1,720,967 research outputs found
Biological rhythms in female reproduction: a link with clinical data, uterine receptivity and implantation
No full textMany aspects of physiological function are strongly circadian. Disturbance of these intrinsic modulators is implicated in disease states, but the role of biological rhythmic control in the context of reproduction is still largely unknown. The circadian network is apparent in all aspects of reproductive functioning; from menstruation to implantation and pregnancy. Endometrial dysfunction may occur if regulatory processes do not happen, with a disruptive effect on the synchronisation of implantation. Whether this dysregulation happens at the level of the endometrium, at the embryo-endometrial interface or at the level of clock genes is not known.This work has investigated the role these biological rhythms, in particular those pertaining to that of uterine receptivity and implantation. By a systematic review and a meta-analysis of shift workers, a population being at risk of adverse early reproductive outcomes was identified. The link between experiencing poor early reproductive outcomes and sleep and activity was further investigated and it was shown that sleeping and activity patterns are different in reproductive pathology as compared with fertile healthy women.The molecular basis of observed relationships between sleep and reproductive difficulty was investigated by examination of the uterine environment. Human samples were compared in-vivo, and with in-vitro culture models in unstimulated, normal menstrual cycles. This was to examine whether the difference in the circadian rhythm, which leads to deleterious effects in other pro-inflammatory disease, could be linked to the uterine environment of women with reproductive pathology. The immunomodulatory uterine secretome profile in women suffering from recurrent implantation failure (RIF) was shown to be different from fertile women.The expression of core clock genes within the uterus was shown to be cyclical in a circadian manner. The effect of decidualisation appeared to effect the phase, but not the period of this expression. The distinct pattern of endometrial secretions in each group of women (RIF and fertile controls) was compared with the reciprocal core clock gene expression, and was shown to be correlated with a four-hour time lag. The geneimmunomodulator association was effected by decidualisation, more so in the women suffering from RIF than the controls. The addition of melatonin to the cell culture model made the RIF endometrium respond more like the control endometrium. After treatment with melatonin, cells from women with RIF had a more similar geneimmunomodulator profile to the control women. This effect was more noticeable after decidualisation. Whether or not this can be considered a beneficial alteration has not been ascertained
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
A randomized controlled trial assessing whether listening to music at time of embryo transfer effects anxiety levels
No full textBackground: Fertility treatment may have a negative emotional impact on women. Lower levels of anxiety have been associated with improved treatment success but there is no standardised method for addressing these needs. Music is a safe and beneficial non-pharmacological intervention in a number of medical fields. It may alter subjective and objective psychological anxiety as well as physiological functioning. However, little data exists surrounding the therapeutic use of music in fertility treatment but it may attenuate anxiety.
Methods: An assessor-blinded parallel case control study in an IVF center, England UK. 42 women undergoing assisted reproductive treatment were recruited between February and December 2013. Women were randomised by random envelopes containing equal sized 'music' (listened to self-selected music during embryo transfer) or 'control' (no music) groups. Participants completed the Spielberger State-Trait Anxiety Inventory prior to, and immediately following a post-treatment observation period. Primary outcome was change in anxiety level.
Results: 32 of 42 women (76.2%) were less anxious following treatment (mean change in anxiety score 6.9 95%CI 4.2-9.6, P<0.01) without difference between the study group (7.1 95% CI 3.5-10.7) (P=0.46) and controls (6.7 95%CI 2.3-11.1). Clinical pregnancy rates (55.0%) did not differ between music and control groups (P=0.95).
