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Salari S, Lee S, Mangels J, Flyckt R, Madeira J, Gordon J, Keenan J, Lee M, Lin P, Pennings G, Sweet C, Klock S, Lindheim SR. Psychosocial outcomes of children born via embryo donation. Hum Reprod 2024; 39:779-783. [PMID: 38373211 DOI: 10.1093/humrep/deae023] [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: 11/04/2023] [Revised: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
STUDY QUESTION What are parents' perceptions of their relationships with and the psychosocial adjustments of their children who are born via embryo donation? SUMMARY ANSWER Families created through embryo donation have well-adjusted parent-child relationships and reassuring child psychosocial outcomes. WHAT IS KNOWN ALREADY Embryo donation is an effective and growing form of third-party reproduction, but there is limited research in this field. Prior studies suggest that families created through gamete donation function well regarding parent-child relationship quality and child behavioral and socioemotional adjustment. STUDY DESIGN, SIZE, DURATION This is a cross-sectional survey study with 187 total participants. PARTICIPANTS/MATERIALS, SETTING, METHODS Parents of children born via embryo donation were recruited nationally by contacting all embryo donation programs registered with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) as well as medically directed embryo donation or 'embryo adoption' centers. Participants completed three online Qualtrics questionnaires. The first was a survey including 33 questions on demographics, the procurement process, and self-reported obstetric outcomes. Participants also completed two standardized measures assessing children's behavior and parents' adjustment to parenthood: the Strengths and Difficulties Questionnaire (SDQ) and the Parental Acceptance-Rejection Questionnaire (PARQ). Scoring of the SDQ and PARQ was totaled and compared to standardized values (SDQ) or previously published results on other forms of gamete donation (PARQ), such as oocyte donation and sperm donation. MAIN RESULTS AND THE ROLE OF CHANCE On the SDQ (n = 46), the average total difficulties scores by age were: 8.2 ± 0.98 for ages 2-4, 7.6 ± 0.93 for ages 5-10, and 3.5 ± 0.77 for ages 11-17; this is compared to the normal reported range of 0-13, which indicates that clinically significant psychosocial problems are unlikely. Across all ages and individual categories (emotional symptoms, conduct problem, hyperactivity, peer problem, prosocial), scores on the SDQ were within the normal ranges. The average PARQ score (n = 70) for all respondents was 27.5 ± 1.18 (range: 24-96), suggesting perceived parental acceptance. LIMITATIONS, REASONS FOR CAUTION Because this study was cross-sectional, it could not capture familial relationships over time. This survey-based study design allows for potential selection bias (parents of well-adjusted children may be more likely to participate). Additionally, the overall sample size is relatively small; however, it remains one of the largest published to date. Another significant limitation to this study is the lack of generalizability: most participants were recruited from private, faith-based, embryo donation programs who are demographically similar. WIDER IMPLICATIONS OF THE FINDINGS Though embryo donation is an established form of third-party reproduction, it is significantly less robustly studied compared to other forms of gamete donation (oocyte or sperm donation). This study provides a larger data set with a more expanded age range of children compared to the limited number of previously published studies. Furthermore, these findings indicate a high parental disclosure rate with respect to the use of embryo donation which contrasts previous findings. STUDY FUNDING/COMPETING INTEREST(S) No external funding source was utilized for the completion of this study. No conflicts are disclosed. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Salomeh Salari
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Seungho Lee
- Department of Obstetrics and Gynecology, University of California Irvine, Orange, CA, USA
| | | | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jody Madeira
- Indiana University Maurer School of Law, Bloomington, IN, USA
| | - John Gordon
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee, Knoxville, TN, USA
| | - Jeffrey Keenan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Tennessee, Knoxville, TN, USA
- National Embryo Donation Center, Knoxville, TN, USA
| | - Miryoung Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Brownsville, TX, USA
| | - Paul Lin
- Seattle Reproductive Medicine, Seattle, WA, USA
| | - Guido Pennings
- Department of Philosophy and Moral Science, Ghent University, Ghent, Belgium
| | - Craig Sweet
- Embryo Donation International, Fort Myers, FL, USA
| | - Susan Klock
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Fairborn, OH, USA
- Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Baylor Scott & White Department of Obstetrics & Gynecology, Temple, TX, USA
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Williamson E, Prytkova V, Kohl-Thomas B, Flyckt R, Kim ST, Pereira N, Lindheim SR. Monochorionic Multiple Pregnancies After Single Blastocyst Transfer: A Reminder of Potential Sequelae. J Obstet Gynaecol Can 2024; 46:102253. [PMID: 38442957 DOI: 10.1016/j.jogc.2023.102253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
| | | | - Belinda Kohl-Thomas
- Baylor Scott and White Health, Department of Obstetrics and Gynecology, Dallas, TX, USA; Texas A&M School of Medicine, Temple, Texas, USA
| | - Rebecca Flyckt
- Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sung Tae Kim
- Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nigel Pereira
- Mount Sinai Fertility, University of Toronto, Toronto, ON
| | - Steven R Lindheim
- University of Central Florida College of Medicine, Orlando, FL, USA; Baylor Scott and White Health, Department of Obstetrics and Gynecology, Dallas, TX, USA; Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.
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Williamson E, Prytkova V, Kohl-Thomas B, Flyckt R, Kim ST, Pereira N, Lindheim SR. Grossesse multiple monochoriale après le transfert d'un seul blastocyste : un rappel des séquelles potentielles. Journal of Obstetrics and Gynaecology Canada 2024; 46:102331. [PMID: 38442959 DOI: 10.1016/j.jogc.2023.102331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
| | | | - Belinda Kohl-Thomas
- Baylor Scott and White Health, Department of Obstetrics and Gynecology, Dallas, TX, USA; Texas A&M School of Medicine, Temple, Texas, USA
| | - Rebecca Flyckt
- Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sung Tae Kim
- Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nigel Pereira
- Mount Sinai Fertility, University of Toronto, Toronto, ON
| | - Steven R Lindheim
- University of Central Florida College of Medicine, Orlando, FL, USA; Baylor Scott and White Health, Department of Obstetrics and Gynecology, Dallas, TX, USA; Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China.
