- Cost-effectiveness of pre-exposure prophylaxis for HIV prevention for conception in the United States. [Journal Article]
- AIDSAIDS 2018 Sep 17
- CONCLUSIONS: From a U.S. healthcare sector perspective, when the male partner was not reliably suppressed, PrEP became economically attractive, and in some cases, cost saving.
- Status of preimplantation genetic testing and embryo selection. [Journal Article]
- RBReprod Biomed Online 2018 Aug 20
- At the recent 2018 PGDIS congress, a review of randomized controlled trials of preimplantation genetic testing for aneuploidies (PGT-A) showed improved ongoing pregnancy rates per transfer in experie...
At the recent 2018 PGDIS congress, a review of randomized controlled trials of preimplantation genetic testing for aneuploidies (PGT-A) showed improved ongoing pregnancy rates per transfer in experienced centres and in women aged 35 years and older. Young women produce 40% abnormal embryos (20-60% range), but not all centres see a selection advantage; this indicates the need for more emphasis in improving biopsy and case management. Some chromosome abnormalities are iatrogenic; PGT-A could, therefore, be used as assisted reproductive technology (ART) quality control. Great improvements in non-invasive PGT by testing spent media have been reported, ranging from 80-95% concordance with trophectoderm biopsy, probably precluding the need for biopsy soon. Mosaicism was widely discussed, with PGDIS agreeing to update their guidelines, but continuing to recommend prioritizing euploid, followed by mosaic embryos. Techniques to allow simultaneous single sample analysis of aneuploidy and inherited mutations are improving, but this does not extend to de-novo mutations. Convincing data were presented on the efficacy of using endometrial receptivity tests to improve ART outcomes adjuvant or independently of PGT-A. Imprinting, CRISPR and cloning were also discussed, with a concluding presentation on the first extensive data (aneuploidy and morphology) on in-vivo conceived embryos.
- Advances in Fertility Preservation for Young Women With Cancer. [Journal Article]
- ASAm Soc Clin Oncol Educ Book 2018 May 23; (38):27-37
- Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is asso...
Female patients of reproductive age with cancer often require treatment that can compromise their future fertility. Treatment-related infertility is an important cancer survivorship issue and is associated with depression and diminished quality of life. Recent advances in reproductive health care provide the opportunity to preserve fertility prior to the initiation of cancer therapy. Clinical guidelines recommend that oncology providers counsel patients about the risk of treatment-related infertility and fertility preservation options, and that they refer those who are interested in fertility preservation to fertility specialists. Guidelines endorse the use of assisted reproductive techniques (ART) provided by reproductive endocrinologists to preserve fertility in young female patients with cancer. In addition, ovarian suppression with gonadotropin-releasing hormone (GnRH) agonists may be considered for ovarian protection during chemotherapy. This article reviews currently available and emerging ART for fertility preservation in female patients of reproductive age with cancer and current data supporting the use of ovarian suppression for ovarian protection during chemotherapy in this population. We also review the uptake of fertility services and discuss barriers to fertility preservation in female patients of reproductive age with cancer.
- Pretesticular and Testicular Effects of Systemic Sarcoidosis: A Case Report. [Journal Article]
- JRJ Reprod Med 2017 Mar-Apr; 62(3-4):204-6
- CONCLUSIONS: This case illustrates the difficulties faced in managing the fertility of men who develop systemic sarcoidosis. It also highlights the diagnostic and therapeutic challenges faced by physicians when presented with a case of systemic sarcoidosis.
- Young Women’s Attitudes Towards Modern Reproductive Practices: A Survey Study Assessing What Young Women Want. [Journal Article]
- JRJ Reprod Med 2017 Mar-Apr; 62(3-4):111-18
- CONCLUSIONS: Reproductive autonomy and fertility preservation are important to young educated females, a population sought-after for oocyte donation. Potential donors’ desires for additional rights merit consideration as oocyte demand increases and frozen-oocyte banks emerge.
- Risk of ovarian torsion is reduced in GnRH agonist triggered freeze-all cycles: a retrospective cohort study. [Journal Article]
- JOJ Obstet Gynaecol 2018 Sep 19; :1-6
- Ovarian torsion (OT) in IVF is rare, however, the consequences are significant, which include ovariotomy. In the present study, it was aimed for the first time to compare the incidence of OT between ...
