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Messaoud KB, Guibert J, Bouyer J, de La Rochebrochard E. Strong social disparities in access to IVF/ICSI despite free cost of treatment: a French population-based nationwide cohort study. BMC Womens Health 2023; 23:621. [PMID: 37993813 PMCID: PMC10664362 DOI: 10.1186/s12905-023-02784-4] [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: 02/13/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Access to IVF/ICSI is facilitated when the financial barrier is removed. In a national context where in vitro fertilisation (IVF)/intracytoplasmic sperm Injection (ICSI) treatment is cost-free, how many women do not access IVF/ICSI and what are the factors associated with non-access? METHODS Using French national health insurance databases, the cohort included 20,240 women aged 18-43 years living in France who underwent unsuccessful treatment (no pregnancy) with clomiphene citrate (CC) and/or gonadotropins with treatment started between January and August 2016. The outcome measure was non-access to IVF/ICSI during the 24-month following start of infertility care. Factors associated with non-access to IVF/ICSI were explored using mixed effects logistic regression. RESULTS In the cohort, 65.4% of women did not access IVF/ICSI. In multivariable analysis, non-access to IVF/ICSI was higher in younger women (18-25 years: (OR 2.17, 95% CI: 1.85-2.54) and in older women (40-43 years: (OR=3.60, 95% CI: 3.25-3.98)). Non-access was higher among women below the poverty line (OR=3.76, 95% CI: 3.34-4.23) and showed a significant upward trend with increasing deprivation of place of residence. Distance to the nearest fertility centre was not significantly associated with non-access to IVF/ICSI. CONCLUSIONS In a national context of cost-free ART treatment, a large proportion of women did not access treatment, with a strong social gradient that raises important issues. We need to understand the underlying social mechanisms to develop an efficient and equitable health policy regarding infertility care.
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Affiliation(s)
- Khaoula Ben Messaoud
- Institut National d'Etudes Démographiques (Ined), UR14 - Sexual and Reproductive Health and Rights Unit, 93300, Aubervilliers, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.
| | - Juliette Guibert
- Centre Médico-Chirurgical de La Baie de Morlaix, Rond-Point de La Vierge Noire, 29600, Morlaix, France
| | - Jean Bouyer
- Institut National d'Etudes Démographiques (Ined), UR14 - Sexual and Reproductive Health and Rights Unit, 93300, Aubervilliers, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
| | - Elise de La Rochebrochard
- Institut National d'Etudes Démographiques (Ined), UR14 - Sexual and Reproductive Health and Rights Unit, 93300, Aubervilliers, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
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Belaisch Allart J, Santulli P. [French bioethics law one year later: Dream or nightmare?]. Gynecol Obstet Fertil Senol 2023; 51:109-110. [PMID: 36529379 DOI: 10.1016/j.gofs.2022.12.001] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- J Belaisch Allart
- Service de médecine de la reproduction, centre hospitalier des 4 villes, 92310 Saint Cloud, France; CNGOF91, boulevard Sébastopol, 75002 Paris, France.
| | - P Santulli
- Université de Paris cité, faculté de santé, faculté de médecine Paris Centre, Paris, France; Assistance publique-hôpitaux de Paris (AP-HP), hôpital universitaire Paris Centre, centre hospitalier universitaire (CHU) Cochin, Paris, France; Service de gynécologie-obstétrique II, médecine de la reproduction, Paris, France; Institut Cochin, Inserm U1016, Paris, France
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Negro R. Outcomes in Pregnant Patients with Subclinical Hypothyroidism and Thy-roid Autoimmunity: A Critical Appraisal of Recent Randomized Con-trolled Trials. Endocr Metab Immune Disord Drug Targets 2020; 21:1387-1391. [PMID: 33200703 DOI: 10.2174/1871530320999201116200153] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The management of subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) in pregnancy is still uncertain. Over the years, several scientific societies published guidelines on the management of thyroid dysfunction before, during, and after pregnancy, the most recent ones being published by the American Thyroid Association (ATA) in 2017. OBJECTIVE This study aimed to review the published literature in the field since 2017 onward to investigate whether new findings can change ATA recommendations. METHODS Literature search was conducted in PubMed between March 2017 (date of the publication of the ATA guidelines) and March 2020. Research was restricted to randomized controlled trials (RCTs), having pregnancy-related complications in patients with SCH and TAI as the main focus. RESULTS A