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Eliwa J, Carugno J, Flyckt R. The barriers and future directions of interspecialty collaboration in reproductive surgery. Fertil Steril 2023; 120:1266. [PMID: 37839724 DOI: 10.1016/j.fertnstert.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Jasmine Eliwa
- Department of Obstetrics and Gynecology, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jose Carugno
- Obstetrics, Gynecology, and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
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Onyewuenyi TL, Williamson E, Flyckt R, Bates W, Lindheim SR. World IVF Day: Let the Celebration Begin! J Obstet Gynaecol Can 2023; 45:475-476. [PMID: 37400182 DOI: 10.1016/j.jogc.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
| | | | - Rebecca Flyckt
- University Hospitals Cleveland Medical Center, Division of Reproductive Endocrinology and Infertility, Cleveland, OH
| | - Wright Bates
- Baylor Scott & White Health, Department of Obstetrics & Gynecology, Texas A&M School of Medicine, Temple, TX
| | - Steven R Lindheim
- University of Central Florida College of Medicine, Orlando, FL; Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH; Center for Reproductive Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Onyewuenyi TL, Williamson E, Flyckt R, Bates W, Lindheim SR. Journée mondiale de la FIV : Que les célébrations commencent! J Obstet Gynaecol Can 2023; 45:477-478. [PMID: 37400183 DOI: 10.1016/j.jogc.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
| | | | - Rebecca Flyckt
- Centre hospitalier universitaire de Cleveland, Division d'endocrinologie de la reproduction et d'infertilité, Cleveland, Ohio
| | - Wright Bates
- Baylor Scott & White Health, Département d'obstétrique et gynécologie, École de médecine, Université A&M du Texas, Temple, Tex
| | - Steven R Lindheim
- Collège de médecine de l'Université de Floride centrale, Orlando, Flor; Département d'obstétrique et gynécologie, École de médecine Boonshoft, Université d'État Wright, Dayton, Ohio; Centre de médecine reproductive, hôpital Renji, École de médecine, Université Jiao Tong de Shanghai, Shanghai, Chine.
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Brännström M, Racowsky C, Richards EG, Flyckt R, Stillman RJ, O'Brien JE, Ryan GL, de Ziegler D. Absolute uterine infertility (AUI) A Cornelian dilemma: uterine transplantation or surrogacy? Fertil Steril 2023; 119:918-929. [PMID: 37037300 DOI: 10.1016/j.fertnstert.2023.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Affiliation(s)
- Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Stockholm IVF-EUGIN, Stockholm, Sweden; Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch, Suresnes, France
| | - Catherine Racowsky
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch, Suresnes, France; Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elliott G Richards
- Division of Reproductive Endocrinology and Infertility, Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44915
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals, 1000 Auburn Dr., Suite 310, Beachwood, OH 44122
| | | | | | - Ginny L Ryan
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle WA
| | - Dominique de Ziegler
- Dept of Obstetrics, Gynecology and Reproductive Medicine, Hopital Foch - Université de Paris Ouest UVSQ, Paris France
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Petrozza JC, Fitz V, Bhagavath B, Carugno J, Kwal J, Mikhail E, Nash M, Barakzai SK, Roque DR, Bregar AJ, Findley J, Neblett M, Flyckt R, Khan Z, Lindheim SR. Surgical approach to 4 different reproductive pathologies by 3 different gynecologic subspecialties: more similarities or differences? Fertil Steril 2023; 119:377-389. [PMID: 36574916 DOI: 10.1016/j.fertnstert.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Affiliation(s)
- John C Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Fitz
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bala Bhagavath
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jaclyn Kwal
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Moawad Nash
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Syem K Barakzai
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dario R Roque
- Division of Gynecologic Oncology, Feinberg School of Medicine, Northwestern University
| | - Amy J Bregar
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Michael Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Obstetrics and Gynecology, University of Central Florida, Orlando, Florida; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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Santoro N, Flyckt R, Davis A, Finkelstein J, Crawford S, Sun F, Derby C, Morrison A, Sluss P, Zhang H. Anti-Müllerian Hormone Level Decline in Patients Undergoing Hysterectomy With and Without Oophorectomy Compared With Natural Menopause. Obstet Gynecol 2023; 141:331-340. [PMID: 36649324 PMCID: PMC9858351 DOI: 10.1097/aog.0000000000005049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the relationship between hysterectomy with and without ovarian conservation and the onset of ovarian failure using anti-müllerian hormone (AMH) levels and imputed final menstrual period (FMP). METHODS A total of 1,428 women with an observed FMP and 232 women who underwent hysterectomy (159 with bilateral salpingo-oophorectomy [BSO], 13 with one ovary conserved, and 60 with both ovaries conserved) and who had serial AMH measurements were included from SWAN (The Study of Women's Health Across the Nation), a multi-ethnic, multi-site, community-based study. Anti-müllerian hormone levels were sampled annually with at least one presurgery or pre-FMP measurement at least one postsurgery or post-FMP measurement. Surgery-related differences in patterns of AMH levels with respect to surgery date or FMP were estimated using piecewise linear mixed modeling; differences in age at first undetectable AMH level were estimated using survival analyses. RESULTS Patients with conservation of one or both ovaries or natural menopause demonstrated similar patterns of decline in AMH levels when anchored to surgery or FMP. Patients with hysterectomy (all types) had a later counterfactual FMP (52.9±0.2 SEM) compared with the observed FMP in those with natural menopause (52.1±0.1 years, P =.002). Those undergoing BSO had an immediate reduction in AMH level to undetectable after surgery. CONCLUSION Hysterectomy does not lead to a more rapid decline in AMH levels postoperatively compared with natural menopause. Patients undergoing BSO have a rapid loss of AMH, consistent with complete removal of the ovaries. These data suggest that hysterectomy as currently performed does not compromise ovarian reserve.
