022; 37:2908-2920. [PMID: 36166702 DOI: 10.1093/humrep/deac212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/08/2021] [Revised: 08/18/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Is the metabolic health of men conceived using ICSI different to that of IVF and spontaneously conceived (SC) men? SUMMARY ANSWER ICSI-conceived men aged 18-24 years, compared with SC controls, showed differences in some metabolic parameters including higher resting diastolic blood pressure (BP) and homeostasis model assessment for insulin resistance (HOMA-IR) scores, although the metabolic parameters of ICSI- and IVF-conceived singleton men were more comparable. WHAT IS KNOWN ALREADY Some studies suggest that IVF-conceived offspring may have poorer cardiovascular and metabolic profiles than SC children. Few studies have examined the metabolic health of ICSI-conceived offspring. STUDY DESIGN, SIZE, DURATION This cohort study compared the metabolic health of ICSI-conceived men to IVF-conceived and SC controls who were derived from prior cohorts. Participants included 121 ICSI-conceived men (including 100 singletons), 74 IVF-conceived controls (all singletons) and 688 SC controls (including 662 singletons). PARTICIPANTS/MATERIALS, SETTING, METHODS Resting systolic and diastolic BP (measured using an automated sphygmomanometer), height, weight, BMI, body surface area and fasting serum metabolic markers including fasting insulin, glucose, total cholesterol, high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol, triglycerides, highly sensitive C-reactive protein (hsCRP) and HOMA-IR were compared between groups. Data were analysed using multivariable linear regression adjusted for various covariates including age and education level. MAIN RESULTS AND THE ROLE OF CHANCE After adjusting for covariates, compared to 688 SC controls, 121 ICSI-conceived men had higher diastolic BP (β 4.9, 95% CI 1.1-8.7), lower fasting glucose (β -0.7, 95% CI -0.9 to -0.5), higher fasting insulin (ratio 2.2, 95% CI 1.6-3.0), higher HOMA-IR (ratio 1.9, 95% CI 1.4-2.6), higher HDLC (β 0.2, 95% CI 0.07-0.3) and lower hsCRP (ratio 0.4, 95% CI 0.2-0.7) levels. Compared to 74 IVF-conceived singletons, only glucose differed in the ICSI-conceived singleton men (β -0.4, 95% CI -0.7 to -0.1). No differences were seen in the paternal infertility subgroups. LIMITATIONS, REASONS FOR CAUTION The recruitment rate of ICSI-conceived men in this study was low and potential for recruitment bias exists. The ICSI-conceived men, the IVF-conceived men and SC controls were from different cohorts with different birth years and different geographical locations. Assessment of study groups and controls was not contemporaneous, and the measurements differed for some outcomes (BP, insulin, glucose, lipids and hsCRP). WIDER IMPLICATIONS OF THE FINDINGS These observations require confirmation in a larger study with a focus on potential mechanisms. Further efforts to identify whether health differences are due to parental characteristics and/or factors related to the ICSI procedure are also necessary. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by an Australian National Health and Medical Research Council Partnership Grant (NHMRC APP1140706) and was partially funded by the Monash IVF Research and Education Foundation. S.R.C. was supported through an Australian Government Research Training Program Scholarship. R.J.H. is supported by an NHMRC project grant (634457), and J.H. and R.I.M. have been supported by the NHMRC as Senior and Principal Research Fellows respectively (J.H. fellowship number: 1021252; R.I.M. fellowship number: 1022327). L.R. is a minority shareholder and the Group Medical Director for Monash IVF Group, and reports personal fees from Monash IVF Group and Ferring Australia, honoraria from Ferring Australia and travel fees from Merck Serono and MSD and Guerbet; R.J.H. is the Medical Director of Fertility Specialists of Western Australia and has equity in Western IVF; R.I.M. is a consultant for and shareholder of Monash IVF Group and S.R.C. reports personal fees from Besins Healthcare and nonfinancial support from Merck outside of the submitted work. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S R Catford
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - J Halliday
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - S Lewis
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - M K O'Bryan
- The School of BioSciences and Bio21 Institute, Faculty of Science, University of Melbourne, Melbourne, Australia
| | - D J Handelsman
- The ANZAC Research Institute, University of Sydney, Sydney, Australia
- Department of Andrology, Concord Repatriation General Hospital, Sydney, Australia
| | - R J Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia
- Fertility Specialists of Western Australia, Perth, Australia
| | - J McBain
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
- Melbourne IVF, East Melbourne, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Australia
| | - L Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash IVF Group Pty Ltd, Melbourne, Australia
| | - D J Amor
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - R Saffery
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - R I McLachlan
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash IVF Group Pty Ltd, Melbourne, Australia
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Yiallourou SR, Magliano D, Haregu TN, Carrington MJ, Rolnik DL, Rombauts L, Rodrigues A, Ball J, Bruinsma FJ, Da Silva Costa F. Long term all-cause and cardiovascular disease mortality among women who undergo fertility treatment. Med J Aust 2022; 217:532-537. [PMID: 36209740 PMCID: PMC9827840 DOI: 10.5694/mja2.51734] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare age-adjusted all-cause and CVD mortality, relative to the general female population, for women registered for fertility treatment who received it and those who did not. DESIGN Prospective cohort study; analysis of Monash IVF clinical registries data, 1975-2018, linked with National Death Index mortality data. PARTICIPANTS All women who registered for fertility treatment at Monash IVF (Melbourne, Victoria), 1 January 1975 - 1 January 2014, followed until 31 December 2018. MAIN OUTCOME MEASURES Standardised mortality ratios (SMRs) for all-cause and CVD mortality, for women who did or did not undergo fertility treatment; SMRs stratified by area-level socio-economic disadvantage (SEIFA Index of Relative Socioeconomic Disadvantage [IRSD]) and (for women who underwent treatment), by stimulated cycle number and mean oocytes/cycle categories. RESULTS Of 44 149 women registered for fertility treatment, 33 520 underwent treatment (66.4%), 10 629 did not. After adjustment for age, both all-cause (SMR, 0.58; 95% CI, 0.54-0.62) and CVD mortality (SMR, 0.41; 95% CI, 0.32-0.53) were lower than for the general female population. All-cause mortality was similar for women registered with Monash IVF who did (SMR, 0.55; 95% CI, 0.50-0.60) or did not undergo fertility treatment (SMR, 0.63; 95% CI, 0.56-0.70). The SMR was lowest for both treated and untreated women in the fifth IRSD quintile (least disadvantage), but the difference was statistically significant only for untreated women. CVD mortality was lower for registered women who underwent fertility treatment (SMR, 0.29; 95% CI, 0.19-0.43) than for those who did not (SMR, 0.58; 95% CI, 0.42-0.81). CONCLUSION Fertility treatment does not increase long term all-cause or CVD mortality risk. Lower mortality among women registered for fertility treatment probably reflected their lower socio-economic disadvantage.
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Affiliation(s)
- Stephanie R Yiallourou
- Baker Heart and Diabetes InstituteMelbourneVIC,The Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVIC
| | - Dianna Magliano
- Baker Heart and Diabetes InstituteMelbourneVIC,Monash UniversityMelbourneVIC
| | - Tilahun N Haregu
- Baker Heart and Diabetes InstituteMelbourneVIC,Nossal Institute for Global Healththe University of MelbourneMelbourneVIC
| | | | | | - Luk Rombauts
- Monash HealthMelbourneVIC,Monash IVFMelbourneVIC
| | - Andre Rodrigues
- The Parent–Infant Research Institute, Austin HealthMelbourneVIC
| | | | - Fiona J Bruinsma
- Cancer Council VictoriaMelbourneVIC,Centre for Epidemiology and Biostatisticsthe University of MelbourneVIC
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10
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Shekibi M, Heng S, Wang Y, Samarajeewa N, Rombauts L, Nie G. Progesterone suppresses podocalyxin partly by up-regulating miR-145 and miR-199 in human endometrial epithelial cells to enhance receptivity in in-vitro models. Mol Hum Reprod 2022; 28:6705242. [PMID: 36124965 DOI: 10.1093/molehr/gaac034] [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: 03/14/2022] [Revised: 09/07/2022] [Indexed: 11/12/2022] Open
Abstract
Establishment of endometrial surface receptivity is crucial for the initiation of embryo implantation, yet the molecular mechanisms are not well understood especially in the human. We have recently discovered that podocalyxin (PODXL) is a critical negative regulator of human endometrial surface receptivity. PODXL is highly expressed in all epithelial and endothelial cells in the non-receptive endometrium, but down-regulated specifically in the luminal epithelium at receptivity. We have further shown that PODXL inhibits embryo implantation, and that PODXL down-regulation is essential for endometrial surface receptivity. Our previous study also indicated that progesterone down-regulates PODXL, however, the exact molecular regulations are unknown. Here we investigated whether progesterone suppresses PODXL via microRNAs (miRNAs). We first bioinformatically predicted 13 miRNAs that may potentially target human PODXL, then experimentally determined whether any of these 13 miRNAs are altered in primary human endometrial epithelial cells (HEECs) by progesterone, and whether the identified miRNAs can affect PODXL expression in Ishikawa cells without progesterone and alter receptivity to embryo implantation. Progesterone significantly up-regulated miR-145 and miR-199 while suppressing PODXL in HEECs. When these two miRNAs were transfected into Ishikawa cells, both significantly down-regulated PODXL mRNA and protein in the absence of progesterone. Moreover, both miR-145 and miR-199 significantly enhanced receptivity of the Ishikawa monolayer to embryo implantation in in-vitro models. This study thus provides in-vitro evidence that PODXL is down-regulated by progesterone partly via miR-145 and miR-199 during the development of human endometrial epithelial receptivity. These results also reveal the likely importance of hormonal regulation of microRNAs for embryo implantation.
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Affiliation(s)
- Manizha Shekibi
- School of Health and Biomedical Sciences, RMIT University, Victoria, Australia
| | - Sophea Heng
- School of Health and Biomedical Sciences, RMIT University, Victoria, Australia
| | - Yao Wang
- School of Health and Biomedical Sciences, RMIT University, Victoria, Australia
| | | | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,Womens and Newborn Programme, Monash Health, Clayton, Victoria, Australia
| | - Guiying Nie
- School of Health and Biomedical Sciences, RMIT University, Victoria, Australia.,Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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11
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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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12
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Liu Y, Ong K, Korman I, Turner R, Shaker D, Zander-Fox D, Rombauts L. The effect of day 5 blastocyst assessment timing on live birth prediction and development of a prediction algorithm. Reprod Biomed Online 2022; 44:609-616. [DOI: 10.1016/j.rbmo.2022.01.017] [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] [Received: 10/15/2021] [Revised: 12/30/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
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13
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Catford SR, Halliday J, Lewis S, O'Bryan MK, Handelsman DJ, Hart RJ, McBain J, Rombauts L, Amor DJ, Saffery R, McLachlan RI. Reproductive function in men conceived with in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril 2022; 117:727-737. [PMID: 35120745 DOI: 10.1016/j.fertnstert.2021.12.026] [Citation(s) in RCA: 1] [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: 08/13/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the semen quality and reproductive hormones of men conceived by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) compared with men conceived without assisted reproductive technology (ART). DESIGN Cohort study. SETTING IVF centers in Victoria and the Western Australian Raine Study. PATIENT(S) Men conceived with IVF/ICSI and men conceived without ART aged 18-25 years. INTERVENTION(S) Clinical review. MAIN OUTCOME MEASURE(S) The primary outcome was the prevalence of severe oligozoospermia (sperm concentration, <5 million/mL). The secondary outcomes were total sperm count, total and progressive motility, total motile count, normal morphology, and serum testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). RESULTS There was no difference in the prevalence of severe oligozoospermia between 120 men conceived with IVF/ICSI and 356 men conceived without ART (9% vs. 5.3%). Men conceived with IVF/ICSI had similar sperm concentration, total sperm count, and total motile count but lower mean total (55.3% vs. 60.6%) and progressive (44.7% vs. 53.9%) sperm motility with higher mean normal morphology (8.5% vs. 5.4%). Differences in progressive motility (ß, -9.9; 95% confidence interval [CI], -16.7 - -3.0), normal morphology (ß, 4.3; 95% CI, 3.0-5.7), and proportion with abnormal morphology (adjusted odds ratios, 0.1; 95% CI, 0.04-0.5) remained significant after adjusting for confounders. Men conceived with IVF/ICSI had lower mean FSH (3.3 IU/L) and LH (3.9 IU/L) levels and higher mean testosterone levels (19.1 nmol/L) than controls (4.2 IU/L, 11.0 IU/L, and 16.8 nmol/L). CONCLUSION This study of men conceived with IVF/ICSI found similar sperm output to men conceived without ART. Overall, the results are reassuring.