Conclusions: Listening to self-selected music 15 minutes before and after embryo transfer does not significantly impact on anxiety levels of women undergoing assisted conception treatment nor clinical pregnancy rates. Music therapy has not been shown to reduce anxiety at time of ET and the effects of interventions such as hypnosis, acupuncture, aromatherapy and other forms of relaxation therapy remain to be explored
Late reproductive effects of cancer treatment
No full textGynaecologists are seeing an ever-growing population of cancer survivors who are at risk from developing a broad range of adverse outcomes relating to cancer treatment. This review discusses the most commonly observed reproductive concerns in young people who are awaiting, or have undergone treatment for cancer. We also discuss the options for maintaining fertility in both men and women, and possible subsequent pregnancy outcomes. The fertility preservation options available to any particular cancer survivor will depend on age at the time of diagnosis and treatment, the cancer type and primary site, the stage and the type of treatment.<br/
Are skin scar characteristics associated with the degree of pelvic adhesions at laparoscopy?
No full textObjectiveTo investigate whether individual or a combination of abdominal surgical scar characteristics can predict the severity and extent of intra-abdominal adhesions.DesignA prospective cohort study.SettingA tertiary referral center in the United Kingdom.Patient(s)One hundred women who had previously undergone abdominopelvic surgery and were undergoing an elective laparoscopic gynecologic operations.Intervention(s)Abdominal scars were evaluated preoperatively using the modified Manchester Scar Questionnaire Adhesions were assessed intraoperatively and compared with the cutaneous findings.Main Outcome Measure(s)Presence and severity of intra-abdominal adhesions.Result(s)Of 100 women recruited into this study, 71 (71%) women were found to have intra-abdominal Aadhesions, and 29 (29%) had no adhesions. Women who had more than one abdominal scar, a palpable scar, and/or a longer scar were most likely to have pelvic adhesions during the current surgery. Women with the highest mean scar scores also had a greater total adhesion score.Conclusion(s)Adhesions are a common postoperative consequence of open or laparoscopic surgery. Skin scar characteristics are associated with the presence and degree of pelvic adhesions. Future studies should examine whether these characteristics can be used as a preoperative predictive tool to facilitate surgical decision-making and elective operating room organization
Identifying stably expressed housekeeping genes in the endometrium of fertile women, women with recurrent implantation failure and recurrent miscarriages
No full textHousekeeping genes (HKG) are presumed to be constitutively expressed throughout tissue types but recent studies have shown they vary with pathophysiology. Often, validation of appropriate HKG is not made. There is no consensus on which HKGs are most stably expressed in endometrial tissue so this study aimed to identify the most stable HKG in the endometrium of women with recurrent implantation failure (RIF) and recurrent miscarriages (RM). Inclusion criteria were women between 25-45 years (n=45) suffering recurrent miscarriage (RM), recurrent implantation failure (RIF) or fertile controls. Endometrial biopsies were taken and total RNA extraction, cDNA synthesis and PCR was performed using 10 candidate HKG. The genes were arranged in terms of stability and normalisation was determined. Several HKGs not previously tested in endometrial samples were found to be more stable than those previously identified as the most stable. Of these, the 5 most stable HKG (in order of stability) were Prdm4 (PR domain 4)>Ube4a (Ubiquitin-Conjugating Enzyme 4a)> Enox2 (Ecto-NOX Disulfide-Thiol Exchanger 2)>Ube2d2 (Ubiquitin-conjugating enzyme E2D 2)>Actb (Actin beta). We therefore recommend using at least four of the aforementioned HKG for normalisation of endometrial tissues taken from patients with RM and RIF
Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK
No full textBackground: The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods: A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results: There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2-4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1-1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1-97.1%)]. Of 540/1246 [43.3% (95% CI 40.6-46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8-25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2-40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2-38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3-27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5-22.1%)] FGR cases were originally attributed correctly. Conclusion: This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.</p