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Affiliation(s)
- Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado 80045
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology, Case Western Reserve University, Cleveland, Ohio 44106
| | - Anne Davis
- current address: IVI RMA Global, San Diego, California 92121
| | - Joel Finkelstein
- Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Sybil Crawford
- Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts 01605
| | - Fangbai Sun
- Department of Statistics and Data Science, Yale University School of Medicine, New Haven Connecticut 06511
| | - Carol Derby
- Departments of Neurology and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York 10461
| | | | - Patrick Sluss
- Department of Clinical Pathology, Massachusetts General Hospital, Boston, Massachusetts 01224
| | - Heping Zhang
- Department of Statistics and Data Science, Yale University School of Medicine, New Haven Connecticut 06511
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Agarwal S, Chamoun D, Flyckt R, Lindheim SR. Clinical Conundrum: Spontaneous Ovarian Hyperstimulation Syndrome. J Obstet Gynaecol Can 2022; 44:1181-1184. [PMID: 36410935 DOI: 10.1016/j.jogc.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Shruti Agarwal
- Camran Nezhat Institute, Minimally Invasive & Robotic Surgery, Woodside, CA.
| | | | - Rebecca Flyckt
- University Hospitals of Cleveland, Department of Obstetrics and Gynecology, Beachwood, OH
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, OH; University of Central Florida College of Medicine, Department of Obstetrics and Gynecology, Orlando, FL; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
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Agarwal S, Chamoun D, Flyckt R, Lindheim SR. Raisonnement clinique : Syndrome d'hyperstimulation ovarienne spontanée. J Obstet Gynaecol Can 2022; 44:1185-1189. [PMID: 36410936 DOI: 10.1016/j.jogc.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Shruti Agarwal
- Camran Nezhat Institute, Chirurgie minimalement invasive et robotisée, Woodside, Californie.
| | | | - Rebecca Flyckt
- University Hospitals de Cleveland, Département d'obstétrique et gynécologie, Beachwood, Ohio
| | - Steven R Lindheim
- Département d'obstétrique et gynécologie, École de médecine Boonshoft, Université d'État Wright, Dayton, Ohio; Collège de médecine de l'Université de Floride centrale, Département d'obstétrique et gynécologie, Orlando, Floride; Centre de médecine reproductive de l'hôpital Renji, École de médecine, Université Jiao Tong de Shanghai, Shanghai, République populaire de Chine
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Salari SM, Coyne KD, Chung RK, Findley J, Lindheim SR, Flyckt R. EARLY PREGNANCY FAILURE: A NOVEL APPLICATION FOR HYSTEROSCOPIC MORCELLATION. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.829] [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: 11/17/2022]
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Fischer L, Chung RK, Kim ST, Flyckt R, Weinerman RS. LUTEINIZING HORMONE SUPPLEMENTATION WITH HUMAN MENOPAUSAL GONADOTROPIN VERSUS LOW-DOSE HUMAN CHORIONIC GONADOTROPIN DURING STIMULATION DOES NOT AFFECT PREGNANCY OUTCOMES AFTER FRESH EMBRYO TRANSFER. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.616] [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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Coyne KD, Tribout JA, Tribout H, Flyckt R, Weinerman RS. LONGITUDINAL FOLLOW UP OF PATIENTS DIAGNOSED WITH COVID-19 DEMONSTRATES NO DECREASE IN OVARIAN RESERVE AS DEMONSTRATED BY SERUM ANTI-MÜLLERIAN HORMONE (AMH) AT 3 AND 6 MONTHS: A PILOT STUDY. Fertil Steril 2022; 118. [PMCID: PMC9595315 DOI: 10.1016/j.fertnstert.2022.08.537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kathryn D. Coyne
- University Hospitals Fertility Center/Case Western Reserve University, Beachwood, OH
| | | | - Heather Tribout
- University Hospitals Fertility Center/Case Western Reserve University, Beachwood, OH
| | | | - Rachel S. Weinerman
- University Hospitals Fertility Center/Case Western Reserve University, Beachwood, OH
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Coyne KD, Chung RK, Flyckt R, Petrozza JC, Lindheim SR. On the shoulders of giants: perspectives in minimally invasive reproductive surgery. Fertil Steril 2021; 117:459-460. [PMID: 34937666 DOI: 10.1016/j.fertnstert.2021.11.017] [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: 08/27/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/04/2022]
Abstract
The purpose of this video is to illustrate the evolution of minimally invasive surgery from the perspectives of several pioneering surgeons in the field of reproductive surgery who, among others, were present during its nascence and exponential growth. Interviews were conducted with five reproductive surgeons who had foundational roles in the innovation of operative laparoscopy and hysteroscopy. Surgeons interviewed include Drs. Victor Gomel, Togas Tulandi, Stephen Corson, Jacques Donnez, and Camran Nezhat. The interviews were conducted using standardized questions and recorded, edited, and grouped both thematically and in sequence to develop an illustration of their perspectives. A diverse array of reproductive surgeons has been instrumental in establishing minimally invasive surgery as a safe and effective means of diagnosing and treating patients with infertility. The transition from laparotomy to laparoscopy consistently has had distinct challenges for each but ultimately led to significant advances in surgical management and improvement in outcomes for patients with infertility and chronic pelvic pain. Through structured interviews from some of our surgical pioneers, they not only recognize their predecessors and contemporaries but also teach us valuable lessons about our history, sparking innovation, and newer surgical applications of reproductive surgery in reproductive endocrinology and infertility practice.
