IVF and other ART in low- and middle-income countries: a systematic landscape analysis
AbstractBACKGROUNDInfertility affects 48.5 million couples worldwide with a prevalence estimated at 3.5 –16.7% in low- and middle-income countries (LMIC), and as high as 30–40% in Sub-Saharan Africa. ART services are not accessible to the majority of these infertile couples due to the high cost of treatments in addition to cultural, religious and legal barriers. Infertility and childlessness, part icularly in LMIC, have devastating consequences, which has resulted in considerable interest in developing affordable IVF procedures. However, there is a paucity of evidence on the safety, efficiency and ability to replicate ...
Source: Human Reproduction Update - November 25, 2020 Category: OBGYN Source Type: research
Neurophysiology of cognitive behavioural therapy, deep breathing and progressive muscle relaxation used in conjunction with ART treatments: a narrative review
AbstractBACKGROUNDInfertility is defined as the failure to achieve clinical pregnancy after 12 months of regular unprotected intercourse. It could be due to male or female factors, each requiring different treatment options. ART treatment exposes couples to numerous psychological stressors. Therefore, it has been recommended by the ESHRE Psychology and Counselling Guideline Development Gro up recently that psychosocial support should be offered as a complementary therapy during infertility treatments. In this context, the efficiency of different psychological interventions, such as cognitive behaviour therapy (CBT), dee...
Source: Human Reproduction Update - November 25, 2020 Category: OBGYN Source Type: research
The other face of advanced paternal age: a scoping review of its terminological, social, public health, psychological, ethical and regulatory aspects
AbstractBACKGROUNDThere is a global tendency for parents to conceive children later in life. The maternal dimension of the postponement transition has been thoroughly studied, but interest in the paternal side is more recent. For the moment, most literature reviews on the topic have focused on the consequences of advanced paternal age (APA) on fertility, pregnancy and the health of the child.OBJECTIVE AND RATIONALEThe present review seeks to move the focus away from the biological and medical dimensions of APA and synthesise the knowledge of the other face of APA.SEARCH METHODSWe used the scoping review methodology. Search...
Source: Human Reproduction Update - November 17, 2020 Category: OBGYN Source Type: research
Endometriosis and cancer: a systematic review and meta-analysis
AbstractBACKGROUNDEndometriosis is an often chronic, inflammatory gynaecologic condition affecting 190 million women worldwide. Studies have reported an elevated cancer risk among patients with endometriosis. However, prior research has included methodologic issues that impede valid and robust interpretation.OBJECTIVE AND RATIONALEWe conducted a meta-analysis of studies investigating the association between endometriosis and cancer risk and analysed the results by methodologic characteristics. We discuss the implications of cancer screening in patients and management challenges faced by clinicians.SEARCH METHODSWe searched...
Source: Human Reproduction Update - November 17, 2020 Category: OBGYN Source Type: research
Preconception genome medicine: current state and future perspectives to improve infertility diagnosis and reproductive and health outcomes based on individual genomic data
AbstractBACKGROUNDOur genetic code is now readable, writable and hackable. The recent escalation of genome-wide sequencing (GS) applications in population diagnostics will not only enable the assessment of risks of transmitting well-defined monogenic disorders at preconceptional stages (i.e. carrier screening), but also facilitate identification of multifactorial genetic predispositions to sub-lethal pathologies, including those affecting reproductive fitness. Through GS, the acquisition and curation of reproductive-related findings will warrant the expansion of genetic assessment to new areas of genomic prediction of repr...
Source: Human Reproduction Update - November 16, 2020 Category: OBGYN Source Type: research
Mild versus conventional ovarian stimulation for IVF in poor, normal and hyper-responders: a systematic review and meta-analysis
AbstractBACKGROUNDMild ovarian stimulation has emerged as an alternative to conventional IVF with the advantages of being more patient-friendly and less expensive. Inadequate data on pregnancy outcomes and concerns about the cycle cancellation rate (CCR) have prevented mild, or low-dose, IVF from gaining wide acceptance.OBJECTIVE AND RATIONALETo evaluate parallel-group randomised controlled trials (RCTs) on IVF where comparisons were made between a mild ( ≤150 IU daily dose) and conventional stimulation in terms of clinical outcomes and cost-effectiveness in patients described as poor, normal and non-polycystic ovary syn...
Source: Human Reproduction Update - November 4, 2020 Category: OBGYN Source Type: research
Persistent organic pollutants and couple fecundability: a systematic review
AbstractBACKGROUNDDespite increasing regulation, exposure to persistent organic pollutants (POPs) remains a serious public health concern due to their accumulation in the environment and ability to biomagnify up the food chain. POPs are associated with endocrine-disrupting effects including adverse reproductive outcomes that could affect fecundability, i.e. the capacity to conceive a pregnancy, quantified as time to pregnancy (TTP).OBJECTIVE AND RATIONALEResults of epidemiologic studies that examine the impact of various chemical classes of POPs on TTP have not been synthesised. We undertook a systematic review to summaris...
