1,720,973 research outputs found
Nutritional supplementation and artificial reproductive technique (ART) outcomes
No full textApproximately one in six couples suffer from subfertility, and many seek treatment with artificial reproductive technologies (ART). Despite improvements in laboratory techniques and ovarian stimulation, ongoing pregnancy rates per cycle remain at ~25%. Couples wanting to improve their chances may turn to adjuvant therapies, such as nutritional supplements. There is growing evidence that periconceptional nutritional status is a key determinant of fertility and long-term health of the offspring, and a lucrative market has developed to meet the demand based on these benefits. However, the practice of routine dietary supplementation before and during IVF treatment has not been subject to well-powered prospective randomised trials. In this article, the potential roles of specific nutritional supplements in the context of improving IVF outcomes are reviewed and an assessment is made of the evidence base supporting their clinical use in this context. Finally, current research needs in the field are outline
Periconceptional Nutritional and environmental determinants of human embryo health
No full textIntroductionWhilst undergoing artificial reproductive treatments, physicians and patients try a wide variety of approaches to improve the periconceptional environment of the developing gametes and embryos and hence the chances of success. Recently, a ‘Mediterranean’ diet, high in vegetable oils and fish, has been reported to increase pregnancy rates by up to 40%. In addition to parental dietary changes, keeping the embryos in a more stable environment (observing them via time lapse technology rather than removing them from their incubator to grade them) may improve their quality. However, up to now, few prospective randomized controlled trials have investigated the impact of periconceptional dietary interventions or the stability of the embryos’ culture environment on fertility outcomes.MethodsTwo trials have been carried out to examine these hypotheses:1. The PREPARE trial: A randomised double blinded controlled trial of 111 couples examining the effect of a six week dietary intervention of omega-3 fatty acids and vitamin D on morphokinetic markers of embryo quality.2. The PROMOTE trial: A prospective and randomised trial comparing embryo development and metabolic activity of embryos cultured in the MINC (standard benchtop) versus the EmbryoScope (time lapse) incubators.ResultsThere was a statistically significant increases in Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA) in erythrocytes and in vitamin D in blood serum following the dietary intervention (all p<0.001). The development of embryos generated from the couples in the study group to the four cell stage (CC4) was accelerated compared to the control group (p<0.001). These embryos also demonstrated a significantly shortened S3 (meaning more synchronous cell division from the five to eight cell stage) (p=0.031). The fatty acid composition of follicular fluid was altered by the dietary intervention and correlations were made with the embryo quality. The short intervention did not have an effect on sperm quality. Culturing embryos in the EmbryoScope significantly increased the number of blastocysts formed on day 5 (159 EmbryoScope versus 133 MINC; P = 0.015) and altered the carbohydrate utilisation and amino acid consumption and production of those embryos.ConclusionsImproving a couple’s preconceptional diet and providing a more stable environment for embryo culture improves markers of embryo quality. Further work is needed to examine whether this improvement causes an increase in pregnancy rates and to establish dosing and the longevity of a dietary intervention before clinical recommendations can be made
Nutrition for preconception health and fertility
No full textBackground: the importance of preconception care is now widely recognised. Optimisation of the lifestyle, nutrition, and the health of a couple not only affects the chances of conception and a successful pregnancy but also the health of the resulting offspring. Currently, limited data reinforce the importance of further research examining the role of individual nutrients. The complex interactions that these nutrients have with each other and the resultant effect on fertility should also be a focus for future investigation. Modifiable risk factors such as alcohol, caffeine, and body mass index should be optimised prior to attempting to conceive. New research is examining the role of personalised preconception advice.Summary: this review examines the roles of macronutrients, micronutrients, and lifestyle in fertility and reproductive health. Raising awareness of the importance of the effect of preconception nutrition and lifestyle on hormone balance, gamete development, implantation, and pregnancy should be paramount. This applies to all healthcare professionals who come into contact with people of child-bearing age, as well as the general public.</p
Preconception lifestyle modification of decidua to decrease early pregnancy loss: feeding the endometrium
No full text With IVF results now showing good evidence of having reached a steady plateau [1] despite the introduction of impressive new laboratory techniques aimed at selecting the embryo most likely to implant, attention is increasingly turning to the other key determining factor of successful implantation: the endometrium. The uterine factor in implantation has long been considered to be minor, but as the impact of further advances in embryology appears likely to remain incremental at best, clinicians, scientists, and biotech companies are focusing on the maternal side of the implantation equation. The concept of clinical manipulation of endometrial receptivity in infertility is not new. Many patients are offered a “smorgasbord” of adjuvant therapies aimed at improving the chance of the transferred embryo successfully implanting, but the clinical impact of these largely empirical therapies has thus far been disappointing. Perhaps it is time therefore to consider the endometrium in a different way. The paradigm of the endometrium as an essentially passive partner in implantation has gained currency with the growth of embryology and the impressive gains made in culture, freezing, and selection techniques. This reductionist view of the endometrium has gained support from results of oocyte donation programs, in which good outcomes are reported in women who failed to conceive with their own eggs. The assumption