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Affiliation(s)
- Kathryn D Coyne
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca K Chung
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John C Petrozza
- Division of Reproductive Medicine and IVF, Massachusetts General Fertility Center, Boston, Massachusetts
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Wright State University, Boonshoft School of Medicine, Dayton, Ohio; Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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Coyne K, Flyckt R, Findley J. A management algorithm and proposed pathogenesis for retroperitoneal ectopic pregnancies. Fertil Steril 2021; 116:1200-1201. [PMID: 34489085 DOI: 10.1016/j.fertnstert.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Kathryn Coyne
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Joseph Findley
- Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Coyne KD, Chung RK, Flyckt R, Petrozza JC, Lindheim SR. ON THE SHOULDERS OF GIANTS: THE HISTORY OF MINIMALLY INVASIVE REPRODUCTIVE SURGERY. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.1181] [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: 11/16/2022]
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18
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Markwei MT, Farrell R, Yao M, Desai N, Flyckt R. PREIMPLANTATION AND PRENATAL GENETIC TESTING UPTAKE IN MOTHERS FOLLOWING ASSISTED REPRODUCTIVE TECHNOLOGY. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.067] [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: 11/17/2022]
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19
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Salari SM, Chung RK, Chattopadhyay R, Tribout H, Brown A, Howard M, Flyckt R, Weinerman RS. THE IMPACT OF COVID-19 DIAGNOSIS ON FERTILITY-RELATED STRESS AND FERTILITY OUTCOMES IN AN IVF POPULATION. Fertil Steril 2021. [PMCID: PMC8446849 DOI: 10.1016/j.fertnstert.2021.07.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Lee M, Sechler S, Mason AT, Flyckt R, Kim ST. INTRAUTERINE INSEMINATION CYCLE CHARACTERISTICS ASSOCIATED WITH MULTIPLE GESTATION. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.632] [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: 10/20/2022]
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21
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Chaturvedi A, Chung RK, Flyckt R, Kim ST, Weinerman RS. LENGTH OF ESTROGEN SUPPLEMENTATION AND TYPE OF ESTROGEN DELIVERY HAS NO IMPACT ON REPRODUCTIVE SUCCESS. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.650] [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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22
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Chung RK, Hoffberg E, Salari SM, Flyckt R, Findley J, Weinerman RS, Kim ST. THE EFFECT OF OOCYTE MATURITY INDEX ON BLASTOCYST RATE AND PREGNANCY OUTCOMES. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.07.668] [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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23
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Lee M, Sechler S, Mason A, Amaddio A, Flyckt R, Kim S. PREDICTORS FOR SUCCESS OF INTRAUTERINE INSEMINATION: A RETROSPECTIVE ANALYSIS. Fertil Steril 2021. [DOI: 10.1016/j.fertnstert.2021.05.031] [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: 10/20/2022]
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24
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Chattopadhyay R, Richards E, Libby V, Flyckt R. Preimplantation genetic testing for aneuploidy in uterus transplant patients. Ther Adv Reprod Health 2021; 15:26334941211009848. [PMID: 33959719 PMCID: PMC8064656 DOI: 10.1177/26334941211009848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/14/2020] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
Abstract
Uterus transplantation is an emerging treatment for uterine factor infertility. In vitro fertilization with cryopreservation of embryos prior is required before a patient can be listed for transplant. Whether or not to perform universal preimplantation genetic testing for aneuploidy should be addressed by centers considering a uterus transplant program. The advantages and disadvantages of preimplantation genetic testing for aneuploidy in this unique population are presented. The available literature is reviewed to determine the utility of preimplantation genetic testing for aneuploidy in uterus transplantation protocols. Theoretical benefits of preimplantation genetic testing for aneuploidy include decreased time to pregnancy in a population that benefits from minimization of exposure to immunosuppressive agents and decreased chance of spontaneous abortion requiring a dilation and curettage. Drawbacks include increased cost per in vitro fertilization cycle, increased number of required in vitro fertilization cycles to achieve a suitable number of embryos prior to listing for transplant, and a questionable benefit to live birth rate in younger patients. Thoughtful consideration of whether or not to use preimplantation genetic testing for aneuploidy is necessary in uterus transplant trials. Age is likely a primary factor that can be useful in determining which uterus transplant recipients benefit from preimplantation genetic testing for aneuploidy.
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Affiliation(s)
- Rhea Chattopadhyay
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, University Hospitals MacDonald Women's Hospital, Cleveland, OH, USA
| | - Elliott Richards
- Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA
| | - Valerie Libby
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, University Hospitals MacDonald Women's Hospital, Cleveland, OH, USA
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, University Hospitals MacDonald Women's Hospital, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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25
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Bouchelion A, Flyckt R. Stream one, do one, teach one. Fertil Steril 2021; 115:1187. [PMID: 33743957 DOI: 10.1016/j.fertnstert.2021.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ashleigh Bouchelion
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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26
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Lee M, Farrell RM, Flyckt R. An insider perspective from Mayer-Rokitansky-Küster-Hauser syndrome patients on uterus transplantation. Fertil Steril 2021; 115:911-912. [PMID: 33618896 DOI: 10.1016/j.fertnstert.2021.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Mabel Lee
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Ruth M Farrell
- Obstetrics, Gynecology and Women's Health Institute, Center for Bioethics, Cleveland Clinic, Cleveland, Ohio
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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27
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Davis AC, Richards EG, Arian SE, Falcone T, Desai N, Yao M, Chiesa-Vottero A, Flyckt R. Diverse Approaches to Ovarian Tissue Cryopreservation Have Equivalent Outcomes in Markers of Tissue Viability. Reprod Sci 2021; 28:2129-2135. [PMID: 33599949 DOI: 10.1007/s43032-021-00486-6] [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: 07/10/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
Ovarian tissue cryopreservation (OTC) is an accepted method of fertility preservation. However, OTC is not standardized and many variations exist in the freezing strategy, tissue processing, and surgical approach. In this pilot study, we used a sheep model to compare slow freezing versus vitrification techniques, as well as the feasibility of processing ovarian tissue into a hyaluronan suspension of small ovarian units. Twelve ovaries were harvested from six female ewes. Paired tissues from each animal were assigned to different treatments and underwent freezing, thawing, autotransplantation, and second-look surgery, for a total of 18 surgical procedures and 3 measured time points. Treatments included whole tissue strips versus gel suspension and slow freezing versus vitrification. At each of the time points, tissue viability was measured by immunohistochemical analysis of CD31 and cleaved caspase-3 (CCASP3). CD31 and CCASP3 expression levels were equivalent between slow freezing and vitrification, and between whole ovarian tissue strips and gel suspension of fragmented ovarian tissue, at all time points. These preliminary data using a sheep model suggest that ovarian tissue is robust and likely to be minimally affected by aggressive fragmentation using a hyaluronan suspension. Furthermore, we provide evidence in support of vitrification as a viable option in OTC. Hyaluronan suspension of ovarian cortical fragments is novel and may represent a desirable method for reimplantation of frozen-thawed ovarian tissue in patients where occult malignant cells are a concern.