Ovarian torsion (OT) in IVF is rare, however, the consequences are significant, which include ovariotomy. In the present study, it was aimed for the first time to compare the incidence of OT between hCG triggered cycles with ICSI and fresh transfer and GnRH-agonist triggered cycles with the ICSI-freeze-all and frozen embryo transfer (FET). In total, 15,577 ICSI cycles performed between 2001 and 2016 were categorised into two groups (Group 1, n: 9978): cycles with controlled ovarian stimulation (COS) and hCG-triggered (Group 2, n: 5599) and COS, with GnRH-agonist only triggered and freeze-all. Thirteen patients (0.13%) were diagnosed with OT and corrected by laparoscopy (12) and laparotomy (1) in Group 1. One patient (0.018%) was diagnosed with OT and corrected by laparotomy in Group 2 (Group 1 vs. Group 2, p = .049). The incidence of severe ovarian hyperstimulation syndrome (OHSS) was 2.4% in Group 1 and 0.05% in Group 2 (p < .001). The use of freeze-all with GnRH agonist trigger in ART significantly reduced the incidence of OT and concomitantly OHSS, with no effect on the reproductive outcome. Impact Statement What is already known on this subject? Adnexal ovarian torsion (OT) is a well-known gynaecological event that constitutes a surgical emergency. Assisted reproduction technologies (ART) may result in ovarian conditions that predispose patients to ovarian hyperstimulation syndrome (OHSS) and torsion. What the results of this study add? The combined use of GnRH agonist trigger for final oocyte maturation after OS with freeze-all and frozen embryo transfer (FET) significantly reduces the incidence of OT, as well as OHSS. What the implications are of these findings for clinical practice and/or further research? The treatment strategy of GnRH agonist trigger with freeze-all significantly reduces the risks of adverse complications.
- Science of cryopreservation in reproductive medicine - Embryos and oocytes as exemplars. [Review]
- EHEarly Hum Dev 2018 Sep 14
- The modern successes of reproductive medicine are based on the achievements in the fields of artificial fertilization and cryobiology over the last 50years. Cryopreservation of oocytes makes it possi...
The modern successes of reproductive medicine are based on the achievements in the fields of artificial fertilization and cryobiology over the last 50years. Cryopreservation of oocytes makes it possible to preserve their reproductive potential after surgical interventions, treatment of cancer, for delayed pregnancy and to use cells for donation. Cryopreservation of embryos allows not only to reduce the multiple pregnancies rate and to increase the cumulative pregnancy rate as a result of embryo transfer in the following favorable cycles of the patient, but is also a necessary procedure in case of genetic diagnosis or in the case of contraindications for embryo transfer in the stimulated cycle due to possible complications. However, the viability of cryopreserved oocytes and embryos depends on the degree of their cryo damage during the process of freeze-warming. In this regard, it is very important to develop such freezing protocols that minimize the damages caused by the intra- and extracellular ice crystal formation, toxic effect of high concentrations of cryoprotectants and osmotic stresses. The effectiveness of cryopreservation of gametes and embryos is assessed on the basis of morphological, functional and genetic changes in the cells after warming. Special attention should be paid to the ethical issues of assisted reproductive technology, including cryobiotech technologies, which in many countries remain open and in need of settlement.
- Non-surgical embryo transfer technique and recipient mare pregnancy rate. [Comment]
- VRVet Rec 2018 09 15; 183(10):320-322
- The use of assisted reproductive technology before male factor infertility evaluation. [Journal Article]
- TATransl Androl Urol 2018; 7(4):678-685
- CONCLUSIONS: The prior use of ART is common among men presenting for an initial evaluation at a male infertility specialty clinic. Older female partner age was associated with use of reproductive technologies prior to evaluation, however, semen analysis parameters were not.
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- Paternal factors contributing to embryo quality. [Review]
- JAJ Assist Reprod Genet 2018 Sep 11
- CONCLUSIONS: We propose that careful assessment of spermatozoal parameters is essential to achieve embryo development and a healthy live birth. However, the heterogeneity in test results and the different approaches of assessing a single sperm parameter highlight the need for more research and the development of standardized protocols to assess the role of sperm factors affecting embryo quality.