1,721,003 research outputs found
Efficiency and safeness improvement and cost containment strategy in Assisted Reproduction Technique (ART)
No full textOver the years, progress has been made in the field of Reproductive Medicine, passing from the first treatments made of spontaneous cycle, to the introduction of medical strategies of multiple follicular growth stimulation, which is associated to an improvement of outcomes in terms of the number of mature oocytes retrieved, pregnancy rate and live birth rate. The clinical introduction of GnRH antagonists, at the end of the years ' 90, opened new perspectives in ovarian stimulation strategy. Clinical data obtained from randomized controlled trials have shown the benefits of using these drugs in terms of lower dose of gonadotropins, shorter duration of treatment, reduced rates of OHSS, with an overall reduction of costs (Al-Inany HG et al., 2011). Also permitted the use of GnRH agonists for induction of oocyte final maturation, in order to reduce as much as possible OHSS rates.
The ovarian response to stimulation with exogenous gonadotropins during IVF is a critical determinant of live birth rates and adverse outcomes (R.G. Steward et al., 2014; Sunkara et al., 2011). Healthcare providers and national guidelines recognize the need for individualization of the starting dose of gonadotropin by using predictive factors related to patient characteristics and diagnostic markers of ovarian reserve to attain an optimal oocyte yield while minimizing the risk of an excessive response and OHSS.
This research work was carried out in order to identify the best strategies to improve the effectiveness and safety of IVF treatments. The ultimate goal is a reduction of costs associated with IVF by a reduction of cycle cancellation rate and hospitalization rate for ovarian hyperstimulation syndrome (OHSS)
Management of the adnexal mass.
No full textWe read with interest the article from Liu and Zanotti. The authors state that recent evidence suggests that fertility drug use is not an independent risk factor for ovarian cancer, citing the review from Mahdavi et al and a Danish population study. However, this review showed that there was a stronger association between fertility drug use and borderline tumors of the ovary. The Danish study did not provide sufficient data for women who had undergone repeated stimulation cycles with gonadotropins. Moreover, the median age at the end of follow-up (47 years) was below the usual peak age (early 60s) for ovarian cancer. Therefore, women with an adnexal mass and who had a history of several treatments with gonadotropins should require more cautious treatment. We totally agree that intermediate-risk adnexal masses are the most problematic diagnostic and management challenges. We think that one of the main factors that should be considered in the decision-making process is fertility status. The treatment of women with a desire for future fertility or of infertile women should be different from that of women who do not desire future pregnancy or postmenopausal women. Adnexal masses frequently are detected during infertility work-up. It is well-known that any kind of ovarian surgery negatively affects follicular reserve. Therefore, follicular reserve should be assessed before operative decisions by measuring anti-Mullerian hormone plasma levels
SARS-CoV-2 and the next generations: which impact on reproductive tissues?
No full textCoronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2) is a
severe global pandemic, affecting mostly the respiratory system. Understandably, attention is also being directed towards the
urogenital tract. In this work, expression patterns of various host molecules possibly involved in viral entry and replication were
investigated in human female and male reproductive systems by inquiring online repositories, including the Human Protein Atlas,
GTEx, FANTOM5. Our findings highlight that male reproductive tissues could be targeted by SARS-CoV-2, particularly the
testis since it co-expresses the receptor (ACE2) and the protease (TMPRSS) needed for viral entry. We hypothesized that SARSCoV-
2 infection could have repercussions on the fertility status of male individuals Potential infectivity of SARS-CoV-2 in
reproductive tissues should be considered in reproductive medicine and management of in vitro fertilization in present and future
generation
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
Indicazioni della IUI
No full textL’inseminazione intrauterina (IUI) ha come razionale il superamento della barriera mucosa cervicale e l’aumento della percentuale di spermatozoi mobili, con forme normali, a livello del sito di fertilizzazione. Le procedure di lavaggio riducono la concentrazione di prostaglandine, linfochine, citochine e radicali dell’ossigeno da parte di agenti infettivi, spermatozoi non mobili, leucociti, cellule immature, portando così ad un miglioramento della qualità del liquido seminale, con aumento della percentuale di fertilizzazione, in vitro ed in vivo.
Questa tecnica, semplice, non invasiva e poco costosa, offre numerosi vantaggi, quali la necessità di avere attrezzature minime, il ridotto disagio psicologico per la paziente, i rischi minimi di Sindrome da Iperstimolazione Ovarica (OHSS) e di gravidanze multiple (7), garantendo quindi una compliance per l’IUI maggiore rispetto alla fecondazione in vitro (IVF). Ciononostante tale procedura è ancora oggetto di discussione clinica (1,2).