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Affiliation(s)
- Anne Cashmore Davis
- Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44915, USA
| | - Elliott G Richards
- Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44915, USA.
| | - Sara E Arian
- Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Tommaso Falcone
- Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44915, USA
| | - Nina Desai
- Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44915, USA
| | - Meng Yao
- Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Andres Chiesa-Vottero
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Rebecca Flyckt
- Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44915, USA.,Reproductive Endocrinology and Infertility, University Hospitals, 1000 Auburn Dr., Suite 310, Beachwood, OH, 44122, USA
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28
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Alali Z, Graham A, Swan K, Flyckt R, Falcone T, Cui W, Yang X, Christianson J, Nothnick WB. 60S acidic ribosomal protein P1 (RPLP1) is elevated in human endometriotic tissue and in a murine model of endometriosis and is essential for endometriotic epithelial cell survival in vitro. Mol Hum Reprod 2021; 26:53-64. [PMID: 31899515 DOI: 10.1093/molehr/gaz065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/19/2019] [Revised: 10/31/2019] [Indexed: 11/12/2022] Open
Abstract
Endometriosis is a female disease which is defined as the presence of ectopic endometrial tissue and is dependent on estrogen for its survival in these ectopic locations. Expression of the ribosomal protein large P1 (RPLP1) is associated with cell proliferation and invasion in several pathologies, but a role in the pathophysiology of endometriosis has not been explored. In this study, we aimed to evaluate the expression and function of RPLP1 with respect to endometriosis pathophysiology. RPLP1 protein was localised by immunohistochemistry (IHC) in eutopic and ectopic tissue from 28 subjects with confirmed endometriosis and from 20 women without signs or symptoms of the disease, while transcript levels were evaluated by qRT-PCR in 77 endometriotic lesions and 55 matched eutopic endometrial biopsies, and protein expression was evaluated using western blotting in 20 of these matched samples. To evaluate the mechanism for enhanced lesion expression of RPLP1, an experimental murine model of endometriosis was used and RPLP1 expression was localized using IHC. In vitro studies using an endometriosis cell line coupled with shRNA knockdown was used to demonstrate its role in cell survival. Expression of RPLP1 mRNA and protein were significantly higher in ectopic lesion tissue compared to paired eutopic endometrium and immunohistochemical localisation revealed predominant localisation to epithelial cells. This pattern of lesion RPLP1 was recapitulated in mice with experimentally induced endometriosis. Stable knockdown of RPLP1 protein resulted in a significant decrease in cell survival in vitro. These studies reveal that RPLP1 is associated with cell proliferation and/or survival and may play a role in the pathophysiology of endometriosis.
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Affiliation(s)
- Zahraa Alali
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Amanda Graham
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kimberly Swan
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Center for Reproductive Sciences and Institute for Reproductive and Perinatal Research, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Rebecca Flyckt
- Department of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Tommaso Falcone
- Department of Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH 44195, USA.,Cleveland Clinic London, SW1E 6QT, UK
| | - Wei Cui
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Xiaofang Yang
- Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Julie Christianson
- Center for Reproductive Sciences and Institute for Reproductive and Perinatal Research, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Warren B Nothnick
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, KS 66160, USA.,Center for Reproductive Sciences and Institute for Reproductive and Perinatal Research, University of Kansas Medical Center, Kansas City, KS 66160, USA
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29
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Bhide S, Flyckt R, Yao M, Falcone T. Long-term impact of chronic pelvic pain on quality of life in women with and without endometriosis. CLIN EXP OBSTET GYN 2021. [DOI: 10.31083/j.ceog4804135] [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: 11/06/2022]
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30
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Burks C, Lee M, DeSarno M, Findley J, Flyckt R. Excision versus Ablation for Management of Minimal to Mild Endometriosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 28:587-597. [PMID: 33310168 DOI: 10.1016/j.jmig.2020.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 08/27/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to perform an updated analysis of the literature in regard to the surgical management of minimal to mild endometriosis. This study evaluated women of reproductive age with superficial endometriosis to determine if the results of surgical excision compared with those of ablation in improved pain scores postoperatively. DATA SOURCES The following databases were searched from inception to May 2020 for relevant studies: Cochrane Central Register of Controlled Trials, PubMed (MEDLINE), Ovid (MEDLINE), Scopus, and Web of Science. METHODS OF STUDY SELECTION From our literature search, a total of 2633 articles were identified and screened. Ultimately, 4 randomized controlled trials were selected and included in our systematic review. The combined total number of subjects was 346 from these 4 studies, with sample sizes ranging from 24 to 170 participants. Data from 3 of the included studies were able to be compared and analyzed for a meta-analysis. The primary outcome was reduction in the visual analog scale (VAS) score for endometriosis-associated pain (dysmenorrhea, dyschezia, and dyspareunia), with follow-up time ranging from 6 to 60 months postoperatively. TABULATION, INTEGRATION, AND RESULTS Data extracted from each study included the mean reduction in the VAS score from baseline. A random-effects model was used owing to significant heterogeneity across the studies. Statistical analyses were performed using Review Manager 5.3 software (Cochrane Collaboration, London, United Kingdom). The meta-analyses showed no significant differences between the excision and ablation groups in the mean reduction in VAS scores from baseline to 12 months postoperatively for dysmenorrhea (mean difference [MD] -0.03; 95% confidence interval [CI], -1.27 to 1.22; p = .97), dyschezia (MD 0.46; 95% CI, -1.09 to 2.02; p = .56), and dyspareunia (MD 0.10; 95% CI, -2.36 to 2.56; p = .94). In addition, there were no significant differences between the excision and ablation groups in mean VAS scores at the 12-month follow-up and beyond for dysmenorrhea (MD -0.11; 95% CI, -2.14 to 1.93; p = .92), dyschezia (MD 0.01; 95% CI, -0.70 to 0.72; p = .99), and dyspareunia (MD 0.34; 95% CI, -1.61 to 2.30; p = .73). CONCLUSION On the basis of the data from our systematic review and pooled meta-analysis, no significant difference between laparoscopic excision and ablation was noted in regard to improving pain from minimal to mild endometriosis. However, to make definitive conclusions on this topic, larger randomized controlled trials are needed with longer follow-up.