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Affiliation(s)
- Sarah R Catford
- Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Moira K O'Bryan
- The School of BioSciences, Faculty of Science, University of Melbourne, Melbourne, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, Australia
| | - Roger J Hart
- Division of Obstetrics and Gynecology, University of Western Australia, Perth, Australia; Fertility Specialists of Western Australia, Perth, Australia
| | - John McBain
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia; Melbourne IVF, East Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, Melbourne, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Monash IVF Group Pty Ltd, Melbourne, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Monash IVF Group Pty Ltd, Melbourne, Australia
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14
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Shyamsunder A, Hardy T, Yazdani A, Polyakov A, Norman R, Hart R, Agresta F, Rombauts L, Boothroyd C, Chapman M, Sweeten P, Somerville E, Jose R, Wand H, Ledger WL. Higher Doses of FSH Used for Superovulation Do Not Adversely Affect Embryonic Ploidy: A Randomized Controlled Trial (STimulation Resulting in Embryonic Aneuploidy using Menopur (STREAM) Trial). FandR 2021. [DOI: 10.1142/s2661318221500146] [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
Research Question: Does the dose of gonadotropin used for superovulation in IVF affect the proportion of euploid blastocysts obtained after fertilization? Study Design: Multicentre randomized controlled trial recruiting 57 women who were treated with ovarian stimulation using either 150 or 300 IU Menopur per day. Both groups received GnRH antagonist from day 5 of ovarian stimulation and final oocyte maturation was induced using a leuprolide GnRH (gonadotropin releasing hormone) agonist trigger when three or more follicles reached 17 mm diameter. Oocyte collection was scheduled 36–38 hours post trigger. In vitro fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) were performed according to individual unit protocol and embryos were cultured to blastocyst stage. A trophectoderm biopsy was performed on day 5 of embryo culture and used for preimplantation genetic testing for aneuploidy. Euploid embryos were transferred in subsequent frozen embryo transfer cycles with appropriate endometrial preparation. Results: The number of oocytes obtained from women randomized to 150 IU Menopur was between 3 and 17 (mean = 9), whereas the number of oocytes obtained from women randomized to 300 IU Menopur was between 3 and 24 (mean = 11). There was a positive linear relationship between serum AMH concentration and oocyte yield in both the 150 and 300 IU Menopur groups ([Formula: see text] = 0.3359, [Formula: see text] = 0.1129 and [Formula: see text] = 0.3741, [Formula: see text] = 0.1399). The percentage of euploid to aneuploid embryos in the 150 IU Menopur group was 63% and in the 300 IU Menopur group, the proportion was 75%, which was not significantly different ([Formula: see text] = 0.17). Conclusion: The higher dose ovarian stimulation protocol did not significantly increase the number of oocytes retrieved, nor did the higher dose protocol reduce the proportion of euploid embryos created. This study does not support the hypothesis that use of higher doses of gonadotropin for ovarian stimulation results in a reduction in the proportion of euploid embryos obtained after IVF.
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Affiliation(s)
| | - Tristan Hardy
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
| | | | | | | | - Roger Hart
- Fertility Specialists of Western Australia, Perth, Australia
| | | | | | | | - Michael Chapman
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
- IVF Australia, Sydney, Australia
| | - Prudence Sweeten
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
- IVF Australia, Sydney, Australia
| | - Eleanor Somerville
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
| | - Rachel Jose
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
| | - Handan Wand
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
| | - William L. Ledger
- School of Women’s & Children’s Health, University of New South Wales, Sydney, Australia
- IVF Australia, Sydney, Australia
- Fertility and Research Centre, Royal Hospital for Women, Sydney, Australia
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15
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Liu Y, Ong K, Korman I, Turner R, Leyden M, Zander-Fox D, Rombauts L. P–179 Timing of blastocyst observation on day 5: effect on the assessment to predict live birth, and the incorporation into a blastocyst selection model. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.178] [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: 11/12/2022] Open
Abstract
Abstract
Study question
Does variation in day 5 observation timing confound embryo-morphology-based live birth prediction, and is it possible to develop a robust comprehensive numerical prediction model.
Summary answer
Day 5 observation timing confounds embryo-morphology-based live birth prediction. A robust comprehensive numerical prediction model can be developed after considering a number of contributing variables.
What is known already
Embryo development is a dynamic process, and therefore the widely used static observations potentially lead to biased prediction of live birth outcomes. So far, little is known in regard to potential confounding impact of day 5 assessment timing on the static-morphology-based live birth prediction. In addition, the inter-observer variation in morphology-based embryo assessment requires a more robust system to improve consistency of selection.
Study design, size, duration
This retrospective multi-center cohort study included 8866 autologous oocyte in vitro fertilisation treatment cycles performed at 14 associated clinics within the same network during 2012–2018. Only fresh cycles with single day 5 embryo transfers were included for analysis with all pregnancies followed up until birth. Repeat cycles of same patients were excluded to avoid clustering effect in statistical analysis.
Participants/materials, setting, methods
Dataset was randomly split into two subsets at 60:40 ratio, with one (n = 5274) used for regression analysis and model development and the other (n = 3592) used for model testing. Multiple logistic regression was performed to evaluate live birth predicting power of several potential contributors, expressed by odds ratio (OR) and 95% confidence interval (CI). A comprehensive prediction model was subsequently developed based on calculated weights of contributing factors, then tested via receiver operating characteristics (ROC) analysis.
Main results and the role of chance
The timings of day 5 observation of 8866 included embryos, measured by hours post insemination (HPI), distributed in a bell shape ranging from 112.0 to 120.0 h (mean±SD 115.7±1.7 h). After taking into account female age at egg collection (grouped as < 30 yr, 30–34 yr, 35–39 yr, 40–44 yr, and 45 yr or older), whether or not the first egg collection, number of eggs collected, embryo developmental stage (grouped as pre-blastocyst, early blastocyst, expanding blastocyst, expanded blastocyst, and hatching/hatched blastocyst) and morphology score(A/B/C/D); multivariate logistic regression analysis showed significant association (OR 1.096, 95% CI 1.020–1.177, P = 0.012) between HPI groups (112–113.9 h, 114–115.9 h, 116–117.9 , and 118–120 h) and subsequent live birth outcomes. A comprehensive numerical scoring system was developed based on the statistically significant predictors including female age (OR 1.465, 95% CI 1.364–1.574, P = 0.000), embryo developmental stage (OR 1.341, 95% CI 1.244–1.445, P = 0.000), morphology score (OR 1.520, 95% CI 1.392–1.661, P = 0.000) and HPI (OR mentioned above); with a formula of Score = (Female_age_group/5)*1.465 + (Developmental_stage/5)*1.341 + (Morpho_Score/4)*1.520 + (HPI_Group/4)*1.096. ROC analysis showed statistically significant predictive power of the resulting model as expressed by area under the ROC curve using both the development (0.690, 0.675–0.704, P = 0.000) and testing (0.685, 0.667–0.703, P = 0.000) subsets.
Limitations, reasons for caution
The retrospective design does not allow for controlling of unknown confounders. HPI was based on static observations in this study so future time-lapse study may bring more insights with more accurate observation and measurement.
Wider implications of the findings: The varying HPIs at day 5 observation were alarming as this could confound live birth prediction using embryology parameters. It is important to standardise the timing of embryo observations. The inclusion of HPI into a comprehensive numerical scoring system for live birth prediction may potentially improve its robustness
Trial registration number
Not applicable
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Affiliation(s)
- Y Liu
- Monash IVF Group, Queensland- Science, Southport, Australia
| | - K Ong
- Monash IVF Gold Coast, Medical, Southport, Australia
| | - I Korman
- Monash IVF Gold Coast, Medical, Southport, Australia
| | - R Turner
- Monash IVF Auchenflower, Medical, Auchenflower, Australia
| | - M Leyden
- Monash IVF Rockhampton, Medical, Rockhampton, Australia
| | - D Zander-Fox
- Monash IVF Group, Victoria- Science, Richmond, Australia
| | - L Rombauts
- Monash IVF Group, Medical, Richmond, Australia
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16
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Takamura M, Zhou W, Rombauts L, Dimitriadis E. The long noncoding RNA PTENP1 regulates human endometrial epithelial adhesive capacity in vitro: implications in infertility. Biol Reprod 2021; 102:53-62. [PMID: 31504217 DOI: 10.1093/biolre/ioz173] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/16/2019] [Accepted: 08/26/2019] [Indexed: 12/14/2022] Open
Abstract
There is general consensus that the synchronous development of the embryo and endometrium is absolutely essential for successful implantation. Recent studies have strongly suggested that embryo-secreted factors are able to deliver into the endometrial cavity/endometrium and alter its protein profile in preparation for implantation. However, there is limited research focusing on long noncoding RNA (lncRNA) changes in the endometrium that brought about by the embryonic derived factors. It has been suggested that lncRNA has intricate interplay with microRNA (miR), small (~19-22 nucleotides), non-protein-coding RNA, to regulate protein production in the endometrium, thus controlling adhesive capacity. Here through microarray assays, we compare the lncRNA profile of the primary human endometrial epithelial cells (HEECs) that have been precultured with blastocyst-conditioned media (BCM) from embryos that implanted versus nonimplanted. Our data indicate a substantial change of lncRNA expression in HEECs, including 9 up-regulated and 12 down-regulated lncRNAs after incubation with implanted BCM. Selective knockdown of PTENP1, the most increased lncRNA after implanted BCM treatment in the HEECs, compromised the spheroid adhesion (P < 0.001). Characterization of PTENP1 confirmed its expression in the luminal epithelium with staining appeared most intense in the midsecretory phase. Furthermore, we have recorded a substantial change of miR profile upon PTENP1 knockdown in HEECs. Overexpression of miR-590-3p, a novel predicted target of PTENP1, impaired spheroid adhesion (P < 0.001). Collectively, these data have supported a novel regulation system that lncRNAs were able to participate in the regulation of implantation through association with miRs.
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Affiliation(s)
- Masashi Takamura
- Centre for Reproductive Health, The Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Wei Zhou
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
| | - Luk Rombauts
- Monash IVF, Monash Surgical Private Hospital, Clayton, VIC, Australia
| | - Evdokia Dimitriadis
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.,Gynaecology Research Centre, Royal Women's Hospital, Parkville, VIC, Australia
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17
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Al-Zubaidi U, Adhikari D, Cinar O, Zhang QH, Yuen WS, Murphy MP, Rombauts L, Robker RL, Carroll J. Mitochondria-targeted therapeutics, MitoQ and BGP-15, reverse aging-associated meiotic spindle defects in mouse and human oocytes. Hum Reprod 2021; 36:771-784. [PMID: 33367783 DOI: 10.1093/humrep/deaa300] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [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: 06/26/2020] [Revised: 09/28/2020] [Indexed: 12/22/2022] Open
Abstract
STUDY QUESTION Do mitochondria-targeted therapies reverse ageing- and oxidative stress-induced spindle defects in oocytes from mice and humans? SUMMARY ANSWER Exposure to MitoQ or BGP-15 during IVM protected against spindle and chromosomal defects in mouse oocytes exposed to oxidative stress or derived from reproductively aged mice whilst MitoQ promoted nuclear maturation and protected against chromosomal misalignments in human oocytes. WHAT IS KNOWN ALREADY Spindle and chromosomal abnormalities in oocytes are more prevalent with maternal aging, increasing the risk of aneuploidy, miscarriage and genetic disorders such as Down's syndrome. The origin of compromised oocyte function may be founded in mitochondrial dysfunction and increased reactive oxygen species (ROS). STUDY DESIGN, SIZE, DURATION Oocytes from young and old mice were treated with MitoQ and/or BGP-15 during IVM. To directly induce mitochondrial dysfunction, oocytes were treated with H2O2, and then treated the MitoQ and/or BGP-15. Immature human oocytes were cultured with or without MitoQ. Each experiment was repeated at least three times, and data were analyzed by unpaired-sample t-test or chi-square test. PARTICIPANTS/MATERIALS, SETTING, METHODS Immature germinal vesicle (GV) stage oocytes from 1-, 12- and 18-month-old mice were obtained from preovulatory ovarian follicles. Oocytes were treated with MitoQ and/or BGP-15 during IVM. GV-stage human oocytes were cultured with or without MitoQ. Mitochondrial membrane potential and mitochondrial ROS were measured by live-cell imaging. Meiotic spindle and chromosome alignments were visualized by immunofluorescent labeling of fixed oocytes and the 3-dimensional images were analyzed by Imaris. MAIN RESULTS AND THE ROLE OF CHANCE MitoQ or BGP-15 during IVM protects against spindle and chromosomal defects in oocytes exposed to oxidative stress and in oocytes from aged mice (P < 0.001). In human oocytes, the presence of MitoQ during IVM promoted nuclear maturation and had a similar positive effect in protecting against chromosomal misalignments (P < 0.001). LIMITATIONS, REASONS FOR CAUTION Our study identifies two excellent candidates that may help to improve fertility in older women. However, these potential therapies must be tested for efficacy in clinical IVM systems, and undergo thorough examination of resultant offspring in preclinical models before utilization. WIDER IMPLICATIONS OF THE FINDINGS Our results using in-vitro systems for oocyte maturation in both mouse and human provide proof of principle that mitochondrially targeted molecules such as MitoQ and BGP-15 may represent a novel therapeutic approach against maternal aging-related spindle and chromosomal abnormalities. STUDY FUNDING/COMPETING INTEREST(S) The project was financially supported by the National Health and Medical Research Council and Australian Research Council, Australia. U.A.-Z. was supported by the Iraqi Higher Education and Scientific Research Ministry PhD scholarship and O.C. was supported by TUBITAK-1059B191601275. M.P.M. consults for MitoQ Inc. and holds patents in mitochondria-targeted therapies. R.L.R. is an inventor on patents relating to the use of BGP-15 to improve gamete quality. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Usama Al-Zubaidi
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia.,Applied Embryology Department, High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, AL-Nahrain University, Baghdad, Iraq
| | - Deepak Adhikari
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Ozgur Cinar
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia.,Department of Histology and Embryology, Ankara University School of Medicine, Ankara, Turkey
| | - Qing-Hua Zhang
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Wai Shan Yuen
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
| | - Michael P Murphy
- MRC Mitochondrial Biology Unit, University of Cambridge, Hills Road, Cambridge CB2 0XY, UK
| | - Luk Rombauts
- Monash IVF, Melbourne, VIC, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
| | - Rebecca L Robker
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia.,School of Medicine, Robinson Research Institute, The University of Adelaide, Adelaide, SA 5005, Australia
| | - John Carroll
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, VIC 3800, Australia
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18
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Lensen S, Chen S, Goodman L, Rombauts L, Farquhar C, Hammarberg K. IVF add-ons in Australia and New Zealand: A systematic assessment of IVF clinic websites. Aust N Z J Obstet Gynaecol 2021; 61:430-438. [PMID: 33594674 DOI: 10.1111/ajo.13321] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/29/2020] [Revised: 12/17/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND In vitro fertilisation (IVF) 'add-ons' are extra (non-essential) procedures, techniques or medicines, which usually claim to increase the chance of a successful IVF outcome. Use of IVF add-ons is believed to be widespread in many settings; however, information about add-on availability in Australasia is lacking. AIMS To understand which add-ons are advertised on Australasian IVF clinic websites, and what is the evidence for their benefit. MATERIALS AND METHODS A systematic assessment of website content was undertaken between December 2019-April 2020, capturing IVF add-ons advertised, including costs, claims of benefit, statements of risk or limitations, and evidence of effectiveness for improving live birth and pregnancy. A literature review assessed the strength and quality of evidence for each add-on. RESULTS Of the 40 included IVF clinics websites, 31 (78%) listed one or more IVF add-ons. A total of 21 different add-ons or add-on groups were identified, the most common being preimplantation genetic testing for aneuploidies (offered by 63% of clinics), time-lapse systems (33%) and assisted hatching (28%). In most cases (77%), descriptions of the IVF add-ons were accompanied by claims of benefit. Most claims (90%) were not quantified and very few referenced scientific publications to support the claims (9.8%). None of the add-ons were supported by high-quality evidence of benefit for pregnancy or live birth rates. The cost of IVF add-ons varied from $0 to $3700 (AUD/NZD). CONCLUSIONS There is widespread advertising of add-ons on IVF clinic websites, which report benefits for add-ons that are not supported by high-quality evidence.
