BACKGROUND Heterotopic pregnancy(HP)is a rare condition in which both ectopic and intrauterine pregnancies occur.HP is uncommon after natural conception but has recently received more attention due to the widespread u...BACKGROUND Heterotopic pregnancy(HP)is a rare condition in which both ectopic and intrauterine pregnancies occur.HP is uncommon after natural conception but has recently received more attention due to the widespread use of assisted reproductive techniques(ART)such as ovulation promotion therapy.CASE SUMMARY Here,we describe a case of HP that occurred after ART with concurrent tubal and intrauterine singleton pregnancies.This was treated successfully with surgery to preserve the intrauterine pregnancy,resulting in the birth of a low-weight premature infant.This case report aims to increase awareness of the possibility of HP during routine first-trimester ultrasound examinations,especially in pregnancies resulting from ART and even if multiple intrauterine pregnancies are present.CONCLUSION This case alerts us to the importance of comprehensive data collection during regular consultations.It is important for us to remind ourselves of the possibility of HP in all patients presenting after ART,especially in women with an established and stable intrauterine pregnancy that complain of constant abdominal discomfort and also in women with an unusually raised human chorionic gonadotropin level compared with simplex intrauterine pregnancy.This will allow symptomatic and timeous treatment of patients with better results.展开更多
The global outbreak of the coronavirus disease 2019(COVID-19) led to the suspension of most treatments with assisted reproductive technique(ART). However, with the recent successful control of the pandemic in China, t...The global outbreak of the coronavirus disease 2019(COVID-19) led to the suspension of most treatments with assisted reproductive technique(ART). However, with the recent successful control of the pandemic in China, there is an urgent public need to resume full reproductive care. To determine whether the COVID-19 pandemic had any adverse effects on female fertility and the pregnancy outcomes of women undergoing ART, a systematic review and meta-analysis was conducted using the electronic Chinese and English databases. Dichotomous outcomes were summarized as prevalence, and odds ratios(ORs)and continuous outcomes as standardized mean difference(SMD) with 95% confidence interval(CI). The risk of bias and subgroup analyses were assessed using Stata/SE 15.1 and R 4.1.2. The results showed that compared with women treated by ART in the pre-COVID-19 time frame, women undergoing ART after the COVID-19 pandemic exhibited no significant difference in the clinical pregnancy rate(OR 1.07, 95% CI 0.97 to 1.19;I2=0.0%), miscarriage rate(OR 0.95, 95% CI 0.79 to1.14;I2=38.4%), embryo cryopreservation rate(OR 2.90, 95% CI 0.17 to 48.13;I2=85.4%), and oocyte cryopreservation rate(OR 0.30, 95% CI 0.03 to 3.65;I2=81.6%). This review provided additional evidence for gynecologists to guide the management of women undergoing ART treatment during the COVID-19 pandemic timeframe.展开更多
Having children in African and indeed Nigerian is very important;there are numerous reaosns why people have children,in fact,the stability or otherwise of marraige is often anchored on the presence and number of child...Having children in African and indeed Nigerian is very important;there are numerous reaosns why people have children,in fact,the stability or otherwise of marraige is often anchored on the presence and number of children in each home.Consequently,there are lots of attendant problems in marraiges where there are no children,such as emotional and psychological truma,disquietedness,neglect,deprivatoion,and many other challenges.Indeed there is a very high negative impact of childlessness on marriage in Africa.Modernity has however,brought some cure to childlessness through the Assisted Reproductive Techniques(ART)whose main aim is to establish pregnancy through scientific methods aside the natural means.ART in spite of its success rate has equally brought alongside some issues within the customary law regime particularly when the treatment options require donor gametes which removes consanguinity and affinity between the child and the parent.This paper using the doctrinal method,therefore examines the interference,impact and challenges of ART on marriage,succession,and some other aspects of customary law and institutions.展开更多
Reproductive medicine has been transformed by assisted reproductive technologies(ART),providing multiple options for infertile couples to conceive biological offspring.The medical and legal frameworks,governing the pr...Reproductive medicine has been transformed by assisted reproductive technologies(ART),providing multiple options for infertile couples to conceive biological offspring.The medical and legal frameworks,governing the practice of embryologists in ART,focus on the ethical and safe handling of gametes and embryos.Embryologists play a crucial role in the success of ART procedures,requiring technical expertise and a thorough understanding of legal and ethical considerations.The importance of quality control,safety protocols,and sterility in ART laboratories is essential to ensure optimal embryo development and patient well-being.The legal responsibilities of an embryologist under the Assisted Reproductive Technology(Regulation)Act,2021 in India are required.This review emphasizes the importance of record-keeping,patient confidentiality,informed consent,and adherence to legal and ethical standards to minimize the risk of malpractice claims.Overall,this narrative review provides a detailed overview of the medical,legal,and ethical frameworks governing embryologists'practice in ART,underscoring the significance of responsible and ethical conduct in this rapidly advancing field.展开更多