that this indicates that only embryo quality is the determining factor ignores the more hormonally physiological environment into which embryos derived from donor eggs are placed. Indeed, the excellent results now being achieved with frozen embryo thaw cycles, where embryos are transferred into an unstimulated endometrium, are being widely attributed to this factor. However, the intra-uterine environment is now being recognized as a key factor, not only in determining successful implantation, but in the nutrition and programming of the peri-implantation embryo. These new insights are providing novel opportunities for therapeutic and indeed nutritional interventions aimed at optimizing the peri-conceptional milieu. It is time to re-evaluate the endometrium as a more active partner in implantation. In this chapter, recent advances in our understanding of the dynamic biosensor and supportive role played by the endometrium will be outlined, and preconceptional interventions aimed at improving endometrial function will be reviewed. Finally, novel strategies for modifying preconceptional behaviors will be introduced.</p
Interprofessional education with medical and midwifery students: a prospective evaluation
No full textBackground/Aims Interprofessional working is essential for safe, high-quality obstetric and midwifery care. This study aimed to design, implement and test an interprofessional education activity bringing together two healthcare professions at the University of Southampton to explore opportunities for students' learning and problem solving. Methods A total of 30 student midwives and four rotations of 70 medical students attended a 1-hour facilitated online education activity (four total) and completed an online evaluation. Results Overall, 16 of the 86 students positively evaluated the activities, valuing the chance to learn about each other's profession and sharing knowledge through small group discussions. Conclusions Interprofessional education supports learners through reflective practice to consider differences in professional scope and responsibilities essential in obstetric and midwifery care. Implications for practice Future enhancements to existing curricula could include a year-long clinical case study as well as half-day simulations. Students could present their experiences via an interprofessional case conference at the end of the year.</p
Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss
No full textIt is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12-1.28 and OR 1.21, 95% CI 1.06-1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25-2.50 and OR 1.35, 95% CI 1.07-1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.</p
The effect of pregnancy vitamin D supplementation on maternal blood pressure: real-world data analysis within the MAVIDOS randomised placebo-controlled trial
Full text linkPurpose: observational studies have suggested negative associations between maternal 25-hydroxyvitamin D (25(OH)D) status and risk of hypertensive disorders of pregnancy [pregnancy-induced hypertension (PIH) and preeclampsia (PET)]. Data from intervention studies are limited. We hypothesised that vitamin D supplementation would lower maternal blood pressure (BP) during pregnancy and reduce the incidence of hypertensive disorders of pregnancy.Methods: the Maternal Vitamin D Osteoporosis Study (MAVIDOS) was a randomised placebo-controlled trial. Pregnant women with a baseline 25(OH)D of 25–100 nmol/l were randomized to either 1000 IU/day cholecalciferol or placebo from 14 to 17 weeks’ gestation until delivery. BP recordings documented during routine clinical pregnancy care were obtained from clinical records and grouped into gestational windows based on the schedule for routine antenatal care in the United Kingdom (23+0–24+6, 27+0–28+6, 33+0–35+6, 37+0–38+6, 39+0–40+6 and ≥ 41+0 weeks+days). Systolic and diastolic BP measurements in these gestational windows were compared between randomisation groups. Diagnoses of PIH or PET (in accordance with national guidelines) and the use of antihypertensive agents were also noted and compared between groups.Results: data for 734 women (366 cholecalciferol, 368 placebo) were included. Maternal mean systolic and diastolic BP did not differ between the randomization groups at any of the gestations studied. The incidences of PIH (placebo 1.6%, cholecalciferol 3.6%, p = 0.10) and PET (placebo 3.3%, cholecalciferol 3.8%, p = 0.68) were similar between the two groups.Conclusions: gestational vitamin D supplementation with 1000 IU/day from 14 to 17 weeks gestation did not lower maternal BP or reduce the incidences of PIH or PET in this trial
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
A randomised controlled trial of a preconceptional dietary intervention in women undergoing IVF treatment (PREPARE trial)
Full text linkBACKGROUND: In vitro fertilisation (IVF) treatment provides an opportunity to study early developmental responses to periconceptional dietary interventions. Retrospective studies have suggested links between preconception diet and fertility, and more recently, a "Mediterranean" diet has been reported to increase pregnancy rates by up to 40%. In addition, a prospective study examining increased intake of omega-3 polyunsaturated fats demonstrated a quickened rate of embryo development after IVF. However, up to now, few prospective randomised controlled trials have investigated the impact of periconceptional dietary interventions on fertility outcomes.METHODS AND DESIGN: The study is a randomised controlled trial of a dietary intervention consisting of olive oil for cooking, an olive oil based spread, and a daily supplement drink enriched with Vitamin D (10 microgram daily) and marine omega-3 fatty acids (2 g daily) for 6 weeks preconception versus a control diet of sunflower seed oil for cooking, a sunflower oil based spread, and a daily supplement drink without added Vitamin D or marine omega-3 fatty acids. Couples undergoing IVF will be randomised to either the intervention or control group (55 in each arm). The primary endpoint is embryo developmental competency in vitro, measured by validated morphokinetic markers. Secondary outcomes will include the effect of the dietary intervention on the nutritional content of the intrauterine environment.DISCUSSION: This approach will enable rigorous examination of the impact of the dietary intervention on early embryo development, together with the influence of the peri-implantation intra-uterine nutritional environment
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