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Affiliation(s)
- Sarah Lensen
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Sheng Chen
- Victorian Assisted Reproductive Treatment Authority, Melbourne, Victoria, Australia
| | - Lucy Goodman
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Cindy Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Karin Hammarberg
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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19
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Pundir J, Achilli C, Bhide P, Sabatini L, Legro RS, Rombauts L, Teede H, Coomarasamy A, Zamora J, Thangaratinam S. Risk of foetal harm with letrozole use in fertility treatment: a systematic review and meta-analysis. Hum Reprod Update 2020; 27:474-485. [PMID: 33374012 DOI: 10.1093/humupd/dmaa055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/15/2020] [Revised: 09/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The aromatase inhibitor letrozole is increasingly recommended for ovulation induction, as it is more effective with fewer side-effects than other agents. But many clinicians are reluctant to use the drug for fertility treatment due to a strong-label warning against its use, which warns about congenital malformation risk to the foetus in women seeking pregnancy. OBJECTIVE AND RATIONALE The aim of this study was to determine the risks of congenital malformations and pregnancy loss with letrozole compared with clomiphene primarily, and with other fertility drugs and natural conception. SEARCH METHODS A systematic review and meta-analysis using PRISMA harms guidelines. We searched MEDLINE, EMBASE and other sources from inception until January 2020, with the MeSH words for 'letrozole' and pregnancy OR foetal/neonatal outcome. We included studies reported on congenital malformations in foetuses born to mothers conceived after fertility treatment, with letrozole versus clomiphene, placebo, gonadotrophins, metformin, natural conception or other agents, from randomised trials, comparative cohort studies and non-comparative observational cohorts. Quality of the studies was assessed using Cochrane risk of bias tool and Newcastle Ottawa Scale. The McMaster tool was used to assess the quality of reported harm for foetal congenital malformations in the studies. We compared the absolute risk of events using risk difference measures and pooled the findings using a fixed-effect model. We evaluated the statistical heterogeneity using forest plots and the I2 statistic and funnel plot to assess publication bias. We assessed the strength of evidence for congenital malformation and pregnancy loss as per the GRADE recommendations and with the Fragility index. OUTCOMES We included 46 studies (18 randomised trials; 21 comparative cohorts; 7 non-comparative cohorts). Overall 2.15% (101/4697; 95% CI 1.7 to 2.5) of babies conceived on letrozole for fertility treatment had congenital foetal malformations. We did not observe a significant increase in congenital malformations with letrozole versus clomiphene in the randomised trials (risk difference (RD) 0.01, 95% CI -0.02, 0.03; I2 = 0%; 14 studies) and found a significant reduction in the cohort studies (RD -0.02, 95% CI -0.04, -0.01; I2 = 0%, 11 studies). The fragility index was 44% (7/16) (either an increase in the intervention arm or a decrease in control arm was needed to alter the results). The risks of pregnancy loss were not increased with letrozole versus clomiphene in the 14 randomised trials (RD -0.01, 95% CI -0.06, 0.04; I2 = 0%), and the risks were reduced in the six cohort studies (RD -0.09, 95% CI -0.17, -0.00; I2 = 68%). The GRADE quality of evidence was low to moderate for congenital malformations and pregnancy loss. We did not find any increased congenital malformation risk with letrozole versus gonadotrophins, natural conception or natural cycle ART, but the number of studies was small. WIDER IMPLICATIONS There is no evidence that letrozole increases the risk of congenital foetal malformation or pregnancy loss compared with clomiphene, natural conception or other fertility agents, to warrant warning against its use. Given its therapeutic benefits and lack of evidence of harm to the foetus, clinicians should consider letrozole as first-line agent for ovulation induction.
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Affiliation(s)
- Jyotsna Pundir
- Queen Mary University, London E1 4NS, UK.,Centre for Reproductive Medicine, St. Bartholomew's Hospital, London EC1A 7BE, UK
| | - Chiara Achilli
- Hewitt Fertility Centre, Liverpool Women's Hospital, Liverpool L8 7SS, UK
| | - Priya Bhide
- Centre for Women's Health, Queen Mary University of London, E1 2AB, UK.,Homerton University Hospital, London E9 6SR, UK
| | - Luca Sabatini
- Centre for Reproductive Medicine, St. Bartholomew's Hospital, London EC1A 7BE, UK
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, USA
| | | | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC 3800, Australia
| | - Arri Coomarasamy
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.,Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Javier Zamora
- CIBER Epidemiology and Public Health, Clinical Biostatistics Unit, Hospital Ramon y Cajal Ctra, Madrid 28034, Spain.,Women's Health Research Unit, Queen Mary University of London
| | - Shakila Thangaratinam
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
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20
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Filby CE, Rombauts L, Montgomery GW, Giudice LC, Gargett CE. Cellular Origins of Endometriosis: Towards Novel Diagnostics and Therapeutics. Semin Reprod Med 2020; 38:201-215. [DOI: 10.1055/s-0040-1713429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractEndometriosis remains an enigmatic disease of unknown etiology, with delayed diagnosis and poor therapeutic options. This review will discuss the cellular, physiological, and genomic evidence of Sampson's hypothesis of retrograde menstruation as a cause of pelvic endometriosis and as the basis of phenotypic heterogeneity of the disease. We postulate that collaborative research at the single cell level focused on unlocking the cellular, physiological, and genomic mechanisms of endometriosis will be accompanied by advances in personalized diagnosis and therapies that target unique subtypes of endometriosis disease. These advances will address the clinical conundrums of endometriosis clinical care—including diagnostic delay, suboptimal treatments, disease recurrence, infertility, chronic pelvic pain, and quality of life. There is an urgent need to improve outcomes for women with endometriosis. To achieve this, it is imperative that we understand which cells form the lesions, how they arrive at distant sites, and what factors govern their ability to survive and invade at ectopic locations. This review proposes new research avenues to address these basic questions of endometriosis pathobiology that will lay the foundations for new diagnostic tools and treatment pathways.
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Affiliation(s)
- Caitlin E. Filby
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Reproductive Medicine at Women's Health, Monash Health, Monash IVF, Melbourne, Victoria, Australia
| | - Grant W. Montgomery
- UQ Genome Innovation Hub, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Linda C. Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco, California
| | - Caroline E. Gargett
- The Ritchie Centre, Hudson Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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21
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Catford SR, Lewis S, Halliday J, Kennedy J, O'Bryan MK, McBain J, Amor DJ, Rombauts L, Saffery R, Hart RJ, McLachlan RI. Health and fertility of ICSI-conceived young men: study protocol. Hum Reprod Open 2020; 2020:hoaa042. [PMID: 33033755 PMCID: PMC7532549 DOI: 10.1093/hropen/hoaa042] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/23/2020] [Indexed: 12/27/2022] Open
Abstract
STUDY QUESTIONS What are the long-term health and reproductive outcomes for young men conceived using ICSI whose fathers had spermatogenic failure (STF)? Are there epigenetic consequences of ICSI conception? WHAT IS KNOWN ALREADY Currently, little is known about the health of ICSI-conceived adults, and in particular the health and reproductive potential of ICSI-conceived men whose fathers had STF. Only one group to date has assessed semen parameters and reproductive hormones in ICSI-conceived men and suggested higher rates of impaired semen quality compared to spontaneously conceived (SC) peers. Metabolic parameters in this same cohort of men were mostly comparable. No study has yet evaluated other aspects of adult health. STUDY DESIGN SIZE DURATION This cohort study aims to evaluate the general health and development (aim 1), fertility and metabolic parameters (aim 2) and epigenetic signatures (aim 3) of ICSI-conceived sons whose fathers had STF (ICSI study group). There are three age-matched control groups: ICSI-conceived sons whose fathers had obstructive azoospermia (OAZ) and who will be recruited in this study, as well as IVF sons and SC sons, recruited from other studies. Of 1112 ICSI parents including fathers with STF and OAZ, 78% (n = 867) of mothers and 74% (n = 823) of fathers were traced and contacted. Recruitment of ICSI sons started in March 2017 and will finish in July 2020. Based on preliminary participation rates, we estimate the following sample size will be achieved for the ICSI study group: mothers n = 275, fathers n = 225, sons n = 115. Per aim, the sample sizes of OAZ-ICSI (estimated), IVF and SC controls are: Aim 1-OAZ-ICSI: 28 (maternal surveys)/12 (son surveys), IVF: 352 (maternal surveys)/244 (son surveys), SC: 428 (maternal surveys)/255 (son surveys); Aim 2-OAZ-ICSI: 12, IVF: 72 (metabolic data), SC: 391 (metabolic data)/365 (reproductive data); Aim 3-OAZ-ICSI: 12, IVF: 71, SC: 292. PARTICIPANTS/MATERIALS SETTING METHODS Eligible parents are those who underwent ICSI at one of two major infertility treatment centres in Victoria, Australia and gave birth to one or more males between January 1994 and January 2000. Eligible sons are those aged 18 years or older, whose fathers had STF or OAZ, and whose parents allow researchers to approach sons. IVF and SC controls are age-matched men derived from previous studies, some from the same source population. Participating ICSI parents and sons complete a questionnaire, the latter also undergoing a clinical assessment. Outcome measures include validated survey questions, physical examination (testicular volumes, BMI and resting blood pressure), reproductive hormones (testosterone, sex hormone-binding globulin, FSH, LH), serum metabolic parameters (fasting glucose, insulin, lipid profile, highly sensitive C-reactive protein) and semen analysis. For epigenetic and future genetic analyses, ICSI sons provide specimens of blood, saliva, sperm and seminal fluid while their parents provide a saliva sample. The primary outcomes of interest are the number of mother-reported hospitalisations of the son; son-reported quality of life; prevalence of moderate-severe oligozoospermia (sperm concentration <5 million/ml) and DNA methylation profile. For each outcome, differences between the ICSI study group and each control group will be investigated using multivariable linear and logistic regression for continuous and binary outcomes, respectively. Results will be presented as adjusted odds ratios and 95% CIs. STUDY FUNDING/COMPETING INTERESTS This study is funded by an Australian National Health and Medical Research Council Partnership Grant (NHMRC APP1140706) and was partially funded by the Monash IVF Research and Education Foundation. L.R. is a minority shareholder and the Group Medical Director for Monash IVF Group, and reports personal fees from Monash IVF group and Ferring Australia, honoraria from Ferring Australia, and travel fees from Merck Serono, MSD and Guerbet; R.J.H. is the Medical Director of Fertility Specialists of Western Australia and has equity in Western IVF; R.I.M. is a consultant for and a shareholder of Monash IVF Group and S.R.C. reports personal fees from Besins Healthcare and non-financial support from Merck outside of the submitted work. The remaining authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable. TRIAL REGISTRATION DATE Not applicable. DATE OF FIRST PATIENT’S ENROLMENT Not applicable.