total of 5 RCTs were retrieved, 2 of which investigated pregnant women with SCH and 3 with TAI. Selected studies displayed proofs against treating maternal SCH and hypothyroxinemia because no benefit from LT4 was demonstrated in offspring intelligence quotient and in pregnancy outcomes; moreover, they reported proofs against treating TAI patients because no benefit from LT4 was demonstrated in improving pregnancy rate or live birth rate or reducing miscarriage rate. CONCLUSION RCTs published from 2017 to 2020 might have a significant impact on current ATA guidelines. In particular, they suggested that isolated hypothyroxinemia and SCH should not be treated and that considering treatment in antibody-positive women, especially those with TSH of 2.5-4.0 mIU/L, would not be justified; they suggested that infertility and miscarriage rates are not decreased by LT4 treatment in euthyroid antibody-positive women seeking pregnancy.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Lecce,. Italy
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Mariotti FFN, Gonçalves BSM, Pimpão G, Mônico-Neto M, Antunes HKM, Viana MDB, Céspedes IC, Le Sueur-Maluf L. A single ovarian stimulation, as performed in assisted reproductive technologies, can modulate the anxiety-like behavior and neuronal activation in stress-related brain areas in rats. Horm Behav 2020; 124:104805. [PMID: 32531398 DOI: 10.1016/j.yhbeh.2020.104805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/05/2020] [Accepted: 06/07/2020] [Indexed: 10/24/2022]
Abstract
Infertility affects about 8 to 12% of couples of childbearing age around the world, and is recognized as a global public health issue by the WHO. From a psychosocial perspective, infertile individuals experience intense psychological distress, related to emotional disorders, which have repercussions on marital and social relationships. The symptoms persist even after seeking specialized treatment, such as assisted reproductive technologies (ART). While the stress impact of ART outcome has been comprehensively studied, the role of supraphysiological concentrations of gonadal hormones on stress response, remains to be elucidated. This study aimed to evaluate the effect of a single ovarian stimulation on the stress response in rats. To mimic the context of ART in rodents, female rats were submitted to the superovulation (150 UI/kg of PMSG and 75 UI/kg of hCG) and then to psychogenic stress (restraint stress for 30 min/day, repeated for three days). Anxiety-like behavior was evaluated in the elevated plus-maze, and neuronal activation in the stress-related brain areas assessed by Fos protein immunoreactivity. Corticosterone, estradiol, progesterone and corpora lutea were quantified. Data were analyzed using Generalized Linear Model (GzLM). Our findings indicate anxiolytic-like and protective effects of supraphysiological concentrations of gonadal hormones induced by a single ovarian stimulation on stress response. An activation of hypothalamus-pituitary-adrenal response inhibitory pathways, with participation of the prefrontal cortex, basomedial amygdala, lateral septum, medial preoptic area, dorsomedial and paraventricular hypothalamus, was detected.
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MESH Headings
- Animals
- Anti-Anxiety Agents/pharmacology
- Anxiety/metabolism
- Anxiety/physiopathology
- Anxiety/prevention & control
- Anxiety/psychology
- Behavior, Animal/drug effects
- Behavior, Animal/physiology
- Brain/drug effects
- Brain/pathology
- Brain/physiopathology
- Corticosterone/metabolism
- Female
- Fertility Agents, Female/pharmacology
- Neurons/physiology
- Neuroprotection/drug effects
- Neuroprotection/physiology
- Ovulation Induction
- Prefrontal Cortex/drug effects
- Prefrontal Cortex/pathology
- Prefrontal Cortex/physiopathology
- Rats
- Rats, Wistar
- Reproductive Techniques, Assisted
- Restraint, Physical/adverse effects
- Restraint, Physical/psychology
- Stress, Psychological/metabolism
- Stress, Psychological/physiopathology
- Stress, Psychological/psychology
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Affiliation(s)
| | | | - Giovanna Pimpão
- Departamento de Biociências, Universidade Federal de São Paulo, UNIFESP, 11015-020 Santos, SP, Brazil
| | - Marcos Mônico-Neto
- Departamento de Biociências, Universidade Federal de São Paulo, UNIFESP, 11015-020 Santos, SP, Brazil; Departmento de Psicobiologia, Universidade Federal de São Paulo, UNIFESP, 04024-002 São Paulo, SP, Brazil
| | | | - Milena de Barros Viana
- Departamento de Biociências, Universidade Federal de São Paulo, UNIFESP, 11015-020 Santos, SP, Brazil
| | - Isabel Cristina Céspedes
- Departamento de Biociências, Universidade Federal de São Paulo, UNIFESP, 11015-020 Santos, SP, Brazil
| | - Luciana Le Sueur-Maluf
- Departamento de Biociências, Universidade Federal de São Paulo, UNIFESP, 11015-020 Santos, SP, Brazil.