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Affiliation(s)
- Channing Burks
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt).
| | - Mabel Lee
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt)
| | - Michael DeSarno
- Department of Obstetrics and Gynecology, University of Vermont Medical Center, Burlington, Vermont (Mr. DeSarno and Dr. Findley)
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University of Vermont Medical Center, Burlington, Vermont (Mr. DeSarno and Dr. Findley)
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Burks, Lee, and Flyckt)
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31
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Johannesson L, Testa G, Flyckt R, Farrell R, Quintini C, Wall A, O'Neill K, Tzakis A, Richards EG, Gordon SM, Porrett PM. Guidelines for standardized nomenclature and reporting in uterus transplantation: An opinion from the United States Uterus Transplant Consortium. Am J Transplant 2020; 20:3319-3325. [PMID: 32379930 DOI: 10.1111/ajt.15973] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 02/07/2020] [Revised: 04/08/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023]
Abstract
Uterus transplantation is a nascent but growing field. To support this growth, the United States Uterus Transplant Consortium proposes guidelines for nomenclature related to operative technique, vascular anatomy, and donor, recipient, and offspring outcomes. In terms of anatomy, the group recommends reporting donor arterial inflow and recipient anastomotic site delivering inflow to the graft and offers standardization of the names for the 4 veins originating from the uterus because of current inconsistency in this particular nomenclature. Seven progressive stages with milestones of success are defined for reporting on uterus transplantation outcomes: (1) technical, (2) menstruation, (3) embryo implantation, (4) pregnancy, (5) delivery, (6) graft removal, and (7) long-term follow-up. The 3 primary metrics for success are recipient survival (as reported for other organ transplant recipients), graft survival, and uterus transplant live birth rate (defined as live birth per transplanted recipient). A number of secondary outcomes should also be reported, most of which capture stage-specific milestones, as well as data on graft failure. Outcome metrics for living donors include patient survival, survival free of operative intervention, and data on complications and hospitalizations. Finally, we make specific recommendations on follow-up for offspring born from uterine grafts, which includes specialty surveillance as well as collection and reporting of routine pediatric outcomes. The goal of standardization in reporting is to create consistency and improve the quality of evidence available on the efficacy and value of the procedure.
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Affiliation(s)
- Liza Johannesson
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Rebecca Flyckt
- Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ruth Farrell
- Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Anji Wall
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
| | - Kathleen O'Neill
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andreas Tzakis
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Elliott G Richards
- Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott M Gordon
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Paige M Porrett
- Division of Transplantation, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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D'Amico G, Quintini C, Eghtesad B, Hashimoto K, Ricci S, Flyckt R, Del Prete L, Miller C, Falcone T, Tzakis A. Uterus Recovery from Deceased Donor: Simple Technique Securing Safety of Vital Organs and Uterus Graft. J Am Coll Surg 2020; 232:e1-e6. [PMID: 33217551 DOI: 10.1016/j.jamcollsurg.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Giuseppe D'Amico
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.
| | - Cristiano Quintini
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Bijan Eghtesad
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Koji Hashimoto
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Stephanie Ricci
- Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Rebecca Flyckt
- Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Luca Del Prete
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Charles Miller
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
| | - Tommaso Falcone
- Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Andreas Tzakis
- Departments of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH
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33
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Chattopadhyay R, Momotaz H, Liu JH, Flyckt R, Weinerman RS. WHAT PATIENT FACTORS AFFECT SUCCESS IN WOMEN UTILIZING FROZEN DONOR EGGS? A SART DATABASE ANALYSIS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.759] [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: 10/23/2022]
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34
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Chattopadhyay R, Weinerman RS, Liu JH, Flyckt R, Kim ST. OPTIMIZING FROZEN EMBRYO TRANSFER (FET) SUCCESS: IMPROVED SUCCESS IN NATURAL CYCLES WITH THE USE OF HCG TRIGGER DESPITE SIMILAR OVERALL OUTCOMES WITH GONADOTROPIN STIMULATED, NATURAL, AND PROGRAMMED CYCLES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.888] [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: 11/25/2022]
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35
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Chattopadhyay R, Salari SM, Zhang S, Libby V, Burks C, Flyckt R, Weinerman RS. AMH IS NOT ASSOCIATED WITH HIGH-GRADE EMBRYO QUALITY AS ASSESSED BY DAY 3 AND DAY 5 MORPHOLOGY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.386] [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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36
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Coyne KD, Lee M, Palavos LA, Hamrick J, Belvin BA, Weinerman RS, Flyckt R, Liu JH, Kim ST. EFFECT OF TROPHECTODERM GRADE OF BLASTOCYST AT EMBRYO TRANSFER ON PREGNANCY OUTCOMES. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.399] [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: 10/23/2022]
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37
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Flyckt R, Falcone T, Quintini C, Perni U, Eghtesad B, Richards EG, Farrell RM, Hashimoto K, Miller C, Ricci S, Ferrando CA, D’Amico G, Maikhor S, Priebe D, Chiesa-Vottero A, Heerema-McKenney A, Mawhorter S, Feldman MK, Tzakis A. First birth from a deceased donor uterus in the United States: from severe graft rejection to successful cesarean delivery. Am J Obstet Gynecol 2020; 223:143-151. [PMID: 32151611 DOI: 10.1016/j.ajog.2020.03.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/25/2020] [Accepted: 03/01/2020] [Indexed: 01/29/2023]
Abstract
Uterus transplantation is the only known potential treatment for absolute uterine factor infertility. It offers a unique setting for the investigation of immunologic adaptations of pregnancy in the context of the pharmacologic-induced tolerance of solid organ transplants, thus providing valuable insights into the early maternal-fetal interface. Until recently, all live births resulting from uterus transplantation involved living donors, with only 1 prior birth from a deceased donor. The Cleveland Clinic clinical trial of uterus transplantation opened in 2015. In 2017, a 35 year old woman with congenital absence of the uterus was matched to a 24 year old parous deceased brain-dead donor. Transplantation of the uterus was performed with vaginal anastomosis and vascular anastomoses bilaterally from internal iliac vessels of the donor to the external iliac vessels of the recipient. Induction and maintenance immunosuppression were achieved and subsequently modified in anticipation of pregnancy 6 months after transplant. Prior to planned embryo transfer, ectocervical biopsy revealed ulceration and a significant diffuse, plasma cell-rich mixed inflammatory cell infiltrate, with histology interpreted as grade 3 rejection suspicious for an antibody-mediated component. Aggressive immunosuppressive regimen targeting both cellular and humoral rejection was initiated. After 3 months of treatment, there was no histologic evidence of rejection, and after 3 months from complete clearance of rejection, an uneventful embryo transfer was performed and a pregnancy was established. At 21 weeks, central placenta previa with accreta was diagnosed. A healthy neonate was delivered by cesarean hysterectomy at 34 weeks' gestation. In summary, this paper highlights the first live birth in North America resulting from a deceased donor uterus transplant. This achievement underscores the capacity of the transplanted uterus to recover from a severe, prolonged rejection and yet produce a viable neonate. This is the first delivery from our ongoing clinical trial in uterus transplantation, including the first reported incidence of severe mixed cellular/humoral rejection as well as the first reported placenta accreta.