Source: Human Reproduction Update - November 4, 2020 Category: OBGYN Source Type: research
Plants as source of new therapies for endometriosis: a review of preclinical and clinical studies
AbstractBACKGROUNDGiven the disadvantages and limitations of current endometriosis therapy, there is a progressive increase in studies focusing on plant-derived agents as a natural treatment option with the intention of achieving high efficiency, avoiding adverse effects and preserving the chance for successful pregnancy. The heterogeneity of these studies in terms of evaluated agents, applied approaches and outcomes illustrates the need for an up-to-date summary and critical view on this rapidly growing field in endometriosis research.OBJECTIVE AND RATIONALEThis review provides a comprehensive overview of plant-derived ag...
Source: Human Reproduction Update - October 30, 2020 Category: OBGYN Source Type: research
Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety
This article examines the evidence of foetal exposure to OTC analgesia, starting from different routes of exposure to evidence, or the lack thereof, linking maternal consumption to offspring ill health. There is a very high prevalence of maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association ofin utero exposure at different pregnancy trim...
Source: Human Reproduction Update - October 29, 2020 Category: OBGYN Source Type: research
Molecular genetics of infertility: loss-of-function mutations in humans and corresponding knockout/mutated mice
AbstractBACKGROUNDInfertility is a major issue in human reproductive health, affecting an estimated 15% of couples worldwide. Infertility can result from disorders of sex development (DSD) or from reproductive endocrine disorders (REDs) with onset in infancy, early childhood or adolescence. Male infertility, accounting for roughly half of all infertility cases, generally manifests as decreased sperm count (azoospermia or oligozoospermia), attenuated sperm motility (asthenozoospermia) or a higher proportion of morphologically abnormal sperm (teratozoospermia). Female infertility can be divided into several classical types, ...
Source: Human Reproduction Update - October 29, 2020 Category: OBGYN Source Type: research
Immunological changes associated with adenomyosis: a systematic review
The objective was to systematically review the literature regarding the role of the immune system in development of adenomyosis in the inner and the outer myometrium, in humans.SEARCH METHODSA systematic review of published human studies was performed in MEDLINE, EMBASE and Cochrane Library databases from 1970 to February 2019 using the combination of Medical Subject Headings (MeSH): Adenomyosis AND ( ‘Immune System’ OR ‘Gonadal Steroid Hormones’), and free-text terms for the following search terms (and their variants): Adenomyosis AND (immunity OR immune OR macrophage OR ‘natural killer cell’ OR lymphocyte* OR...
Source: Human Reproduction Update - October 25, 2020 Category: OBGYN Source Type: research
Recovery of menses after functional hypothalamic amenorrhoea: if, when and why
AbstractBACKGROUNDProlonged amenorrhoea occurs as a consequence of functional hypothalamic amenorrhoea (FHA) which is most often induced by weight loss, vigorous exercise or emotional stress. Unfortunately, removal of these triggers does not always result in the return of menses. The prevalence and conditions underlying the timing of return of menses vary strongly and some women report amenorrhoea several years after having achieved and maintained normal weight and/or energy balance. A better understanding of these factors would also allow improved counselling in the context of infertility. Although BMI, percentage body fa...
Source: Human Reproduction Update - October 17, 2020 Category: OBGYN Source Type: research
Outcomes of pregnancies using donor sperm compared with those using partner sperm: systematic review and meta-analysis
The objective of this study was to establish whether pregnancies conceived using donor sperm are at higher risk of obstetric and perinatal complications than those conceived with partner sperm. As more treatments are being carried out using donor sperm, attention is being given to obstetric and perinatal outcomes, as eventsin utero and at delivery have implications for long-term health. There is a need to know if there is any difference in the outcomes of pregnancies between those conceived using donor versus partner sperm in order to adequately inform and counsel couples.SEARCH METHODSWe performed a systematic review and ...
Source: Human Reproduction Update - October 15, 2020 Category: OBGYN Source Type: research
Current approaches and developments in transcript profiling of the human placenta
AbstractBACKGROUNDThe placenta is the active interface between mother and foetus, bearing the molecular marks of rapid development and exposuresin utero. The placenta is routinely discarded at delivery, providing a valuable resource to explore maternal-offspring health and disease in pregnancy. Genome-wide profiling of the human placental transcriptome provides an unbiased approach to study normal maternal –placental–foetal physiology and pathologies.OBJECTIVE AND RATIONALETo date, many studies have examined the human placental transcriptome, but often within a narrow focus. This review aims to provide a comprehensive ...
Source: Human Reproduction Update - October 12, 2020 Category: OBGYN Source Type: research
Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis
AbstractBACKGROUNDAlthough surgery for endometriosis can improve pain and fertility, the risk of disease recurrence is high. There is little consensus regarding the benefit of medical therapy in preventing recurrence of endometriosis following surgery.OBJECTIVE AND RATIONALEWe performed a review of prospective observational studies and randomised controlled trials (RCTs) to evaluate the risk of endometriosis recurrence in patients undergoing post-operative hormonal suppression, compared to placebo/expectant management.SEARCH METHODSThe following databases were searched from inception to March 2020 for RCTs and prospective ...
Source: Human Reproduction Update - October 6, 2020 Category: OBGYN Source Type: research