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Affiliation(s)
- S R Catford
- Hudson Institute of Medical Research, Melbourne 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia.,Murdoch Children's Research Institute, Melbourne 3052, Australia
| | - S Lewis
- Murdoch Children's Research Institute, Melbourne 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - J Halliday
- Murdoch Children's Research Institute, Melbourne 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - J Kennedy
- Murdoch Children's Research Institute, Melbourne 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - M K O'Bryan
- The School of Biological Sciences, Monash University, Melbourne 3168, Australia
| | - J McBain
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne 3052, Australia.,Melbourne IVF, East Melbourne 3002, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne 3052, Australia
| | - D J Amor
- Murdoch Children's Research Institute, Melbourne 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - L Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia.,Monash IVF Group Pty Ltd, Melbourne 3121, Australia
| | - R Saffery
- Murdoch Children's Research Institute, Melbourne 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne 3052, Australia
| | - R J Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley 6009, Australia.,Fertility Specialists of Western Australia, Claremont 6010, Australia
| | - R I McLachlan
- Hudson Institute of Medical Research, Melbourne 3168, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia.,Monash IVF Group Pty Ltd, Melbourne 3121, Australia
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22
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Bryan ER, McLachlan RI, Rombauts L, Katz DJ, Yazdani A, Bogoevski K, Chang C, Giles ML, Carey AJ, Armitage CW, Trim LK, McLaughlin EA, Beagley KW. Detection of chlamydia infection within human testicular biopsies. Hum Reprod 2020; 34:1891-1898. [PMID: 31586185 PMCID: PMC6810529 DOI: 10.1093/humrep/dez169] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/20/2019] [Revised: 07/12/2019] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Can Chlamydia be found in the testes of infertile men? SUMMARY ANSWER Chlamydia can be found in 16.7% of fresh testicular biopsies and 45.3% of fixed testicular biopsies taken from a selection of infertile men. WHAT IS KNOWN ALREADY Male chlamydial infection has been understudied despite male and female infections occurring at similar rates. This is particularly true of asymptomatic infections, which occur in 50% of cases. Chlamydial infection has also been associated with increased sperm DNA damage and reduced male fertility. STUDY DESIGN, SIZE, DURATION We collected diagnostic (fixed, n = 100) and therapeutic (fresh, n = 18) human testicular biopsies during sperm recovery procedures from moderately to severely infertile men in a cross-sectional approach to sampling. PARTICIPANTS/MATERIALS, SETTING, METHODS The diagnostic and therapeutic biopsies were tested for Chlamydia-specific DNA and protein, using real-time PCR and immunohistochemical approaches, respectively. Serum samples matched to the fresh biopsies were also assayed for the presence of Chlamydia-specific antibodies using immunoblotting techniques. MAIN RESULTS AND THE ROLE OF CHANCE Chlamydial major outer membrane protein was detected in fixed biopsies at a rate of 45.3%. This was confirmed by detection of chlamydial DNA and TC0500 protein (replication marker). C. trachomatis DNA was detected in fresh biopsies at a rate of 16.7%, and the sera from each of these three positive patients contained C. trachomatis-specific antibodies. Overall, C. trachomatis-specific antibodies were detected in 72.2% of the serum samples from the patients providing fresh biopsies, although none of the patients were symptomatic nor had they reported a previous sexually transmitted infection diagnosis including Chlamydia. LIMITATIONS, REASONS FOR CAUTION No reproductively healthy male testicular biopsies were tested for the presence of Chlamydia DNA or proteins or Chlamydia-specific antibodies due to the unavailability of these samples. WIDER IMPLICATIONS FOR THE FINDINGS Application of Chlamydia-specific PCR and immunohistochemistry in this human male infertility context of testicular biopsies reveals evidence of a high prevalence of previously unrecognised infection, which may potentially have a pathogenic role in spermatogenic failure. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by the Australian NHMRC under project grant number APP1062198. We also acknowledge assistance from the Monash IVF Group and Queensland Fertility Group in the collection of fresh biopsies, and the Monash Health and co-author McLachlan (declared equity interest) in retrieval and sectioning of fixed biopsies. E.M. declares an equity interest in the study due to financing of fixed biopsy sectioning. All other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Emily R Bryan
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Robert I McLachlan
- Monash IVF Group, 89 Bridge Road, Richmond, VIC 3121, Australia.,Department of Obstetrics and Gynecology, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia.,Hudson Institute of Medical Research, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Luk Rombauts
- Monash IVF Group, 89 Bridge Road, Richmond, VIC 3121, Australia.,Department of Obstetrics and Gynecology, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC 3168, Australia
| | - Darren J Katz
- Men's Health Melbourne, 233 Collins Street, Melbourne, VIC 3000, Australia.,Department of Surgery, Western Health, Melbourne, VIC 3000, Australia
| | - Anusch Yazdani
- Queensland Fertility Group, 55 Little Edward Street, Spring Hill, QLD 4000, Australia
| | - Kristofor Bogoevski
- Histology Services, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| | - Crystal Chang
- Histology Services, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| | - Michelle L Giles
- Ritchie Centre, Department of Obstetrics and Gynecology, Monash University, Melbourne, VIC 3000, Australia
| | - Alison J Carey
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Charles W Armitage
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Logan K Trim
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
| | - Eileen A McLaughlin
- School of Environmental and Life Sciences, Faculty of Science, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,School of Science Faculty of Science and Technology, University of Canberra, Kirinari Street, Bruce, ACT 2617, Australia.,School of Biological Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Kenneth W Beagley
- School of Biomedical Sciences and Institute of Health & Biomedical Innovation, Queensland University of Technology, 300 Herston Rd, Herston, QLD 4006, Australia
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23
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Hunt S, Low X, Dunn M, Costa FDS, Vollenhoven B, Mol BW, Rombauts L. Assessing Peristalsis at the Endometrial–Myometrial Junctional Zone: A Reproducible Ultrasound Technique? FandR 2020. [DOI: 10.1142/s2661318220500152] [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: Uterine peristalsis occurs in the endometrial–myometrial junctional zone. It is involved in sperm transport and embryo implantation in spontaneous and in vitro fertilization (IVF) cycles. We investigated the reproducibility of transvaginal assessment of peristalsis and endometrial combined thickness (ECT) as a surrogate marker for contraction frequency and directionality. Methods: We studied 74 women undergoing IVF between 2015 and 2018. On day 9 of stimulation, participants had a transvaginal ultrasound to assess follicular development and ECT. Women proceeding to fresh embryo transfer had an ultrasound preprocedure. A videoclip was analyzed for frequency (total contractions per minute) and directionality of contractions (cervical to fundal [CF] and fundal to cervical [FC]). Anonymized images were reviewed on three separate occasions by a single observer. Intraclass correlation (ICC with 95% CI) and Bland–Altman plots were constructed to assess intraobserver agreement. Secondary analysis was performed to assess peristalsis with ECT and pregnancy rates. Results: Between the first and second observations, there was suboptimal correlation between visual assessment of contraction frequency and directionality (ICC–total 0.67 (0.43–0.80) p < 0.001, ICC–CF 0.62 (0.35–0.78), p < 0.001, ICC–FC 0.74 (0.55–0.85), p < 0.001. Correlation for both frequency and directionality significantly improved between second and third viewing (ICC–total 0.97 (0.95–0.98), p < 0.001, ICC–CF 0.84 (0.73–0.91), p < 0.001, ICC–FC 0.89 (0.81–0.94), p < 0.001). Good agreement was seen on Bland–Altman plots with narrower limits of agreement on second and third viewing. Median ECT was 10 mm (interquartile range [IQR] 8–12 mm). Women with ECT [Formula: see text] 10 mm versus <10 mm demonstrated more contractions per minute (2.2 ± 0.7 vs. 1.7 ± 0.6, p = 0.02). The clinical and ongoing pregnancy rates were 33% (20/60) and 22% (13/60), respectively. There was no association between pregnancy and peristalsis frequency or directionality. Conclusion: Uterine peristalsis is a reproducible observation displaying a learning curve to achieve excellent agreement. Endometrial thickness [Formula: see text]10 mm was associated with increased contraction frequency. There was no association between contraction frequency and/or directionality and clinical pregnancy rates.
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Affiliation(s)
- Sarah Hunt
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash IVF, Clayton, Australia
- Monash Health, Clayton, Australia
| | - Xin Low
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | | | | | - Beverley Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash IVF, Clayton, Australia
- Monash Health, Clayton, Australia
| | - Ben W. Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash Health, Clayton, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Monash IVF, Clayton, Australia
- Monash Health, Clayton, Australia
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24
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Leonardi M, Horne AW, Armour M, Missmer SA, Roman H, Rombauts L, Hummelshoj L, Wattiez A, Condous G, Johnson NP. Endometriosis and the Coronavirus (COVID-19) Pandemic: Clinical Advice and Future Considerations. Front Reprod Health 2020; 2:5. [PMID: 36304710 PMCID: PMC9580813 DOI: 10.3389/frph.2020.00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/22/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mathew Leonardi
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- *Correspondence: Mathew Leonardi
| | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, NSW, Australia
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Boston Center for Endometriosis, Boston Children's Hospital and Brigham & Women's Hospital, Boston, MA, United States
- Department of Obstetrics, Gynecology, and Reproductive Biology College of Human Medicine, Secchia Center, Michigan State University, Grand Rapids, MI, United States
- World Endometriosis Society, Vancouver, BC, Canada
| | - Horace Roman
- World Endometriosis Society, Vancouver, BC, Canada
- Endometriosis Centre, Clinic Tivoli-Ducos, Bordeaux, France
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Luk Rombauts
- World Endometriosis Society, Vancouver, BC, Canada
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Lone Hummelshoj
- World Endometriosis Society, Vancouver, BC, Canada
- Endometriosis.org, London, United Kingdom
| | - Arnaud Wattiez
- Latifa Hospital, Dubai, United Arab Emirates
- Department of Obstetrics and Gynecology, University of Strasbourg, Strasbourg, France
| | - George Condous
- Acute Gynaecology, Early Pregnancy, and Advanced Endoscopy Surgery Unit, Nepean Hospital, Kingswood, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, Australia
| | - Neil P. Johnson
- World Endometriosis Society, Vancouver, BC, Canada
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Auckland Gynaecology Group and Repromed Auckland, Auckland, New Zealand
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25
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Duffy J, Hirsch M, Vercoe M, Abbott J, Barker C, Collura B, Drake R, Evers J, Hickey M, Horne AW, Hull ML, Kolekar S, Lensen S, Johnson NP, Mahajan V, Mol BW, Otter AS, Puscasiu L, Rodriguez MB, Rombauts L, Vail A, Wang R, Farquhar CM. A core outcome set for future endometriosis research: an international consensus development study. BJOG 2020; 127:967-974. [PMID: 32227676 DOI: 10.1111/1471-0528.16157] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To develop a core outcome set for endometriosis. DESIGN Consensus development study. SETTING International. POPULATION One hundred and sixteen healthcare professionals, 31 researchers and 206 patient representatives. METHODS Modified Delphi method and modified nominal group technique. RESULTS The final core outcome set includes three core outcomes for trials evaluating potential treatments for pain and other symptoms associated with endometriosis: overall pain; improvement in the most troublesome symptom; and quality of life. In addition, eight core outcomes for trials evaluating potential treatments for infertility associated with endometriosis were identified: viable intrauterine pregnancy confirmed by ultrasound; pregnancy loss, including ectopic pregnancy, miscarriage, stillbirth and termination of pregnancy; live birth; time to pregnancy leading to live birth; gestational age at delivery; birthweight; neonatal mortality; and major congenital abnormalities. Two core outcomes applicable to all trials were also identified: adverse events and patient satisfaction with treatment. CONCLUSIONS Using robust consensus science methods, healthcare professionals, researchers and women with endometriosis have developed a core outcome set to standardise outcome selection, collection and reporting across future randomised controlled trials and systematic reviews evaluating potential treatments for endometriosis. TWEETABLE ABSTRACT: @coreoutcomes for future #endometriosis research have been developed @jamesmnduffy.
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Affiliation(s)
- Jmn Duffy
- Institute for Women's Health, University College London, London, UK.,King's Fertility, The Fetal Medicine Research Institute, London, UK
| | - M Hirsch
- Institute for Women's Health, University College London, London, UK.,University College London Hospitals NHS Foundation Trust, London, UK
| | - M Vercoe
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - J Abbott
- School of Women's and Children's Health, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - C Barker
- Radcliffe Women's Health Patient Participation Group, University of Oxford, Oxford, UK
| | - B Collura
- Resolve: The National Infertility Association, McLean, Virginia, USA
| | - R Drake
- endo:outcomes Patient and Public Participation Group, University of Auckland, Auckland, New Zealand
| | - Jlh Evers
- Centre for Reproductive Medicine and Biology, University Medical Centre Maastricht, Maastricht, the Netherlands
| | - M Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - A W Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - M L Hull
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - S Kolekar
- endo:outcomes Patient and Public Participation Group, University of Auckland, Auckland, New Zealand
| | - S Lensen
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - N P Johnson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.,World Endometriosis Society, Vancouver, British Columbia, Canada
| | - V Mahajan
- endo:outcomes Patient and Public Participation Group, University of Auckland, Auckland, New Zealand
| | - B W Mol
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - A-S Otter
- Osakidetza, OSI Bilbao, Basurto, Spain
| | - L Puscasiu
- University of Medicine, Pharmacy, Science, and Technology, Targu Mures, Romania
| | - M B Rodriguez
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
| | - L Rombauts
- Department of Obstetrics and Gynaecology, School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - A Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - R Wang
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - C M Farquhar
- Cochrane Gynaecology and Fertility Group, University of Auckland, Auckland, New Zealand
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26
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Mazraani R, Timms P, Hill PC, Suaalii-Sauni T, Niupulusu T, Temese SVA, Iosefa-Siitia L, Auvaa L, Tapelu SA, Motu MF, Righarts A, Walsh MS, Rombauts L, Allan JA, Horner P, Huston WM. Evaluation of a PGP3 ELISA for surveillance of the burden of Chlamydia infection in women from Australia and Samoa. Pathog Dis 2020; 77:5519228. [PMID: 31201421 PMCID: PMC6607412 DOI: 10.1093/femspd/ftz031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 06/10/2019] [Indexed: 01/10/2023] Open
Abstract
Serological assays can be used to investigate the population burden of infection and potentially sequelae from Chlamydia. We investigated the PGP3 ELISA as a sero-epidemiological tool for infection or sub-fertility in Australian and Samoan women. The PGP3 ELISA absorbance levels were compared between groups of women with infertility, fertile, and current chlamydial infections. In the Australian groups, women with chlamydial tubal factor infertility had significantly higher absorbance levels in the PGP3 ELISA compared to fertile women (P < 0.0001), but not when compared to women with current chlamydial infection (P = 0.44). In the Samoan study, where the prevalence of chlamydial infections is much higher there were significant differences in the PGP3 ELISA absorbance levels between chlamydial sub-fertile women and fertile women (P = 0.003). There was no difference between chlamydial sub-fertile women and women with a current infection (P = 0.829). The results support that the PGP3 assay is effective for sero-epidemiological analysis of burden of infection, but not for evaluation of chlamydial pathological sequelae such as infertility.