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Garruti G, Depalo R, De Angelis M. Weighing the Impact of Diet and Lifestyle on Female Reproductive Function. Curr Med Chem 2019; 26:3584-3592. [PMID: 28521685 DOI: 10.2174/0929867324666170518101008] [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] [Received: 12/07/2016] [Revised: 04/23/2017] [Accepted: 04/23/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the last years, several scientific societies and expert groups focused on the role played by nutritional factors, lifestyle and excess of body fat in interfering with female reproduction and fertility. In many studies a confounding factor is represented by polycystic ovary syndrome (PCOS) which is one of the major causes of infertility where genetic and family history are certainly playing a role, together with lifestyle and nutritional factors. METHODS In an attempt to define "the optimal fertility diet", we consider the role played by Mediterranean lifestyle and some macronutrients (animal and vegetable proteins) on ovulatory disorders and female fertility also considering some new visions derived from randomized trials of lifestyle programs in obese infertile women asking for in vitro fertilization or alternative assisted reproduction technologies. RESULTS Several reports are in favor of an increased consumption of either proteins or low-glycemic index carbohydrates to improve ovulatory disorders and female fertility. In studies concerning infertile women undergoing assisted reproduction, either structured exercise sessions and dietary intervention programs seem to be effective in improving menstrual cycles and fertility as demonstrated by the increased rate of natural conceptions. CONCLUSION The findings of this review confirm the important impact of Mediterranean diet and lifestyle in preserving and improving fertility. However, epigenetic factors are very important in determining fertility rate, but genetic background and ethnicity are also playing crucial roles.
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Affiliation(s)
- Gabriella Garruti
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, D.E.T.O., University of Bari " Aldo Moro", Bari, Italy
| | - Raffaella Depalo
- Unit of Pathophysiology of Human Reproduction and Gametes Cryopreservation, Department of Gynecology, Obstetric and Neonatology, Italy
| | - Maria De Angelis
- Department of Soil, Plant and Food Science, University of Bari " Aldo Moro", Bari, Italy
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Vlachopoulos C, Kosteria I, Sakka S, Gkourogianni A, Terentes-Printzios D, Koutagiar I, Skoumas I, Miliou A, Papassotiriou I, Gardikioti V, Loutradis D, Chrousos G, Kanaka-Gantenbein C, Tousoulis D. PCSK9 and Lp(a) levels of children born after assisted reproduction technologies. J Assist Reprod Genet 2019; 36:1091-9. [PMID: 31079266 DOI: 10.1007/s10815-019-01474-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Proprotein convertase subtilisin/kexin type 9 (PCSK9) and lipoprotein (a) (Lp[a]) levels are associated with cardiovascular risk. To investigate PCSK9 and Lp(a) levels of children born after assisted reproduction technologies (ART) compared with naturally conceived (NC) controls. METHODS In this exposure-matched cohort study, 73 racial-, sex-, and age-matched children (mean age 98 ± 35 months) of ART (intracytoplasmic sperm injection [ICSI] n = 33, classic in vitro fertilization [IVF] n = 40) and 73 NC children were assessed. Blood lipid profile, including PCSK9 and Lp(a) levels, was measured. Children were grouped according to age (< 8 years, 8-10 years, ≥ 10 years). RESULTS In the overall population, PCSK9 levels were related to total cholesterol, low-density lipoprotein, and systolic blood pressure, while Lp(a) levels were related to age, apolipoprotein-B, birth weight, height, waist-to-hip ratio, insulin resistance, insulin, and high-sensitivity C-reactive protein. No significant differences were observed regarding lipid biomarkers between ART and NC children. However, a significant interaction was found between age groups and conception method (p < 0.001) showing that PCSK9 levels increase with age in ART children, while they decline with age in NC offspring. IVF children showed higher levels of adjusted mean Lp(a) than ICSI (13.5 vs. 6.8 mg/dl, p = 0.010) and NC children (12.3 vs. 8.3 mg/dl, p = 0.048). CONCLUSIONS We show that PCSK9 levels increase with age in ART children, indicating a gradual deterioration of lipidemic profile that could lead to increased cardiovascular risk. Moreover, our results indicate that ART method may be of importance given that classic IVF is associated with higher levels of Lp(a).