The rapidly evolving environment of assisted reproductive technology(ART)requires consideration of how new innovations are reshaping clinical practice as much as research.In particular,there are three key areas that,w...The rapidly evolving environment of assisted reproductive technology(ART)requires consideration of how new innovations are reshaping clinical practice as much as research.In particular,there are three key areas that,while full of promise,also present significant challenges:the use of artificial intelligence(AI)in embryo selection,the impact of personalized medicine on ART success rates,and the ethical considerations of genetic screening of embryos[1].This letter is meant to provoke further discussion and highlight the need for harmonized global guidelines as these advances continue to reshape the reproductive medicine environment.展开更多
BACKGROUND Acupuncture,an ancient practice,is gaining recognition as a complementary and alternative medicine,especially in assisted reproductive technology.It plays a crucial role in enhancing embryo transfer success...BACKGROUND Acupuncture,an ancient practice,is gaining recognition as a complementary and alternative medicine,especially in assisted reproductive technology.It plays a crucial role in enhancing embryo transfer success rates.Research indicates that acupuncture can improve blood flow,increase endometrial receptivity regulate pressure,and affect neuroendocrine activities in the ovaries and uterus during embryo implantation,therefore improving pregnancy outcomes.AIM To highlight recent developments related to acupuncture's influence on embryo transfer and elucidating the precise mechanisms by which acupuncture influences embryo transfer.METHODS We searched database including PubMed,Cochrane Library up to September 2024 for relevant studies and patents to evaluate the effects of acupuncture on women undergoing in vitro fertilization(IVF).The experimental design included an intervention group using needling,and a control group consisting of no needling or sham needling.The main outcome is clinical pregnancy rate(CPR),while secondary includes live birth rate(LBR)and biochemical pregnancy rate(BPR).We examined the influence of adjunctive needling on pregnancy outcomes by analyzing variations in the main outcomes.RESULTS A total of 145 randomized controlled trials involving 27748 participants were analyzed.Data revealed that the overall CPR was significantly elevated in all acupuncture cohorts compared to the control group[relative risk(RR):1.21,95%CI:1.07-1.38,P=0.01].In contrast,the aggregated LBR did not exhibit a corresponding increase,and notable statistical heterogeneity was observed among the studies.Acupuncture-assisted frozen-thawed embryo transfer enhanced the BPR(RR:1.51,95%CI:1.21-1.89,P=0.03)and improved endometrial morphology(RR:1.41,95%CI:1.13-1.75,P=0.01).Furthermore,IVF outcomes were significantly superior in the acupuncture group when acupuncture was administered during controlled ovarian hyperstimulation(RR:1.71,95%CI:1.08-2.13,95%CI:1.08-4.21,P=0.03).CONCLUSION We find that acupuncture positively influences pregnancy rates in women receiving IVF treatment.Nonetheless,there are no established guidelines for optimal acupuncture protocols.Considering the methodological limitations identified in current research,there is a need for larger,methodologically rigorous studies.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.It typically develops in patients with advanced chronic liver disease and only rarely occurs during pregnancy.CASE SUMMARY We report ...BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.It typically develops in patients with advanced chronic liver disease and only rarely occurs during pregnancy.CASE SUMMARY We report the case of a 46-year-old woman with HBeAg-negative chronic hepatitis B virus(HBV)infection,persistently low HBV DNA levels,and normal aminotransferase values,who developed HCC in a non-cirrhotic liver during a pregnancy achieved through assisted reproduction techniques.Antiviral therapy with Entecavir was initiated shortly before conception because of an increase in HBV DNA levels and was subsequently switched to Tenofovir during pregnancy.Despite a spontaneous miscarriage,alpha-fetoprotein levels continued to rise,prompting magnetic resonance imaging,which revealed a solitary hepatic nodule measuring 18 mm.The patient underwent hepatic resection,and histological examination confirmed a moderately differentiated HCC.Despite complete surgical resection,two early recurrences occurred within 15 months.Tumour and non-tumour liver tissues were collected intra-operatively,snap-frozen,and processed for molecular analyses to assess total HBV DNA,covalently closed circular DNA and HBV RNA levels.CONCLUSION HBV infection and pregnancy-related immunological imbalance may contribute to HCC development,underscoring the need for careful surveillance in HBsAg-positive women.展开更多