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Rehmer JM, Ferrando CA, Flyckt R, Falcone T. Techniques for successful vaginal anastomosis in the uterine transplantation patient. Fertil Steril 2020; 115:802-803. [PMID: 32682518 DOI: 10.1016/j.fertnstert.2020.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/20/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To demonstrate techniques for successful donor-to-recipient vaginal anastomosis in uterine transplantation including illustration of a tension-free technique. DESIGN This video uses live-action footage from surgery, detailed animations, and illustrations to review the step-by-step technique we use for vaginal anastomosis in uterine transplantation. Institutional Review Board approval was obtained for this experimental surgery. SETTING Academic medical center. PATIENT(S) Patients undergoing uterine transplantation. INTERVENTION(S) Preparation of recipient vagina with illustration of challenges and risk secondary to dense adhesions between bladder and neo-vagina. Use of surgical techniques. Key steps include appropriate preparation of both donor and recipient vaginal tissues and a tension-free closure with horizontal mattress stitches. MAIN OUTCOME MEASURE(S) Intraoperative techniques in the clinical research trial of uterine transplantation. RESULTS Successful vaginal anastomosis in the uterine transplantation patient. CONCLUSION(S) This video provides a step-by-step guide to vaginal anastomosis in uterine transplantation patients. Our team has applied techniques from vaginal reconstructive surgery in an attempt to reduce the occurrence of postoperative vaginal strictures, with attention to planned donor and recipient anastomosis site tissue preparation and closure of the anastomosis using a tension-free suturing technique.
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Affiliation(s)
- Jenna M Rehmer
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio.
| | - Cecile A Ferrando
- Center for Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
| | - Rebecca Flyckt
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
| | - Tommaso Falcone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio
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Farrell RM, Johannesson L, Flyckt R, Richards EG, Testa G, Tzakis A, Falcone T. Evolving ethical issues with advances in uterus transplantation. Am J Obstet Gynecol 2020; 222:584.e1-584.e5. [PMID: 31981513 DOI: 10.1016/j.ajog.2020.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
While uterus transplantation was once considered only a theoretical possibility for patients with uterine factor infertility, researchers have now developed methods of transplantation that have led to successful pregnancies with multiple children born to date. Because of the unique and significant nature of this type of research, it has been undertaken with collaboration not only with scientists and physicians but also with bioethicists, who paved the initial path for research of uterus transplantation to take place. As the science of uterus transplantation continues to advance, so too must the public dialogue among obstetrician/gynecologists, transplant surgeons, bioethicists, and other key stakeholders in defining the continued direction of research in addition to planning for the clinical implementation of uterus transplantation as a therapeutic option. Given the rapid advances in this field, the time has come to revisit the fundamental questions raised at the inception of uterus transplantation and, looking forward, determine the future of this approach given emerging data on the procedure's impact on individuals, families, and society.
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Libby V, Mesiano S, Flyckt R, Weinerman R. hCG AND GnRH AGONIST TRIGGERS DIFFERENTIALLY ALTER LEUKOCYTE EXPRESSION IN THE PERI-IMPLANTATION ENDOMETRIUM FOLLOWING SUPEROVULATION IN A MOUSE MODEL. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.02.073] [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: 11/25/2022]
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Feldman MK, Hunter SA, Perni UC, Liu P, Quintini C, Tzakis AG, Flyckt R. New Frontier: Role of the Radiologist in Uterine Transplantation. Radiographics 2020; 40:608. [DOI: 10.1148/rg.2020204003] [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: 11/11/2022]
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Abstract
Fertility concerns are common in men and women of reproductive age, and primary care physicians are often the first line in addressing, assessing, and referring these patients. This article reviews the answers to questions patients often ask, and outlines a practical framework for the evaluation and management of the infertile couple. Up-to-date information is provided on available assisted reproductive technologies for the infertile couple, as well as preserving fertility in the setting of aging-related changes in the female reproductive system.
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Affiliation(s)
- Rebecca Flyckt
- Director, Fertility Preservation Program, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. .,Assistant Professor, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Tommaso Falcone
- Chief of Staff, Chief Academic Officer, and Medical Director, Cleveland Clinic London, UK.,Professor of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
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Abstract
Although women are inextricably involved in the study of germline editing, their interests have not been significantly represented in debates about the evolution of genome editing technology. Discussions have taken place about effects of germline editing on women as parents and members of families, but key discussions about women's health and well-being as patients and subjects are lacking. This neglect is due in part to restrictions on uterine transfer of modified human embryos, a boundary that has now been crossed. As a result, only scant discussion has taken place about safeguards needed to ensure that women who participate in germline modification research are not exposed to disproportionate risk in exchange for benefits they might expect for future offspring. This omission sets the stage for serious ethical implications for women and their families.