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Hua J, Wan YY. Whole-exome sequencing identified a novel mutation of AURKC in a Chinese family with macrozoospermia. J Assist Reprod Genet 2018; 36:529-534. [PMID: 30594972 PMCID: PMC6439091 DOI: 10.1007/s10815-018-1374-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/14/2018] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Macrozoospermia is a rare sperm morphologic abnormality associated with male infertility and is characterized by a high percentage of spermatozoa with large irregular heads. The aim of this study was to identify the genetic cause of an infertile male with macrozoospermia from a consanguineous family. METHODS Whole-exome sequencing (WES) was performed using peripheral blood genomic DNA from the patient and his parents. RESULTS WES analysis of the patient with macrozoospermia from a consanguineous family allowed the identification of a novel homozygous missense variant in the AURKC gene (c.269G>A). Bioinformatics analysis also suggested this variant a pathogenic mutation. Quantitative real-time PCR analysis showed that the mRNA level of AURKC is significantly decreased in the patient compared with his father. Moreover, no embryos were available for transfer after ICSI. CONCLUSIONS These results further support the important role of AURKC in male infertility and guide the practitioner in optimal decision making for patients with macrozoospermia.
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Affiliation(s)
- Juan Hua
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China
| | - Yang-Yang Wan
- Center for Reproductive Medicine, Anhui Provincial Hospital Affiliated to University of Science and Technology of China, Hefei City, Anhui Province, China.
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8
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Negro R. Thyroid and Assisted Reproduction Technologies: A Brief Clinical Update with Recommendations for Practice. Endocr Metab Immune Disord Drug Targets 2018; 18:194-200. [PMID: 29384068 DOI: 10.2174/1871530318666180131103029] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/20/2017] [Accepted: 11/17/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Infertility is a common disease that in about one third of cases has a female cause and often requires assisted reproduction technologies (ART) to conceive. Also thyroid autoimmunity (TAI), with or without hypothyroidism, is a common disease, particularly in females, and referral for endocrine consultation is not infrequent. DISCUSSION In the last 15 years a remarkable amount of studies has been published that investigated the pathophysiology of women suffering from TAI, who undergo ART. Due to insufficient sample size, data about the association between infertility and TAI/subclinical hypothyroidism are conflicting. In relation to pregnancy rate, miscarriage, and live births (primary outcomes) data of the literature do not allow to clearly demonstrating an unfavorable impact attributable to TAI/subclinical hypothyroidism; however, secondary outcomes like ovarian reserve or oocytes quality look like worsened. CONCLUSION For sure, the therapeutic regimens used for controlled ovarian hyperstimulation (COH) induce a deterioration of thyroid function in patients suffering from TAI [with or without Levothyroxine (LT4) treatment]. This picture places patients in a condition of increased risk of developing untimely TSH elevation during fertilization; then, it is reasonable that a patient, above all if thyroid antibody positive, would have a TSH value <2.5mIU/L before undergoing COH, and that would be strictly monitored to start or increase LT4 treatment, when necessary.
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Affiliation(s)
- Roberto Negro
- Division of Endocrinology, "V. Fazzi" Hospital, Piazza Muratore, 1. 73100, Lecce, Italy
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Condat A, Mendes N, Drouineaud V, Gründler N, Lagrange C, Chiland C, Wolf JP, Ansermet F, Cohen D. Biotechnologies that empower transgender persons to self-actualize as individuals, partners, spouses, and parents are defining new ways to conceive a child: psychological considerations and ethical issues. Philos Ethics Humanit Med 2018; 13:1. [PMID: 29343272 PMCID: PMC5772725 DOI: 10.1186/s13010-018-0054-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/03/2018] [Indexed: 06/07/2023] Open
Abstract
Today, thanks to biomedical technologies advances, some persons with fertility issues can conceive. Transgender persons benefit also from these advances and can not only actualize their self-identified sexual identities but also experience parenthood. Based on clinical multidisciplinary seminars that gathered child psychiatrists and psychoanalysts interested in the fields of assisted reproduction technology (ART) and gender dysphoria, philosophers interested in bioethics, biologists interested in ART, and endocrinologists interested in pubertal suppression, we explore how new biotechnical advances, whether in gender transition or procreation, could create new ways to conceive a child possible. After reviewing the various medical/surgical techniques for physical gender transition and the current ART options, we discuss how these new ways for persons to self-actualize and to experience parenthood can not only improve the condition of transgender persons (and the human condition as a whole through greater equity) but also introduce some elements of change in the habitual patterns of thinking especially in France. Finally, we discuss the ethical issues that accompany the arrival of these children and provide creative solutions to help society handle, accept, and support the advances made in this area.
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Affiliation(s)
- Agnès Condat
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, Paris, France.
- CESP INSERM 1018, ED3C, université Paris Descartes, Paris, France.