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Affiliation(s)
- Rami Mazraani
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Peter Timms
- Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, 9016, New Zealand
| | - Tamaailau Suaalii-Sauni
- School of Languages and Cultures, Victoria University of Wellington, Wellington, 2820, New Zealand
| | | | - Seiuli V A Temese
- Centre for Samoa Studies, National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa
| | | | | | | | | | - Antoinette Righarts
- Preventive and Social Medicine, Dunedin School of Medicine, The University of Otago, Dunedin, 9016, New Zealand
| | - Michael S Walsh
- Planning, Funding and Health Outcomes, Waitemata and Auckland District Health Boards, Auckland, New Zealand
| | - Luk Rombauts
- MIMR-PH Institute of Medical Research, Monash, Australia
| | - John A Allan
- UC Health Clinical School, The Wesley Hospital, Auchenflower, Queensland, 4066, Australia
| | - Patrick Horner
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Wilhelmina M Huston
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW 2007, Australia
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27
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Fernando S, Wallace EM, Rombauts L, White N, Hong J, Vollenhoven B, Lolatgis N, Hope N, Wong M, Lawrence M, Lawrence A, Russell C, Leong K, Thomas P, da Silva Costa F. The effect of melatonin on ultrasound markers of follicular development: A double-blind placebo-controlled randomised trial. Aust N Z J Obstet Gynaecol 2019; 60:141-148. [PMID: 31583699 DOI: 10.1111/ajo.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Melatonin is a potent oxygen scavenger and is capable of altering blood flow in various vascular beds. AIMS We aimed to determine the effect of melatonin on ovarian vascular indices during ovarian stimulation for in vitro fertilisation (IVF). MATERIALS AND METHODS This is a pilot double-blind placebo-controlled randomised trial. Sixty-nine women (mean age 35.8 ± 4.3 years) undergoing their first cycle of IVF were randomised to receive either placebo, 2, 4 or 8 mg of melatonin, twice a day. Each participant underwent a transvaginal ultrasound at days 6-10 assessing follicular number and size. The vascularisation index (VI), flow index (FI) and vascularisation-flow index (VFI) were measured. These indices were then correlated with embryological outcomes. Informed consent was obtained from participants. This trial was registered with the Australia New Zealand Clinical Trials Registry (ACTRN12613001317785). RESULTS The number of follicles did not differ between groups (P = 0.4). There were no differences in the VI (P = 0.4), FI (P = 0.1) or VFI (P = 0.3) in the right ovary or the FI (P = 0.3) or VFI (P = 0.3) in the left ovary between groups. When comparing placebo to any dose of melatonin, there were no differences in any measured parameter. While there was correlation between the number of follicles on ultrasound and all measured embryological outcomes, there was no correlation between ovarian vascular indices and these important clinical outcomes. CONCLUSIONS Melatonin does not appear to change ovarian vascular indices during ovarian stimulation. In addition, such vascular indices cannot predict the number or quality of oocytes or embryos obtained in an IVF cycle. These findings require confirmation in future larger studies.
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Affiliation(s)
- Shavi Fernando
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Hudson Institute of Medical Research, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia
| | - Euan Morrison Wallace
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Luk Rombauts
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Melbourne, Victoria, Australia
| | - Nikki White
- Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - Jennifer Hong
- Monash Ultrasound for Women, Melbourne, Victoria, Australia
| | - Beverley Vollenhoven
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Melbourne, Victoria, Australia
| | | | | | | | - Mark Lawrence
- Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Melbourne, Victoria, Australia
| | - Anthony Lawrence
- Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Melbourne, Victoria, Australia
| | | | | | - Philip Thomas
- Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Melbourne, Victoria, Australia
| | - Fabricio da Silva Costa
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Monash Women's, Monash Health, Melbourne, Victoria, Australia.,Monash Ultrasound for Women, Melbourne, Victoria, Australia
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28
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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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29
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Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, Hart R, Johnson L, Jordan C, Legro RS, Norman RJ, Moran L, Mocanu E, Qiao J, Rodgers RJ, Rombauts L, Tassone EC, Thangaratinam S, Vanky E, Teede HJ. A brief update on the evidence supporting the treatment of infertility in polycystic ovary syndrome. Aust N Z J Obstet Gynaecol 2019; 59:867-873. [DOI: 10.1111/ajo.13051] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/05/2019] [Indexed: 01/19/2023]
Affiliation(s)
| | - Marie L. Misso
- National Health and Medical Research Council Centre for Research Excellence in PCOS Monash University Melbourne Victoria Australia
- Adelaide University Adelaide South Australia Australia
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Adam Balen
- Leeds Fertility Leeds Teaching Hospitals London UK
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Luigi Devoto
- Faculty of Medicine University of Chile Santiago de Chile Chile
| | - Rhonda M. Garad
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Roger Hart
- Division of Obstetrics and Gynaecology University of Western Australia Perth Western Australia Australia
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority Melbourne Victoria Australia
| | - Cailin Jordan
- Genea Hollywood Fertility Perth Western Australia Australia
| | - Richard S. Legro
- Department of Obstetrics and Gynecology Penn State College of Medicine Hershey PA USA
| | - Rob J. Norman
- National Health and Medical Research Council Centre for Research Excellence in PCOS Monash University Melbourne Victoria Australia
- Adelaide University Adelaide South Australia Australia
- Robinson Research Institute University of Adelaide and Fertility SA Adelaide South Australia Australia
| | - Lisa Moran
- National Health and Medical Research Council Centre for Research Excellence in PCOS Monash University Melbourne Victoria Australia
- Adelaide University Adelaide South Australia Australia
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Edgar Mocanu
- Royal College of Surgeons Rotunda Hospital Dublin Ireland
| | - Jie Qiao
- Department of Obstetrics and Gynaecology Medical Center for Human Reproduction Peking University Third Hospital Beijing China
| | - Ray J. Rodgers
- Robinson Research Institute The University of Adelaide Adelaide South Australia Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology Monash University Melbourne Victoria Australia
| | - Eliza C. Tassone
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
| | - Shakila Thangaratinam
- Barts Research Centre for Women's Health (BARC) Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine Norwegian University of Science and Technology Trondheim Norway
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation Monash Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
- Monash Health Melbourne Victoria Australia
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30
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Costello M, Garad R, Hart R, Homer H, Johnson L, Jordan C, Mocanu E, Qiao J, Rombauts L, Teede HJ, Vanky E, Venetis C, Ledger W. A Review of First Line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med Sci (Basel) 2019; 7:medsci7090095. [PMID: 31510088 PMCID: PMC6780967 DOI: 10.3390/medsci7090095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility in women of reproductive age. Lifestyle change is considered the first line treatment for the management of infertile anovulatory women with PCOS, and weight loss for those who are overweight or obese. First line medical ovulation induction therapy to improve fertility outcomes is letrozole, whilst other less efficacious ovulation induction agents, such as clomiphene citrate, metformin, and metformin combined with clomiphene citrate, may also be considered. Metformin combined with clomiphene citrate is more effective than clomiphene citrate alone. In obese women with PCOS, clomiphene citrate could be used in preference to metformin alone whilst clomiphene citrate could be added to metformin alone in order to improve reproductive outcome in all women with PCOS. Gonadotrophins, which are more effective than clomiphene citrate in therapy naïve women with PCOS, can be considered a first line therapy in the presence of ultrasound monitoring, following counselling on the cost and the potential risk of multiple pregnancy.
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Affiliation(s)
- Michael Costello
- University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia.
| | - Rhonda Garad
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, and Monash Health, Melbourne, VIC 3168, Australia.
| | - Roger Hart
- Division of Obstetrics and Gynaecology, The University of Western Australia, University of Western Australia, Crawley, WA 6008, UK.
| | - Hayden Homer
- Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia.
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC 3000, Australia.
| | | | - Edgar Mocanu
- Royal College of Surgeons, Rotunda Hospital, Dublin D02 YN77, Ireland.
| | - Jie Qiao
- Department of Obstetrics and Gynaecology, Medical Center for Human Reproduction, Peking University Third Hospital, Beijing 100191, China.
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia.
| | - Helena J Teede
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne, VIC 3168, Australia.
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway.
| | - Christos Venetis
- University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia.
| | - William Ledger
- University of New South Wales, High St, Kensington, Sydney, NSW 2033, Australia.
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31
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Teede HJ, Misso ML, Boyle JA, Garad RM, McAllister V, Downes L, Gibson M, Hart RJ, Rombauts L, Moran L, Dokras A, Laven J, Piltonen T, Rodgers RJ, Thondan M, Costello MF, Norman RJ. Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Med J Aust 2019; 209:S3-S8. [PMID: 30453865 DOI: 10.5694/mja18.00656] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [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: 06/18/2018] [Accepted: 11/20/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will enable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women's health conditions and beyond. Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility. Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as "at risk" and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple pregnancies compared with clomiphene citrate.
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Affiliation(s)
- Helena J Teede
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Marie L Misso
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Jacqueline A Boyle
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Rhonda M Garad
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Veryan McAllister
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Linda Downes
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Melanie Gibson
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Roger J Hart
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC
| | - Lisa Moran
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Anuja Dokras
- Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joop Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Terhi Piltonen
- Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
| | - Raymond J Rodgers
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | | | - Michael F Costello
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
| | - Robert J Norman
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
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32
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Costello MF, Garad RM, Hart R, Homer H, Johnson L, Jordan C, Mocanu E, Qiao J, Rombauts L, Teede HJ, Vanky E, Venetis CA, Ledger WL. A Review of Second- and Third-line Infertility Treatments and Supporting Evidence in Women with Polycystic Ovary Syndrome. Med Sci (Basel) 2019; 7:E75. [PMID: 31247909 PMCID: PMC6681353 DOI: 10.3390/medsci7070075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 12/04/2022] Open
Abstract
In clomiphene-citrate-resistant anovulatory women with polycystic ovary syndrome (PCOS) and no other infertility factors, either metformin combined with clomiphene citrate or gonadotrophins could be used as a second-line pharmacological therapy, although gonadotrophins are more effective. Gonadotrophins could also be used as a second-line pharmacological therapy in anovulatory women with PCOS and clomiphene-citrate-failure. Laparoscopic ovarian surgery can also be used as a second-line therapy for ovulation induction in anovulatory women with clomiphene-citrate-resistant PCOS and no other infertility factors. The usefulness of letrozole as a second-line pharmacological treatment for ovulation induction in clomiphene-citrate-resistant women with PCOS requires further research. In terms of improving fertility, both pharmacological anti-obesity agents and bariatric surgery should be considered an experimental therapy in anovulatory women with PCOS and no other infertility factors. Where first- or second-line ovulation induction therapies have failed, in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) could be offered as a third-line therapy in women with PCOS in the absence of an absolute indication for IVF/ICSI. For women with PCOS undergoing IVF/ICSI treatment, the gonadotropin-releasing hormone (GnRH) antagonist protocol is preferred and an elective frozen embryo transfer strategy could be considered. In assisted conception units with sufficient expertise, in-vitro maturation (IVM) of oocytes could be offered to women with PCOS.
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Affiliation(s)
- Michael F Costello
- University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia.
| | - Rhonda M Garad
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia.
| | - Roger Hart
- Division of Obstetrics and Gynaecology, The University of Western Australia, University of Western Australia, Crawley, WA 6008, Australia.
| | - Hayden Homer
- Christopher Chen Oocyte Biology Research Laboratory, UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia.
| | - Louise Johnson
- Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC 3000, Australia.
| | | | - Edgar Mocanu
- Royal College of Surgeons, Rotunda Hospital, D02 YN77 Dublin, Ireland.
| | - Jie Qiao
- Department of Obstetrics and Gynaecology, Medical Center for Human Reproduction, Peking University Third Hospital, Beijing 100191, China.
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Melbourne 3168, Australia.
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC 3168, Australia.
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne 3168, VIC, Australia.
- National Health and Medical Research Council Centre for Research Excellence in PCOS, University of Adelaide, Adelaide 5006, SA, Australia.
- University of New South Wales, Sydney 2033, NSW, Australia.
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, 1517 Trondheim, Norway.
| | - Christos A Venetis
- University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia.
| | - William L Ledger
- University of New South Wales, High St. Kensington, Sydney, NSW 2052, Australia.
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Leonardi M, Reid S, Lu C, Gerges B, Chang T, Rombauts L, Healey M, Chou D, Choi S, Al-Mashat D, Ahmed S, Magotti R, Nader R, Adno A, Condous G. Diagnostic Accuracy and Reproducibility of Predicting Cul-de-Sac Obliteration by General Gynaecologists and Minimally Invasive Gynaecologic Surgeons. Journal of Obstetrics and Gynaecology Canada 2019; 41:443-449.e2. [DOI: 10.1016/j.jogc.2018.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
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Norman RJ, Alvino H, Hull LM, Mol BW, Hart RJ, Kelly TL, Rombauts L. Human growth hormone for poor responders: a randomized placebo-controlled trial provides no evidence for improved live birth rate. Reprod Biomed Online 2019; 38:908-915. [PMID: 30954433 DOI: 10.1016/j.rbmo.2019.02.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [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: 11/05/2018] [Revised: 01/18/2019] [Accepted: 02/05/2019] [Indexed: 01/19/2023]
Abstract
RESEARCH QUESTION Does the addition of human growth hormone (HGH) to an IVF cycle improve the live birth rate in previously documented poor responders to FSH? DESIGN Double-blind, placebo-controlled, randomized clinical trial comparing HGH to placebo in maximal stimulation in an IVF cycle. The study was stopped after 4 years. Women receiving ovarian stimulation in one IVF cycle, having failed to produce more than 5 eggs in a previous cycle with more than 250 IU/day of FSH were included. Basal FSH was ≤15 IU/l, body mass index <33 kg/m2, age <41 years. HGH or placebo were added from the start of the cycle in a double-blinded manner. The primary outcome was live birth rate. MAIN RESULTS The live birth rates following an IVF cycle were 9/62 (14.5%) for growth hormone and 7/51 (13.7%) for the placebo group (risk difference 0.8%, 95% confidence interval [CI] -12.1 to 13.7%; odds ratio [OR] 1.07, 95% CI 0.37-3.10). There was a greater odds of oocyte retrieval with growth hormone (OR 5.67, 95% CI 1.54-20.80) but no better chance of embryo transfer (OR 1.42, 95% CI 0.50-4.00). Birth weights were comparable. CONCLUSIONS Planned participant numbers were not reached. It was not possible to demonstrate an increase in live birth rate from the addition of growth hormone in women with a previous poor ovarian response to IVF.