Is sleep deficit associated with infertility and recurrent pregnancy losses? Results from a prospective cohort study
No full textIntroduction: Biological rhythms, the innate cycle of changes in the body’s physiological functions, are circadian if they have a 24-hour period. It is known that sleep is a key feature of human circadian rhythm but the relationship between sleep and female fertility is largely unknown. This paucity of research is surprising given that circadian rhythms are paramount to human physiology and sleep is related to major female reproductive events. This study was designed to investigate whether there is a difference between the sleep and activity parameters of women with poor reproductive outcome compared with healthy, fertile parous women (comparator group) using subjective (questionnaires) and objective (actigraphy and light exposure) measures. Material and methods: A prospective cohort study in a tertiary in vitro fertilization referral centre in the UK; composed of three study groups: women diagnosed with recurrent implantation failure, women with recurrent miscarriage (RM) and a comparison group (fertile women without endometrial pathology). Comparison women were selected gynaecology patients without endometrial disease (ie perineal complaints or altruistic egg donors). Primary outcome was differences in objective length of sleep in each of the participant groups using actigraphy. Secondary outcomes were subjective sleep quality and quantity, using participant questionnaires, light exposure, and the feasibility of machine learning in activity-pattern interpretation. Results: Women with recurrent implantation failure slept daily on average for 7 hours 35 minutes (± 57 min), 53 minutes less than the comparison group (P =.03), although quality of their objective sleep, and quantity of their subjective sleep, were not significantly different. Women with recurrent miscarriage slept less that the comparison women (36 minutes less/night) but more than women with recurrent implantation failure (17 minutes more/night). No difference in light exposure was found between recurrent miscarriage and the recurrent implantation failure and comparison groups. Conclusions: This study demonstrates an objective observation of sleep time reduction in women with subfertility, although it is not yet clear if this association is casual. Given our increased understanding of the internal body clock and circadian rhythm on fertility, our observation warrants further investigation.</p
Influence of shift work on early reproductive outcomes: a systematic review and meta-analysis
No full textOBJECTIVE:To determine whether an association exists between shift work and early reproductive outcomes.DATA SOURCES:MEDLINE, Embase, and Web of Science were searched. Additional sources included Google Scholar, the Cochrane Library, online publications of national colleges, the ClinicalTrials.gov, and references of retrieved papers.METHODS OF STUDY SELECTION:Included studies compared female shift workers (work outside 8:00 AM to 6:00 PM) with nonshift workers with menstrual disruption (cycles less than 25 days or greater than 31 days), infertility (time-to-pregnancy exceeding 12 months), or early spontaneous pregnancy loss (less than 25 weeks).TABULATION, INTEGRATION, AND RESULTS:Two reviewers extracted adjusted and raw data. Random effect models were used to pool data weighting for the inverse of variance. Assessments of heterogeneity, bias, and subgroup analyses were performed. Sixteen independent cohorts from 15 studies (123,403 women) were subject to analysis. Shift workers had increased rates of menstrual disruption (16.05% [2,207/13,749] compared with 13.05% [7,561/57,932] [n=71.681, odds ratio {OR} 1.22, 95% confidence interval {CI} 1.15-1.29, I 0%]) and infertility (11.3% [529/4,668] compared with 9.9% [2,354/23,811] [OR 1.80, 95% CI 1.01-3.20, I 94%]) but not early spontaneous pregnancy loss (11.84% [939/7,931] compared with 12.11% [1,898/15,673] [n=23,604, OR 0.96, 95% CI 0.88-1.05, I 0%]). Night shifts were associated with increased early spontaneous pregnancy loss (n=13,018, OR 1.29, 95% CI 1.11-1.50, I 0%). Confounder adjustment led to persistent relationships between shift work and menstrual disruption (adjusted OR 1.15, 95% CI 1.01-1.31, I 70%) but not infertility (adjusted OR 1.11 95% CI 0.86-1.44, I 61%). The association between night shifts and early spontaneous pregnancy loss remained (adjusted OR 1.41 95% CI 1.22-1.63, I 0%).CONCLUSION:This review provides evidence for an association between performing shift work and early reproductive outcomes, consistent with later pregnancy findings. However, there is currently insufficient evidence for clinicians to advise restricting shift work in women of reproductive age
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