Le principali indicazioni all’IUI, con o senza stimolazione ormonale, sono l’infertilità femminile da fattore cervicale, l’infertilità maschile e la sterilità sine causa
Finasteride and Fertility: Case Report and Review of the Literature
No full textAlthough millions of men have taken or are taking finasteride, there are no documented cases of successful pregnancy in the literature after discontinuation of the drug. Early studies did not show significant influence of finasteride on semen parameters, whereas some recent observations have suggested that in subfertile patients, the effects of the drug might be amplified. Therefore, counseling is particularly difficult for men taking finasteride and planning pregnancy. We report the case of a couple whose male partner had used finasteride for approximately 10 years and who presented for primary infertility. The first semen analysis, carried out 3 months after finasteride cessation, revealed severe oligospermia. One month later, sperm concentration increased, and the following month, the couple spontaneously conceived. A healthy baby was delivered at full term. To the best of our knowledge, this is the first case of successful full-term pregnancy and live birth after long-term use of finasteride, which suggests that treatment with finasteride, even after several years, does not prevent normal conception. However, caution should be advised with the use of finasteride in male partners of couples who are attempting to become pregnant
Systematic review of the complement components as potential biomarkers of pre-eclampsia: pitfalls and opportunities
Full text linkUnlabelled: The complement system (C) is a crucial component of the innate immune system. An increasing body of research has progressively shed light on the pivotal role of C in immunological tolerance at the feto-maternal interface. Excessive C activation or impaired C regulation may determine the onset of pregnancy-related pathological conditions, including pre-eclampsia (PE). Thus, several studies have investigated the presence of C components or split products in blood matrixes (i.e., plasma, serum), urine, and amniotic fluid in PE. In the current study, we systematically reviewed the currently available scientific literature reporting measurements of C components as circulating biomarkers in PE, based on a literature search using Pubmed, Scopus, and Embase databases. A total of 41 out of 456 studies were selected after full-text analysis. Fourteen studies (34.1%) were identified as measuring the blood concentrations of the classical pathway, 5 (12.1%) for the lectin pathway, 28 (68.3%) for the alternative pathway, 17 (41.5%) for the terminal pathway components, and 16 (39%) for C regulators. Retrieved results consistently reported C4, C3, and factor H reduction, and increased circulating levels of C4d, Bb, factor D, C3a, C5a, and C5b-9 in PE compared to normal pregnancies, depicting an overall scenario of excessive C activation and aberrant C regulation. With evidence of C activation and dysregulation, C-targeted therapy is an intriguing perspective in PE management. Moreover, we also discussed emerging pitfalls in C analysis, mainly due to a lack of experimental uniformity and biased cohort selection among different studies and laboratories, aiming to raise a more comprehensive awareness for future standardization. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024503070
The quality of parenting in reproductive donation families: A meta-analysis and systematic review
Full text linkThis review examined whether the absence of a genetic link with one or both parents in families using reproductive donation induced a different quality of parenting from that found in families with spontaneous conception or autologous assisted reproductive technology (AUT-ART), where the genetic mother carries the pregnancy and both parents have a genetic link with their children. MEDLINE, PsycINFO and PubMed were searched for English-language studies published from January 1993 to October 2021. A total of 45 studies were included in the systematic review, and 11 in the meta-analysis. The meta-analysis showed that in reproductive donation families, where there was no genetic link between parents and children, there were higher positive parental values (P = 0.007) and lower negative parental values (P = 0.007) than for parents and children in families that had spontaneously conceived. No statistically significant differences emerged when the reproductive donation families were compared with the AUT-ART families. The study showed that the quality of parenting was not conditioned by the presence or absence of a genetic link; instead, it was influenced by the processes underlying family building, such as the desire to have a child, the involvement of both parents in the childcare and the quality of disclosure
Medical Treatments for Endometriosis-Associated Pelvic Pain.
No full textThe main sequelae of endometriosis are represented by infertility and chronic pelvic pain. Chronic pelvic pain causes disability and distress with a very high economic impact. In the last decades, an impressive amount of pharmacological agents have been tested for the treatment of endometriosis-associated pelvic pain. However, only a few of these have been introduced into clinical practice. Following the results of the controlled studies available, to date, the first-line treatment for endometriosis associated pain is still represented by oral contraceptives used continuously. Progestins represent an acceptable alternative. In women with rectovaginal lesions or colorectal endometriosis, norethisterone acetate at low dosage should be preferred. GnRH analogues may be used as second-line treatment, but significant side effects should be taken into account. Nonsteroidal anti-inflammatory drugs are widely used, but there is inconclusive evidence for their efficacy in relieving endometriosis-associated pelvic pain. Other agents such as GnRH antagonist, aromatase inhibitors, immunomodulators, selective progesterone receptor modulators, and histone deacetylase inhibitors seem to be very promising, but there is not enough evidence to support their introduction into routine clinical practice. Some other agents, such as peroxisome proliferator activated receptors- ligands, antiangiogenic agents, and melatonin have been proven to be efficacious in animal studies, but they have not yet been tested in clinical studie
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