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Affiliation(s)
- Robert J Norman
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia; , Fertility SA, 431 King William Road, Adelaide, SA 5000, Australia.
| | - Helen Alvino
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia
| | - Louise M Hull
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia
| | - Ben W Mol
- University of Adelaide, Robinson Research Institute, North Adelaide, SA 5006, Australia; South Australian Health and Medical Research Institute, Robinson Research Institute, North Adelaide, SA 5006; Monash University, Clayton, VIC 3800, Australia
| | - Roger J Hart
- Fertility Specialists of Western Australia, Claremont, WA 6010; The University of Western Australia, Crawley, WA 6009, Australia
| | - Thu-Lan Kelly
- Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, SA 5006; Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, SA 5001, Australia
| | - Luk Rombauts
- Monash IVF, Monash Surgical Private Hospital, Clayton, VIC 3168, Australia
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Catford SR, O'Bryan MK, McLachlan RI, Delatycki MB, Rombauts L. Germ cell arrest associated with aSETX mutation in ataxia oculomotor apraxia type 2. Reprod Biomed Online 2019; 38:961-965. [PMID: 30642639 DOI: 10.1016/j.rbmo.2018.12.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/21/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 11/19/2022]
Abstract
Ataxia with oculomotor apraxia type 2 (AOA2) is a rare autosomal recessive neurodegenerative disorder characterized by cerebellar atrophy, peripheral neuropathy and oculomotor apraxia. It is caused by mutations in the SETX gene that encodes senataxin, a ubiquitously expressed protein that mediates processes, including transcription, transcription termination, DNA repair, RNA processing, DNA-RNA hybrid (R-loop) elimination and telomere stability. In mice, senataxin is essential for male germ cell development and fertility through its role in meiotic recombination and sex chromosome inactivation. AOA2 is associated with hypogonadism in women, but there are no reports of hypogonadism or infertility in men. We describe the first case of human male infertility caused by germ cell arrest in a man with AOA2. Our patient has a homozygous mutation in the SETX gene (NC_000009.11:g.135158775dup), which results in a frameshift and premature protein termination (NM_015046.6:c.6422dup, p.[Ser2142Glufs*23]). In accordance with the murine phenotype, testis histology revealed disrupted seminiferous tubules with spermatogonia and primary spermatocytes, but absent spermatids. Collectively, these data support an essential role of senataxin in human spermatogenesis, and provide a compelling case that men with AOA2 should be counselled at diagnosis about the possibility of infertility.
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Affiliation(s)
- S R Catford
- Hudson Institute of Medical Research, Clayton 3168, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3168, Melbourne, Australia.
| | - M K O'Bryan
- The School of Biological Sciences, Monash University, Clayton 3800, Melbourne, Australia
| | - R I McLachlan
- Hudson Institute of Medical Research, Clayton 3168, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Clayton 3168, Melbourne, Australia; Monash IVF Group Pty Ltd, Richmond 3121, Melbourne, Australia
| | - M B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville 3052, Melbourne, Australia
| | - L Rombauts
- Department of Obstetrics and Gynecology, Monash University, Clayton 3168, Melbourne, Australia; Monash IVF Group Pty Ltd, Richmond 3121, Melbourne, Australia
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Costello MF, Misso ML, Balen A, Boyle J, Devoto L, Garad RM, Hart R, Johnson L, Jordan C, Legro RS, Norman RJ, Mocanu E, Qiao J, Rodgers RJ, Rombauts L, Tassone EC, Thangaratinam S, Vanky E, Teede HJ. Evidence summaries and recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome: assessment and treatment of infertility. Hum Reprod Open 2019; 2019:hoy021. [PMID: 31486807 PMCID: PMC6396642 DOI: 10.1093/hropen/hoy021] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 09/09/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022] Open
Abstract
STUDY QUESTION What is the recommended assessment and management of infertile women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertize and consumer preference? SUMMARY ANSWER International evidence-based guidelines, including 44 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of infertile women with PCOS. WHAT IS KNOWN ALREADY Previous guidelines on PCOS lacked rigorous evidence-based processes, failed to engage consumer and multidisciplinary perspectives or were outdated. The assessment and management of infertile women with PCOS are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. PARTICIPANTS/MATERIALS, SETTING, METHODS Governance included a six continent international advisory and a project board, a multidisciplinary international guideline development group (GDG), consumer and translation committees. Extensive health professional and consumer engagement informed the guideline scope and priorities. The engaged international society-nominated panel included endocrinology, gynaecology, reproductive endocrinology, obstetrics, public health and other experts, alongside consumers, project management, evidence synthesis and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Extensive online communication and two face-to-face meetings over 15 months addressed 19 prioritized clinical questions involving nine evidence-based reviews and 10 narrative reviews. Evidence-based recommendations (EBRs) were formulated prior to consensus voting within the guideline panel. STUDY DESIGN, SIZE, DURATION International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. A (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, desirable and undesirable consequences, feasibility, acceptability, cost, implementation and ultimately recommendation strength. The guideline was peer-reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREE II criteria and underwent methodological review. This guideline was approved by all members of the GDG and has been approved by the NHMRC. MAIN RESULTS AND THE ROLE OF CHANCE The quality of evidence (QOE) for the EBRs in the assessment and management of infertility in PCOS included very low (n = 1), low (n = 9) and moderate (n = 4) quality with no EBRs based on high-quality evidence. The guideline provides 14 EBRs, 10 clinical consensus recommendations (CCRs) and 20 clinical practice points on the assessment and management of infertility in PCOS. Key changes in this guideline include emphasizing evidence-based fertility therapy, including cheaper and safer fertility management. LIMITATIONS, REASONS FOR CAUTION Overall evidence is generally of low to moderate quality, requiring significantly greater research in this neglected, yet common condition. Regional health systems vary and a process for adaptation of this guideline is provided. WIDER IMPLICATIONS OF THE FINDINGS The international guideline for the assessment and management of infertility in PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. STUDY FUNDING/COMPETING INTEREST(S) The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine (ASRM). GDG members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Norman has declared a minor shareholder interest in the IVF unit Fertility SA, travel support from Merck and grants from Ferring. Prof. Norman also has scientific advisory board duties for Ferring. The remaining authors have no conflicts of interest to declare. This article was not externally peer-reviewed by Human Reproduction Open.
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Affiliation(s)
- M F Costello
- School of Women's and Children's Health, University of New South Wales, High St, Kensington, Sydney, New South Wales, Australia
| | - M L Misso
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Melbourne, Australia
| | - A Balen
- Reproductive Medicine and Surgery, Leeds Centre for Reproductive Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - J Boyle
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Melbourne, Australia
| | - L Devoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - R M Garad
- Monash Health, Clayton, Melbourne, Australia.,National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - R Hart
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, WA, Australia
| | - L Johnson
- Victorian Assisted Reproductive Treatment Authority, Victoria, Australia
| | - C Jordan
- Victorian Assisted Reproductive Treatment Authority, Victoria, Australia.,Genea Hollywood Fertility, 190 Cambridge St, Wembley WA, Australia
| | - R S Legro
- Department of Obstetrics and Gynecology, Penn State University College of Medicine, USA
| | - R J Norman
- National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash University, Melbourne, Victoria, Australia.,Adelaide University, Adelaide, South Australia, Australia
| | - E Mocanu
- Royal College of Surgeons, Rotunda Hospital, 123 St Stephen's Green, Dublin, Ireland
| | - J Qiao
- Peking University Third Hospital, Haidian Qu, Beijing Shi, China
| | - R J Rodgers
- Robinson Research Institute, University of Adelaide and Fertility SA, Adelaide, South Australia, Australia
| | - L Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Melbourne, Victoria 3168, Australia
| | - E C Tassone
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Monash Health, Clayton, Melbourne, Australia
| | - S Thangaratinam
- Barts Research Centre for Women's Health (BARC), Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - E Vanky
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - H J Teede
- Monash Health, Clayton, Melbourne, Australia.,National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Hammarberg K, Kirkman M, Stern C, McLachlan RI, Clarke G, Agresta F, Gook D, Rombauts L, Vollenhoven B, Fisher JRW. Survey of Reproductive Experiences and Outcomes of Cancer Survivors Who Stored Reproductive Material Before Treatment. Hum Reprod 2018; 32:2423-2430. [PMID: 29045667 DOI: 10.1093/humrep/dex314] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 06/26/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
STUDY QUESTION What are the reproductive experiences and outcomes of people who store reproductive material before cancer treatment? SUMMARY ANSWER Of respondents who had tried to achieve pregnancy since completing cancer treatment almost all had succeeded, in most cases through natural conception. WHAT IS KNOWN ALREADY People of reproductive age who are diagnosed with cancer can cryopreserve reproductive material to guard against the adverse effects on fertility of gonadotoxic treatment. Little is known about the reproductive outcomes of people who undergo fertility preservation before cancer treatment. STUDY DESIGN, SIZE, DURATION Cross-sectional survey. PARTICIPANTS/MATERIALS, SETTING, METHODS Women and men who had stored reproductive material before cancer treatment at two private and one public fertility clinics up to June 2014 and were at least 18 years old at the time were identified from medical records and invited to complete an anonymous questionnaire about their reproductive experiences. MAIN RESULTS AND THE ROLE OF CHANCE Of the 870 potential respondents 302 (171 female and 131 male) returned completed questionnaires yielding a response rate of 34.5% (39.5% and 29.7% for female and male respondents, respectively). Current age was similar for women and men (37.2 years) but men had been diagnosed with cancer significantly earlier in life than women (28.2 versus 30.3 years, P = 0.03). Almost two-thirds of respondents wished to have a child or another child in the future, some of whom knew that they were unable to. One in ten respondents was a parent before the cancer diagnosis and around one-third had had a child since diagnosis or was pregnant (or a partner in pregnancy) at the time of the survey. Of those who had tried to conceive since completing cancer treatment (N = 119) 84% (79% of women and 90% of men) had had a child or were pregnant (or a partner in pregnancy). Most of the pregnancies since the diagnosis of cancer occurred after natural conception (58/100, 58%). Of the 22 women (13% of all women) and 35 men (27% of all men) who had used their stored reproductive material four women (18%) and 28 men (80%) had had a child or were pregnant or a partner in pregnancy at the time of completing the survey. The most commonly stated reason for not using the stored material was not being ready to try for a baby. LIMITATIONS, REASON FOR CAUTION The relatively low response rate, particularly among men, means that participation bias may have influenced the findings. As type of cancer was self-reported and we did not ask questions about respondents' cancer treatments, it is not possible to link reproductive outcomes to type of cancer or cancer treatment. Also, there is no way of comparing the sample with the populations they were drawn from as data on reproductive outcomes of people who store reproductive material before cancer treatment are not collected routinely. This might have led to over- or underestimates of the reproductive experiences and outcomes reported in this paper. WIDER IMPLICATIONS OF THE FINDINGS The findings add to the limited evidence about the reproductive outcomes of this growing group of people and can be used to inform the advice given to those contemplating fertility preservation in the context of cancer. STUDY FUNDING/COMPETING INTERESTS The study was funded by the National Health and Medical Research Council (APP1042347). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- K Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Victorian Assisted Reproductive Treatment Authority, Victoria, Australia
| | - M Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - C Stern
- Melbourne IVF, Victoria, Australia.,Reproductive Services, Royal Women's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - R I McLachlan
- Monash IVF, Victoria, Australia.,Andrology Australia, Victoria, Australia.,Hudson Institute, Monash Medical Centre, Victoria, Australia
| | - G Clarke
- Royal Women's Hospital, University of Melbourne, Victoria, Australia
| | | | - D Gook
- Melbourne IVF, Victoria, Australia.,Reproductive Services, Royal Women's Hospital and Department of Obstetrics and Gynaecology, University of Melbourne, Victoria, Australia
| | - L Rombauts
- Monash IVF, Victoria, Australia.,Hudson Institute, Monash Medical Centre, Victoria, Australia.,Monash Health, Monash Medical Centre, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - B Vollenhoven
- Monash IVF, Victoria, Australia.,Monash Health, Monash Medical Centre, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Victoria, Australia
| | - J R W Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
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Fernando S, Wallace EM, Vollenhoven B, Lolatgis N, Hope N, Wong M, Lawrence M, Lawrence A, Russell C, Leong K, Thomas P, Rombauts L. Melatonin in Assisted Reproductive Technology: A Pilot Double-Blind Randomized Placebo-Controlled Clinical Trial. Front Endocrinol (Lausanne) 2018; 9:545. [PMID: 30283403 PMCID: PMC6157331 DOI: 10.3389/fendo.2018.00545] [Citation(s) in RCA: 25] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/28/2018] [Indexed: 01/31/2023] Open
Abstract
Purpose: To explore in a small pilot study whether oral melatonin, administered during ovarian stimulation increases clinical pregnancy rate (CPR) after IVF and what dose might be most effective. Methods: Pilot double-blind, dose-finding, placebo-controlled randomized clinical trial in private IVF clinics in Australia between September 2014 and September 2016. One hundred and sixty women having their first cycle of IVF or ICSI were randomized to receive placebo (n = 40), melatonin 2 mg (n = 41), melatonin 4 mg (n = 39), or melatonin 8 mg (n = 40) twice per day (BD) during ovarian stimulation. The primary outcome was CPR. Secondary outcomes included serum and follicular fluid (FF) melatonin concentrations, oocyte/embryo quantity/quality, and live birth rate (LBR). Analysis was performed using the intention-to-treat principle. Results: There was no difference in CPR or LBR between any of the four groups (p = 0.5). When all the doses of melatonin were compared as a group with placebo, the CPR was 21.7% for the former and 15.0% for the latter [OR 1.57 (95% CI 0.59, 4.14), p = 0.4]. There were also no differences between the groups in total oocyte number, number of MII oocytes, number of fertilized oocytes, or the number or quality of embryos between the groups. This is despite mean FF melatonin concentration in the highest dose group (8 mg BD) being nine-fold higher compared with placebo (P < 0.001). Conclusion: No significant differences were observed in CPR or oocyte and embryo parameters despite finding a nine-fold increase in FF melatonin concentration. However, this study was not sufficiently powered to assess differences in CPR and therefore, these results should be interpreted with caution. Because this was a small RCT, a beneficial effect of melatonin on IVF pregnancy rates cannot be excluded and merits confirmation in further, larger clinical trials. ANZCTR (http://www.anzctr.org.au/ Project ID: ACTRN12613001317785).