- CECOS Paris Cochin, Hôpital Cochin, Paris, France.
| | - Nicolas Mendes
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, Paris, France
- Équipe d'accueil CLIPSYD EA 4430, Connaissance, langage, modélisation (ED 139), université Paris Ouest-Nanterre La Défense, Nanterre, France
- CECOS Paris Cochin, Hôpital Cochin, Paris, France
| | | | - Nouria Gründler
- Lien POPI (périnatalité, orientation psychanalytique et institution), centre Dominique Mahieu-Caputo, Paris, France
| | - Chrystelle Lagrange
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, Paris, France
| | - Colette Chiland
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - François Ansermet
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Université de Genève, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - David Cohen
- Service de Psychiatrie de l'Enfant et de l'Adolescent, Hôpital Pitié-Salpêtrière, Paris, France
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
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Chighizola CB, de Jesus GR, Branch DW. The hidden world of anti-phospholipid antibodies and female infertility: A literature appraisal. Autoimmun Rev 2016; 15:493-500. [PMID: 26827907 DOI: 10.1016/j.autrev.2016.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 01/25/2016] [Indexed: 11/28/2022]
Abstract
Even though the association of anti-phospholipid antibodies (aPL) with infertility is debated, infertile women are commonly screened for aPL. To review evidence, a systematic PubMed search was conducted to retrieve papers addressing (i) the association between aPL and infertility, (ii) the positivity rate of criteria and non-criteria aPL in women with infertility, (iii) the association between aPL and assisted reproduction technologies (ART) outcome, (iv) the efficacy of medical treatments on ART outcome, and (v) the effects of ART on thrombotic risk. A total of 46 papers were considered; several limitations emerged: (i) wide heterogeneity in study populations, (ii) non-prospective design in 90% of studies, and (iii) aPL cutoffs not conforming to international guidelines in more than 75% of studies; aPL positivity not confirmed in 89% of studies. Most studies evinced an association between infertility and anti-β2GPI antibodies and almost all non-criteria aPL. The association rate with infertility was below 50% for lupus anti-coagulant, anti-cardiolipin antibodies (aCL), and anti-phosphatidic acid antibodies. According to our estimates, overall positivity rates of criteria and non-criteria aPL tests are 6% and 3% among infertile women, 1% and 2% among controls, respectively. A significant difference in the positivity rate of patients versus controls emerged for aCL only. Five of 18 studies reported a detrimental effect of aPL on ART outcome. Only one of the six studies assessing the effects of treatment on ART outcome among aPL-positive infertile women reported a benefit. All relevant studies reported no increase in the rate of thrombosis among aPL-positive women undergoing ART.
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Affiliation(s)
- Cecilia B Chighizola
- Rheumatology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Experimental Laboratory of Immunology and Rheumatology Researches, Istituto Auxologico Italiano, via Zucchi 18, Cusano Milanino, Milan, Italy
| | - Guilherme R de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Avenida Professor Manuel de Abreu, 500-1o andar, Vila Isabel CEP, 20550-170, Rio de Janeiro, Brazil; Department of Obstetrics, Instituto Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil
| | - D Ware Branch
- Department of Obstetrics and Gynecology, University of Utah Health Sciences, Intermountain Healthcare, 50 N Medical Dr, Salt Lake City, UT 84132, USA.
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Balasuriya A, Serhal P, Doshi A, Harper JC. Processes involved in assisted reproduction technologies significantly increase sperm DNA fragmentation and phosphatidylserine translocation. Andrologia 2012; 46:86-97. [PMID: 23230887 DOI: 10.1111/and.12052] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 12/26/2022] Open
Abstract
Sperm preparation techniques in assisted reproduction technologies (ART) are potential generators of exogenous stresses that cause additional DNA damage. DNA fragmentation tests, such as the sperm chromatin structure assay, involve freezing sperm samples in the absence of cryoprotectant. Thermal, oxidative stress (OS) and freezing are detrimental to sperm DNA fragmentation and phosphatidylserine (PS) translocation. The primary aim of this study was to subject mature sperm to environmental insults that normally occur during ART. We tested the hypotheses that OS, thermal stress and freeze-thawing caused sperm nuclear and membrane damage and that a positive correlation exists between PS translocation and DNA fragmentation. Sperm DNA integrity deteriorates in semen samples from men with advancing age and a sperm concentration of <15 m ml(-1) . The significant increase in sperm DNA fragmentation at 37 °C after merely 1 h is important clinically as semen liquefaction and short-term sperm storage in an ART cycle involve incubating samples at this temperature. Freezing without a cryoprotectant significantly increases the level of sperm nuclear damage, so it is important not to freeze neat semen prior to DNA fragmentation testing. This study highlights the importance of minimising the production of exogenous stresses during sperm preparation in ART.
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Affiliation(s)
- A Balasuriya
- UCL Centre for PG & D, Institute for Women's Health, University College London, London, UK
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