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Affiliation(s)
- Ruth M Farrell
- A staff physician and the vice chair of research of the OB/GYN and Women's Health Institute at the Cleveland Clinic, in Cleveland, Ohio, where she is also on the staff of the Center for Bioethics
| | - Marsha Michie
- An assistant professor in the Department of Bioethics at Case Western Reserve University School of Medicine in Cleveland, Ohio
| | - Christopher T Scott
- The Dalton Tomlin Chair of Medical Ethics and Health Policy at the Center for Medical Ethics and Health Policy at Baylor College of Medicine in Houston, Texas
| | - Rebecca Flyckt
- The division director of reproductive endocrinology and infertility at University Hospitals Cleveland Medical Center in Cleveland, Ohio, and an associate professor of reproductive biology at Case Western Reserve University
| | - Mary LaPlante
- A clinical assistant professor of surgery in the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, Ohio, and A board-certified obstetrician-gynecologist, and currently serves as a member of the AMA's Council on Science and Public Health
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Feldman MK, Hunter SA, Perni UC, Liu P, Quintini C, Tzakis AG, Flyckt R. New Frontier: Role of the Radiologist in Uterine Transplantation. Radiographics 2019; 40:291-302. [PMID: 31756124 DOI: 10.1148/rg.2020190123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Uterine transplantation (UT) is a novel treatment for absolute uterine factor infertility (AUFI) that is currently being performed under experimental protocols in multiple medical centers worldwide. At the time of this publication, there have been at least 10 live births by women with a transplanted uterus. As successful outcomes from this innovative procedure increase, it is likely that more centers will perform UT. Imaging is performed in multiple steps of the UT process, including preoperative imaging of potential donors and recipients, posttransplant surveillance, and monitoring of pregnancy. Fetal imaging is performed by maternal-fetal medicine professionals, but most imaging examinations in UT are performed by radiologists. Given the significant role of imaging in this groundbreaking surgery, radiologists must be familiar with the causes of AUFI and the role of imaging in establishing this diagnosis. Radiologists working in medical centers where UT is performed should understand the role of imaging in preoperative planning and postoperative surveillance. While data regarding complications of UT are preliminary at best, radiologists must be aware of the risk of vascular compromise and graft failure and their imaging features. The authors provide a brief history of UT and define the radiologist's role in pre- and postoperative imaging assessments.©RSNA, 2019.
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Affiliation(s)
- Myra K Feldman
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
| | - Sara A Hunter
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
| | - Uma C Perni
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
| | - Peter Liu
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
| | - Cristiano Quintini
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
| | - Andreas G Tzakis
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
| | - Rebecca Flyckt
- From the Imaging Institute (M.K.F., S.A.H., P.L.), Women's Health Institute (U.C.P., R.F.), and Digestive Disease and Surgery Institute (C.Q.), Cleveland Clinic, 9500 Euclid Ave, Mail Code A21, Cleveland, OH 44195; and Digestive Disease and Surgery Institute, Cleveland Clinic Florida, Weston, Fla (A.G.T.)
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Hur C, Falcone T, Flyckt R. Post-ablation residual disease: histological assessment of excised peritoneal endometriosis. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1304] [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: 11/16/2022]
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Llarena NC, Shah AB, Kessler H, Falcone T, Flyckt R. Surgical management of deep infiltrating endometriosis involving the rectosigmoid colon. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1298] [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: 11/30/2022]
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Desai N, Goldberg JM, Flyckt R, Attaran M, Tantibhedhyangkul J, Austin CM. Odds of euploidy are significantly associated with not only age but blastocyst morphokinetic parameters and ICM/trophectoderm characteristics. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.512] [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: 10/25/2022]
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Bhide S, Flyckt R, Yao M, Falcone T. A Comparative Study of the Impact of Chronic Pelvic Pain on Quality of Life in Women With and Without Endometriosis [34A]. Obstet Gynecol 2019. [DOI: 10.1097/01.aog.0000559381.43356.1b] [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: 11/25/2022]
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Flyckt R, Farrell RM, Falcone T. Advancing the Science of Uterine Transplantation: Minimizing Living Donor Risk on a Path to Surgical Innovation. J Minim Invasive Gynecol 2019; 26:577-579. [DOI: 10.1016/j.jmig.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 12/31/2022]
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Richards EG, Agatisa PK, Davis AC, Flyckt R, Mabel H, Falcone T, Tzakis A, Farrell RM. Framing the diagnosis and treatment of absolute uterine factor infertility: Insights from in-depth interviews with uterus transplant trial participants. AJOB Empir Bioeth 2019; 10:23-35. [PMID: 30855220 DOI: 10.1080/23294515.2019.1572672] [Citation(s) in RCA: 17] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite procedural innovations and increasing numbers of uterus transplant attempts worldwide, the perspectives of uterus transplant (UTx) trial participants are lacking. METHODS We conducted a mixed-methods study with women with absolute uterine factor infertility (AUFI). Participants included women who had previously contacted the Cleveland Clinic regarding the Uterine Transplant Trial and met the initial eligibility criteria for participation. In-depth interviews were conducted in conjunction with FertiQoL, a validated and widely used tool to measure the impact of infertility on the quality of life of infertility patients. RESULTS All (n = 19) rated their overall health as good; some experienced grief and social isolation. AUFI is a life-framing experience that influences acceptance by family, partners, peers, and one's self. UTx is a means to gain control of reproductive autonomy. UTx allows family-building and the ability to play an active role in prenatal health and well-being. Establishing and maintaining a supportive relationship is a key issue of AUFI and when considering UTx. Risks of UTx are perceived relative to risks to self/child/family posed by adoption/surrogacy. Participants had no overall preference regarding living or deceased donor. CONCLUSIONS The ways in which women with AUFI conceptualize this condition in their lives and choices around UTx and participating in a study of the procedure are multifaceted and textured. These perspectives are critical to understanding its ethical, legal, and social implications.
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Affiliation(s)
- Elliott G Richards
- a Department of Ob/Gyn & Women's Health Institute , Cleveland Clinic , Cleveland , Ohio
| | - Patricia K Agatisa
- a Department of Ob/Gyn & Women's Health Institute , Cleveland Clinic , Cleveland , Ohio
| | - Anne C Davis
- a Department of Ob/Gyn & Women's Health Institute , Cleveland Clinic , Cleveland , Ohio
| | - Rebecca Flyckt
- a Department of Ob/Gyn & Women's Health Institute , Cleveland Clinic , Cleveland , Ohio
| | - Hilary Mabel
- b Center for Bioethics Cleveland Clinic , Cleveland , Ohio
| | - Tommaso Falcone
- a Department of Ob/Gyn & Women's Health Institute , Cleveland Clinic , Cleveland , Ohio
| | - Andreas Tzakis
- c Transplantation Center , Cleveland Clinic Florida , Weston , Florida
| | - Ruth M Farrell
- a Department of Ob/Gyn & Women's Health Institute , Cleveland Clinic , Cleveland , Ohio.,b Center for Bioethics Cleveland Clinic , Cleveland , Ohio
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