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Affiliation(s)
- Shavi Fernando
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Euan Morrison Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Beverley Vollenhoven
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Monash IVF, Richmond, VIC, Australia
| | | | | | | | | | | | | | | | | | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Monash IVF, Richmond, VIC, Australia
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Tomassetti C, Adamson D, Arici A, Canis M, Hompes P, Hummelshoj L, Mol BW, Nardo L, Rombauts L, D’Hooghe T. EndoART: A proposed randomized controlled trial on endometriomas in assisted reproductive technologies, comparing the effect of no intervention, surgery, and prolonged GnRH downregulation on pregnancy rates. Journal of Endometriosis and Pelvic Pain Disorders 2018. [DOI: 10.1177/2284026518784236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Clinical management of endometriomas, prior to starting treatment with assisted reproductive technologies (ART), has since long been a matter of debate. Whereas cystectomy has been advocated in the past, recently more evidence has emerged on the potential negative effect of surgery on ovarian reserve. Parallel to this, prolonged downregulation with GnRH-a (gonadotropin-releasing hormone agonists) has been described to improve ART pregnancy rates in women with endometriosis. However, none of these strategies have been assessed in a large randomized controlled trial. The aim of the EndoART study is to assess whether ovarian surgery or prolonged GnRH-a downregulation result in higher pregnancy rates after ART compared to no intervention in women with endometrioma(s). Methods/design: A parallel randomized multi-center trial has been designed to compare ART pregnancy rates in three different treatment groups: no intervention, ovarian surgery, and prolonged hormonal suppression by GnRH-a prior to ART. The primary outcome measure studied is the clinical pregnancy rate with fetal heart-beat within 6 months after initiation of a fresh ART cycle. Secondary outcome measures studied include live birth rate after one initiated fresh ART cycle, cumulative clinical pregnancy rate with fetal heart-beat and live birth rates (after one fully completed ART cycle: initiated fresh + eventual associated frozen embryo transfer cycles), ART–specific data (e.g. number of oocytes, number of good quality embryos), complications, pelvic pain, and quality of life. Conclusion: This trial may answer the most frequently asked questions by both women with endometriosis and physicians: how do you treat endometrioma in women prior to treatment with ART?
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Affiliation(s)
- Carla Tomassetti
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, Organ Systems, KU Leuven, Leuven, Belgium
| | - David Adamson
- Palo Alto Medical Foundation Fertility Physicians of Northern California, East Palo Alto, CA, USA
| | - Aydin Arici
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Michel Canis
- Department of Gynaecological Surgery, CHU Estaing, Clermont-Ferrand, France
- CICE (Centre International de Chirurgie Endoscopique), Faculty of Medicine, Clermont-Ferrand, France
| | - Peter Hompes
- Vrije Universiteit Medical Center, Center for Reproductive Medicine, Amsterdam, The Netherlands
| | | | - Ben-Willem Mol
- The Robinson Research Institute, School of Medicine, University of Adelaide, The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | | | - Thomas D’Hooghe
- Department of Development and Regeneration, Organ Systems, KU Leuven, Leuven, Belgium
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40
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Robinson AJ, Rombauts L, Ades A, Leong K, Paul E, Piessens S. Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments. Journal of Endometriosis and Pelvic Pain Disorders 2018. [DOI: 10.1177/2284026518767259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: This study aims to evaluate the use of transvaginal ultrasound in predicting superficial endometriosis near the uterosacral ligaments, in women with symptoms of endometriosis. Methods: This was a prospective observational pilot study in which women with symptoms of endometriosis underwent detailed pre-operative transvaginal ultrasound to assess the uterosacral ligament area for thickening (‘white line sign’), tenderness and small hypoechoic nodules. Women with deep infiltrating endometriosis were excluded. The test characteristics of transvaginal ultrasound were reported using histologically or visually proven endometriosis near the ipsilateral uterosacral ligament as a reference standard. Results: In 81 patients who underwent pre-operative transvaginal ultrasound and laparoscopy, no marker had appropriate test characteristics for a diagnostic or screening test for endometriosis near the ipsilateral uterosacral ligament when used alone. The presence of a small hypoechoic nodule on the white line had the highest specificity of the three markers, at 82% (95% confidence interval 66%–92%). Quantitative measurement of the white line also achieved a high specificity of ≥96% using a cut-off of 5.8 and 6.1 mm, on the left and right sides, respectively. Conclusion: Transvaginal ultrasound of the uterosacral ligament area using the three proposed markers is not a clinically useful screening test for superficial endometriosis near the uterosacral ligaments. A grossly thickened white line (≥5.8 mm) and/or the presence of small hypoechoic nodules are highly specific findings for superficial endometriosis near the uterosacral ligaments and may prompt surgical management.
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Affiliation(s)
- Alice J Robinson
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Camberwell Ultrasound for Women, Hawthorn East, VIC, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Monash IVF Group, Richmond, VIC, Australia
| | - Alex Ades
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
| | - Kenneth Leong
- Monash IVF Group, Richmond, VIC, Australia
- Borderless Healthcare Group, Shanghai, China
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Sofie Piessens
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Camberwell Ultrasound for Women, Hawthorn East, VIC, Australia
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Perry E, Beyer C, Willats E, Lin J, Low LY, Mullen J, Rombauts L. Clinical significance of undiagnosed mosaicism in IVF embryos. Reprod Biomed Online 2018. [DOI: 10.1016/j.rbmo.2017.10.033] [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: 10/18/2022]
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Fernando S, Biggs SN, Horne RSC, Vollenhoven B, Lolatgis N, Hope N, Wong M, Lawrence M, Lawrence A, Russell C, Leong K, Thomas P, Rombauts L, Wallace EM. The impact of melatonin on the sleep patterns of women undergoing IVF: a double blind RCT. Hum Reprod Open 2018; 2017:hox027. [PMID: 30895239 PMCID: PMC6276665 DOI: 10.1093/hropen/hox027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/14/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Does melatonin result in a dose–response effect on sleep quality and daytime sleepiness in women undergoing IVF? SUMMARY ANSWER Melatonin, even when given at high doses twice per day, does not cause significant daytime sleepiness or change night time sleep quantity or quality. WHAT IS KNOWN ALREADY Melatonin is being increasingly used as an adjuvant therapy for women undergoing IVF owing to its antioxidative effects. It is widely considered to be sedative but there are scant objective data on the effects of melatonin on sleep in the setting of IVF. STUDY DESIGN SIZE, DURATION The study was a double-blind placebo-controlled randomized trial of 116 women recruited between September 2014 and September 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD Women who were undergoing their first cycle of IVF at private IVF centers were recruited into the RCT and randomized to receive either placebo, 2 mg, 4 mg or 8 mg of melatonin, twice per day (BD) from Day 2 of their cycle until the day before oocyte retrieval. Each participant wore an accelerometer that provides an estimate of sleep and wake activity for up to 1 week of baseline and throughout treatment (up to 2 weeks). They also kept sleep diaries and completed a Karolinska sleepiness score detailing their night time sleep activity and daytime sleepiness, respectively. MAIN RESULTS AND THE ROLE OF CHANCE In total, 116 women were included in the intention-to-treat analysis (placebo BD (n = 32), melatonin 2 mg BD (n = 29), melatonin 4 mg BD (n = 26), melatonin 8 mg BD (n = 29)). There were no significant differences in daytime Karolinska sleepiness score between groups (P = 0.4), nor was there a significant dose–response trend (β=0.05, 95% CI −0.22–0.31, P = 0.7). There were no differences in objective measures of sleep quantity or quality, including wake after sleep onset time, sleep onset latency, and sleep efficiency before and after treatment or between groups. There was an improvement in subjective sleep quality scores from baseline to during treatment in all groups, except 8 mg BD melatonin: placebo (percentage change −13.3%, P = 0.01), 2 mg (−14.1%, P = 0.03), 4 mg (−8.6%, P = 0.01) and 8 mg (−7.8%, P = 0.07). LIMITATIONS, REASONS FOR CAUTION As this was a subset of a larger trial, the melatonin in ART (MIART) trial, it is possible that the sample size was too small to detect statistically significant differences between the groups. WIDER IMPLICATIONS OF THE FINDINGS While this study suggests that melatonin can be used twice per day at high doses to achieve sustained antioxidation effects, with the reassurance that this will not negatively impact daytime sleepiness or night time sleep habits, the sample size is small and may have missed a clinically significant difference. Nevertheless, our findings may have implications not only for future studies of fertility treatments (including meta-analyses), but also in other medical fields where sustained antioxidation is desired. STUDY FUNDING/COMPETING INTERESTS This study was funded by the Monash IVF Research and Education Foundation (PY12_15). S.F. is supported by the National Health and Medical Research Council (Postgraduate Scholarship APP1074342) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Ella Macknight Memorial Scholarship. E.W. is supported by an National Health and Medical Research Council Program Grant (APP1113902). S.F., E.W., R.H., B.V., N.L., N.H., M.W., M.L., A.L., P.T., K.L. have nothing to declare. L.R. is a Minority shareholder in Monash IVF Group, has unrestricted grants from MSD®, Merck-Serono® and Ferring® and receives consulting fees from Ferring®. S.N.B. reports consulting fees from Johnson & Johnson Consumer Inc®, outside the submitted work. TRIAL REGISTRATION NUMBER This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (Project ID: ACTRN12613001317785). TRIAL REGISTRATION DATE 27/11/2013 DATE OF FIRST PATIENT’S ENROLMENT 1/9/2014
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Affiliation(s)
- Shavi Fernando
- Departments of Obstetrics and Gynaecology.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | - Sarah Nichole Biggs
- Paediatrics, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia
| | - Rosemary Sylvia Claire Horne
- Paediatrics, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia
| | - Beverley Vollenhoven
- Departments of Obstetrics and Gynaecology.,Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | | | - Nicole Hope
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Melissa Wong
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Mark Lawrence
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | | | - Chris Russell
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Kenneth Leong
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Philip Thomas
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | - Luk Rombauts
- Departments of Obstetrics and Gynaecology.,Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
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Basnayake SK, Volovsky M, Rombauts L, Osianlis T, Vollenhoven B, Healey M. Progesterone concentrations and dosage with frozen embryo transfers - What's best? Aust N Z J Obstet Gynaecol 2017; 58:533-538. [PMID: 29271471 DOI: 10.1111/ajo.12757] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 12/02/2016] [Accepted: 11/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a lack of consensus on the optimal dose and form of progesterone supplementation during frozen-thawed embryo transfer with hormone replacement therapy. AIMS We aim to identify the serum progesterone concentration on day 16 most likely to result in positive pregnancy outcomes. MATERIALS AND METHODS We undertook a retrospective study of 4582 women who underwent frozen embryo transfer with hormone replacement therapy, or natural frozen embryo transfer, over 14 years at a multi-site private in vitro fertilisation clinic. Embryos were 3-5 days of age at time of transfer. We extracted data on serum progesterone concentrations and outcomes, as well as dose and form of progesterone supplementation, from patient and pharmacy records. RESULTS Increased live birth rates for frozen embryo transfer with hormone replacement therapy were seen with day 16 serum progesterone concentrations >50 nmol/L (26.4% vs 11.3% for <50 nmol/L; adjusted odds ratio (OR) 3.14 (95% CI 2.21-4.48)). Similarly, a decreased pregnancy loss rate was seen in this group (14.3% vs 32.6% for ≤50 nmol/L; adjusted OR 0.26 (95% CI 0.12-0.58)). There was a positive correlation between live births and the number of progesterone doses per day (r = 0.119, P = 0.026) and day 16 progesterone concentrations (r = 0.128, P = 0.011). CONCLUSION Improved pregnancy outcomes are seen with day 16 serum progesterone concentrations >50 nmol/L. There is a statistically significant correlation between live births, number of progesterone doses per day and day 16 serum progesterone concentrations in this study.
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Affiliation(s)
| | | | - Luk Rombauts
- Monash IVF Pty Ltd, Melbourne, Victoria, Australia.,Reproductive Medicine, Monash Health, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Tiki Osianlis
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Beverley Vollenhoven
- Monash IVF Pty Ltd, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.,Obstetrics and Gynaecology, Monash Health, Melbourne, Victoria, Australia
| | - Martin Healey
- Monash IVF Pty Ltd, Melbourne, Victoria, Australia.,Gynaecology 2 Unit, Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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Hammarberg K, Kirkman M, Stern C, McLachlan RI, Clarke G, Agresta F, Gook D, Rombauts L, Vollenhoven B, Fisher JRW. Survey of Reproductive Experiences and Outcomes of Cancer Survivors Who Stored Reproductive Material Before Treatment. Hum Reprod 2017; 33:179. [DOI: 10.1093/humrep/dex345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Indexed: 11/15/2022] Open
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Rombauts L. Vital signs: when twin bliss doesn't measure up. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.06.013] [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: 11/29/2022]
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Chambers GM, Paul RC, Harris K, Fitzgerald O, Boothroyd CV, Rombauts L, Chapman MG, Jorm L. Assisted reproductive technology in Australia and New Zealand: cumulative live birth rates as measures of success. Med J Aust 2017; 207:114-118. [DOI: 10.5694/mja16.01435] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/07/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Georgina M Chambers
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Repon C Paul
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Katie Harris
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | - Oisin Fitzgerald
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, NSW
| | | | | | | | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
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Farquhar C, Rombauts L, Kremer JAM, Lethaby A, Ayeleke RO. Oral contraceptive pill, progestogen or oestrogen pretreatment for ovarian stimulation protocols for women undergoing assisted reproductive techniques. Cochrane Database Syst Rev 2017; 5:CD006109. [PMID: 28540977 PMCID: PMC6481489 DOI: 10.1002/14651858.cd006109.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Among subfertile women undergoing assisted reproductive technology (ART), hormone pills given before ovarian stimulation may improve outcomes. OBJECTIVES To determine whether pretreatment with the combined oral contraceptive pill (COCP) or with a progestogen or oestrogen alone in ovarian stimulation protocols affects outcomes in subfertile couples undergoing ART. SEARCH METHODS We searched the following databases from inception to January 2017: Cochrane Gynaecology and Fertility Group Specialised Register, The Cochrane Central Register Studies Online, MEDLINE, Embase, CINAHL and PsycINFO. We also searched the reference lists of relevant articles and registers of ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of hormonal pretreatment in women undergoing ART. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcomes were live birth or ongoing pregnancy and pregnancy loss. MAIN RESULTS We included 29 RCTs (4701 women) of pretreatment with COCPs, progestogens or oestrogens versus no pretreatment or alternative pretreatments, in gonadotrophin-releasing hormone (GnRH) agonist or antagonist cycles. Overall, evidence quality ranged from very low to moderate. The main limitations were risk of bias and imprecision. Most studies did not describe their methods in adequate detail. Combined oral contraceptive pill versus no pretreatmentWith antagonist cycles in both groups the rate of live birth or ongoing pregnancy was lower in the pretreatment group (OR 0.74, 95% CI 0.58 to 0.95; 6 RCTs; 1335 women; I2 = 0%; moderate quality evidence). There was insufficient evidence to determine whether the groups differed in rates of pregnancy loss (OR 1.36, 95% CI 0.82 to 2.26; 5 RCTs; 868 women; I2 = 0%; moderate quality evidence), multiple pregnancy (OR 2.21, 95% CI 0.53 to 9.26; 2 RCTs; 125 women; I2 = 0%; low quality evidence), ovarian hyperstimulation syndrome (OHSS; OR 0.98, 95% CI 0.28 to 3.40; 2 RCTs; 642 women; I2 = 0%, low quality evidence), or ovarian cyst formation (OR 0.47, 95% CI 0.08 to 2.75; 1 RCT; 64 women; very low quality evidence).In COCP plus antagonist cycles versus no pretreatment in agonist cycles, there was insufficient evidence to determine whether the groups differed in rates of live birth or ongoing pregnancy (OR 0.89, 95% CI 0.64 to 1.25; 4 RCTs; 724 women; I2 = 0%; moderate quality evidence), multiple pregnancy (OR 1.36, 95% CI 0.85 to 2.19; 4 RCTs; 546 women; I2 = 0%; moderate quality evidence), or OHSS (OR 0.63, 95% CI 0.20 to 1.96; 2 RCTs; 290 women, I2 = 0%), but there were fewer pregnancy losses in the pretreatment group (OR 0.40, 95% CI 0.22 to 0.72; 5 RCTs; 780 women; I2 = 0%; moderate quality evidence). There were no data suitable for analysis on ovarian cyst formation.One small study comparing COCP versus no pretreatment in agonist cycles showed no clear difference between the groups for any of the reported outcomes. Progestogen versus no pretreatmentAll studies used the same protocol (antagonist, agonist or gonadotrophins) in both groups. There was insufficient evidence to determine any differences in rates of live birth or ongoing pregnancy (agonist: OR 1.35, 95% CI 0.69 to 2.65; 2 RCTs; 222 women; I2 = 24%; low quality evidence; antagonist: OR 0.67, 95% CI 0.18 to 2.54; 1 RCT; 47 women; low quality evidence; gonadotrophins: OR 0.63, 95% CI 0.09 to 4.23; 1 RCT; 42 women; very low quality evidence), pregnancy loss (agonist: OR 2.26, 95% CI 0.67 to 7.55; 2 RCTs; 222 women; I2 = 0%; low quality evidence; antagonist: OR 0.36, 95% CI 0.06 to 2.09; 1 RCT; 47 women; low quality evidence; gonadotrophins: OR 1.00, 95% CI 0.06 to 17.12; 1 RCT; 42 women; very low quality evidence) or multiple pregnancy (agonist: no data available; antagonist: OR 1.05, 95% CI 0.06 to 17.76; 1 RCT; 47 women; low quality evidence; gonadotrophins: no data available). Three studies, all using agonist cycles, reported ovarian cyst formation: rates were lower in the pretreatment group (OR 0.16, 95% CI 0.08 to 0.32; 374 women; I2 = 1%; moderate quality evidence). There were no data on OHSS. Oestrogen versus no pretreatmentIn antagonist or agonist cycles, there was insufficient evidence to determine whether the groups differed in rates of live birth or ongoing pregnancy (antagonist versus antagonist: OR 0.79, 95% CI 0.53 to 1.17; 2 RCTs; 502 women; I2 = 0%; low quality evidence; antagonist versus agonist: OR 0.88, 95% CI 0.51 to 1.50; 2 RCTs; 242 women; I2 = 0%; very low quality evidence), pregnancy loss (antagonist versus antagonist: OR 0.16, 95% CI 0.02 to 1.47; 1 RCT; 49 women; very low quality evidence; antagonist versus agonist: OR 1.59, 95% CI 0.62 to 4.06; 1 RCT; 220 women; very low quality evidence), multiple pregnancy (antagonist versus antagonist: no data available; antagonist versus agonist: OR 2.24, 95% CI 0.09 to 53.59; 1 RCT; 22 women; very low quality evidence) or OHSS (antagonist versus antagonist: no data available; antagonist versus agonist: OR 1.54, 95% CI 0.25 to 9.42; 1 RCT; 220 women). Ovarian cyst formation was not reported. Head-to-head comparisonsCOCP was compared with progestogen (1 RCT, 44 women), and with oestrogen (2 RCTs, 146 women), and progestogen was compared with oestrogen (1 RCT, 48 women), with an antagonist cycle in both groups. COCP in an agonist cycle was compared with oestrogen in an antagonist cycle (1 RCT, 25 women). Data were scant but there was no clear evidence that any of the groups differed in rates of live birth or ongoing pregnancy, pregnancy loss or other adverse events. AUTHORS' CONCLUSIONS Among women undergoing ovarian stimulation in antagonist protocols, COCP pretreatment was associated with a lower rate of live birth or ongoing pregnancy than no pretreatment. There was insufficient evidence to determine whether rates of live birth or ongoing pregnancy were influenced by pretreatment with progestogens or oestrogens, or by COCP pretreatment using other stimulation protocols. Findings on adverse events were inconclusive, except that progesterone pretreatment may reduce the risk of ovarian cysts in agonist cycles, and COCP in antagonist cycles may reduce the risk of pregnancy loss compared with no pretreatment in agonist cycles.
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Affiliation(s)
- Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Luk Rombauts
- Monash UniversityMonash IVF and Department of O&G246 Clayton RdMelbourneAustralia
| | - Jan AM Kremer
- Radboud University Nijmegen Medical CenterDepartment of Obstetrics and GynaecologyPO Box 9101NijmegenNetherlands6500 HB
| | - Anne Lethaby
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Reuben Olugbenga Ayeleke
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
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Hammarberg K, Kirkman M, Stern C, McLachlan RI, Gook D, Rombauts L, Vollenhoven B, Fisher JRW. Cryopreservation of reproductive material before cancer treatment: a qualitative study of health care professionals' views about ways to enhance clinical care. BMC Health Serv Res 2017; 17:343. [PMID: 28490359 PMCID: PMC5424377 DOI: 10.1186/s12913-017-2292-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer treatment can diminish fertility in women and men. The need for fertility preservation is growing as increasing numbers of people survive cancer. Cryostorage of reproductive material to preserve potential for conception for cancer survivors has moved from being experimental to being a part of clinical management of women and men who are diagnosed with cancer in their reproductive years. There is little existing evidence about how fertility preservation services can be enhanced to meet the complex needs of patients who are diagnosed with cancer in their reproductive years. The aim of this research was to inform clinical practice development by drawing on the collective experience and knowledge of staff at well-established clinics that offer fertility preservation before cancer treatment. METHODS A qualitative research model was adopted using semi-structured interviews with professionals involved in the care of people who freeze reproductive material before cancer treatment. In the state of Victoria, Australia, two large assisted reproductive technology (ART) centres have been providing fertility preservation services for more than two decades. An invitation to participate in a semi-structured interview about clinical care in the context of fertility preservation was emailed to past and current staff members. To capture diverse perspectives, informants were sought from all relevant professions: fertility specialists, andrologists, nurses, embryologists/scientists, counsellors, and administrative staff. Transcripts were analysed thematically. RESULTS Thirteen key informants were interviewed from August 2013 to February 2014. The identified themes relating to enhancing clinical care in a fertility preservation service were communication between oncology and ART specialists; managing urgency; managing patients' expectations; establishing and implementing protocols, systems, and data bases; and maintaining contact with patients. CONCLUSION The collective knowledge of this study's informants, who represent multidisciplinary teams with more than two decades' experience in fertility preservation, yields important insights into strategies that fertility preservation services can employ to promote the integration of oncology and fertility care, the psychosocial care of patients, data recording and monitoring, and reporting of outcomes.
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Affiliation(s)
- Karin Hammarberg
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 549 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Maggie Kirkman
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 549 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Catharyn Stern
- Melbourne IVF, Melbourne, Victoria 3002 Australia
- Reproductive Services, Royal Women’s Hospital, Parkville, Victoria 3052 Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Robert I. McLachlan
- Monash IVF, Clayton, Victoria 3163 Australia
- Andrology Australia, Melbourne, Victoria 3163 Australia
- Hudson Institute of Medical Research, Clayton, Victoria 3163 Australia
| | - Debra Gook
- Melbourne IVF, Melbourne, Victoria 3002 Australia
- Reproductive Services, Royal Women’s Hospital, Parkville, Victoria 3052 Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria 3010 Australia
| | - Luk Rombauts
- Monash IVF, Clayton, Victoria 3163 Australia
- Hudson Institute of Medical Research, Clayton, Victoria 3163 Australia
- Monash Health, Clayton, Victoria 3163 Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3163 Australia
| | - Beverley Vollenhoven
- Monash IVF, Clayton, Victoria 3163 Australia
- Monash Health, Clayton, Victoria 3163 Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3163 Australia
| | - Jane R. W. Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 549 St Kilda Rd, Melbourne, Victoria 3004 Australia
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Rogers PAW, Adamson GD, Al-Jefout M, Becker CM, D’Hooghe TM, Dunselman GAJ, Fazleabas A, Giudice LC, Horne AW, Hull ML, Hummelshoj L, Missmer SA, Montgomery GW, Stratton P, Taylor RN, Rombauts L, Saunders PT, Vincent K, Zondervan KT. Research Priorities for Endometriosis. Reprod Sci 2017; 24:202-226. [PMID: 27368878 PMCID: PMC5933154 DOI: 10.1177/1933719116654991] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The 3rd International Consensus Workshop on Research Priorities in Endometriosis was held in São Paulo on May 4, 2014, following the 12th World Congress on Endometriosis. The workshop was attended by 60 participants from 19 countries and was divided into 5 main sessions covering pathogenesis/pathophysiology, symptoms, diagnosis/classification/prognosis, disease/symptom management, and research policy. This research priorities consensus statement builds on earlier efforts to develop research directions for endometriosis. Of the 56 research recommendations from the 2011 meeting in Montpellier, a total of 41 remained unchanged, 13 were updated, and 2 were deemed to be completed. Fifty-three new research recommendations were made at the 2014 meeting in Sao Paulo, which in addition to the 13 updated recommendations resulted in a total of 66 new recommendations for research. The research recommendations published herein, as well as those from the 2 previous papers from international consensus workshops, are an attempt to promote high-quality research in endometriosis by identifying and agreeing on key issues that require investigation. New areas included in the 2014 recommendations include infertility, patient stratification, and research in emerging nations, in addition to an increased focus on translational research. A revised and updated set of research priorities that builds on this document will be developed at the 13th World Congress on Endometriosis to be held on May 17-20, 2017, in Vancouver, British Columbia, Canada.
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Affiliation(s)
| | - G. David Adamson
- Palo Alto Medical Foundation Fertility Physicians of Northern California,
Palo Alto, CA, USA
- World Endometriosis Research Foundation (WERF), London, United Kingdom
| | | | - Christian M. Becker
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
| | | | - Gerard A. J. Dunselman
- Department of Obstetrics & Gynaecology, Research Institute GROW,
Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Linda C. Giudice
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- University of California, San Francisco, CA, USA
- World Endometriosis Society (WES), Vancouver, Canada
| | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh,
United Kingdom
| | - M. Louise Hull
- The Robinson Institute, University of Adelaide, Adelaide, Australia
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- World Endometriosis Society (WES), Vancouver, Canada
| | - Stacey A. Missmer
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- Harvard Schools of Medicine and Public Health, Boston, MA, USA
| | | | | | - Robert N. Taylor
- World Endometriosis Society (WES), Vancouver, Canada
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Luk Rombauts
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- World Endometriosis Society (WES), Vancouver, Canada
- Monash University, Clayton, Australia
| | - Philippa T. Saunders
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh,
United Kingdom
| | - Katy Vincent
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford,
United Kingdom
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Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, Bush D, Kiesel L, Tamimi R, Sharpe-Timms KL, Rombauts L, Giudice LC. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod 2016; 32:315-324. [DOI: 10.1093/humrep/dew293] [Citation(s) in RCA: 307] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 10/24/2016] [Accepted: 10/30/2016] [Indexed: 01/02/2023] Open
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