Backgrounds:Adverse childhood experiences(ACEs)can increase the likelihood of developing insecure attachment patterns,which in turn may heighten economic concerns and couple dissatisfaction—both generally and particu...Backgrounds:Adverse childhood experiences(ACEs)can increase the likelihood of developing insecure attachment patterns,which in turn may heighten economic concerns and couple dissatisfaction—both generally and particularly in the context of assisted reproduction treatments(ART).These processes together elevate the risk of postpartum depression(PPD).Methods:This study examined psychosocial and relational predictors of PPD in a sample of 149 Spanish women up to 12 months postpartum following ART.(8.1%=artificial insemination with a sperm donor;12.1%=artificial insemination without a sperm donor;67.1%=in vitro fertilization;20.8%=intracytoplasmic sperm injection;12.8%=egg donation;22.1%=frozen-thawed embryo transfer).Predictors included subdomains of ACEs(abuse and household dysfunction),maternal self-efficacy,romantic attachment(anxiety/avoidance),couple satisfaction(ad hoc item,0–10),and financial concerns(ad hoc item,0–10).Results:Hierarchical regression analyses showed that economic worry and low maternal self-efficacy accounted for 29%of the variance in PPD in the final step.Mediation models revealed that attachment anxiety partially mediated the association between childhood abuse and PPD.(?=0.018,95%CI[0.0002,0.0396]),whereas avoidance did not emerge as a significant pathway.There was a lack of association between family dysfunction and attachment dimensions,which should be interpreted cautiously due to the subscale’s limited reliability in this sample.Furthermore,maternal self-efficacy partially mediated the link between financial concerns and PPD(?=0.096,95%CI[0.0003,0.2533]),indicating that economic strain increases depressive symptoms partly by undermining maternal confidence.Conclusion:For women conceiving through ART,the relevance of maternal self-efficacy and socioeconomic stress are highlighted as key targets for prevention and intervention.The role of attachment anxiety is,as well,underscored as a mechanism linking early adversity to PPD.展开更多
Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxid...Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology (ART) improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection (ICSI), and accounted for 870 cycles (438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy). There was a significant increase in the clinical pregnancy rates (OR = 1.59, 95% CI. 1.19-2.12, 12 = 25%) and live birth rates (OR = 2.17, 95% CI: 1,55-3.06, I^2 = 0%) in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes.展开更多
Obtaining high-quality embryos is one of the key factors to improve the clinical pregnancy rate of assisted reproductive technologies(ART).So far,the clinical evaluation of embryo quality depends on embryo morphology....Obtaining high-quality embryos is one of the key factors to improve the clinical pregnancy rate of assisted reproductive technologies(ART).So far,the clinical evaluation of embryo quality depends on embryo morphology.However,the clinical pregnancy rate is still low.Therefore,new indicators are needed to further improve the evaluation of embryo quality.Several studies have shown that the decrease of sperm-specific protein actin-like 7A(ACTL7A)leaded to low fertilization rate,poor embryo development,and even infertility.The aim of this study was to study whether the different expression levels of ACTL7A on sperm can be used as a biomarker for predicting embryo quality.In this study,excluding the factors of severe female infertility,a total of 281 sperm samples were collected to compare the ACTL7A expression levels of sperms with high and low effective embryo rates and analyze the correlation between protein levels and in-vitro fertilization(IVF)laboratory outcomes.Our results indicated that the ACTL7A levels were significantly reduced in sperm samples presenting poor embryo quality.Furthermore,the protein levels showed a significant correlation with fertilization outcomes of ART.ACTL7A has the potential to be a biomarker for predicting success rate of fertilization and effective embryo and the possibility of embryo arrest.In conclusion,sperm-specific protein ACTL7A has a strong correlation with IVF laboratory outcomes and plays important roles in fertilization and embryo development.展开更多
Since 1992, assisted reproductive technology (ART) has been reported as a viable means of helping HIV-1 serodiscordant couples achieve pregnancy while theoretically reducing the risk for viral transmission. While th...Since 1992, assisted reproductive technology (ART) has been reported as a viable means of helping HIV-1 serodiscordant couples achieve pregnancy while theoretically reducing the risk for viral transmission. While the sum of the evidence suggests that ART is effective and safe, numerous controversies still exist, The follow- ing review addresses several of the important issues involved in the use of ART for HIV-serodiscordant couples, including patient selection, semen processing techniques, post-process HIV testing, the use of lUI vs IVF-ICSI.展开更多
Assisted reproductive technology (ART) is an important treatment for infertile people of reproductive age and is also known as fertility treatment. The processes of ART involves the isolation, handling and culture o...Assisted reproductive technology (ART) is an important treatment for infertile people of reproductive age and is also known as fertility treatment. The processes of ART involves the isolation, handling and culture of early embryos, which may result in alterations in genomic methylation at specific loci and influence the proper establishment and maintenance of genomic imprints. Recent studies have identified an increased incidence of imprinting disorders via ART. In this article, we reviewed that the ART may be prone to induction of imprinting methylation errors during embryonic development. Further studies are necessary to elucidate the safety of ART in this field.展开更多
Over the course of the past 35 years,assisted reproductive technologies(ARTs)have been increasingly used worldwide,while debates on their safety have been generated.Birth defects and imprinting disorders were reported...Over the course of the past 35 years,assisted reproductive technologies(ARTs)have been increasingly used worldwide,while debates on their safety have been generated.Birth defects and imprinting disorders were reported in previous research.Thus,the psychological development of children born following ARTs has become a major concern nowadays.This review gives a systematic view of psychological well-being of children conceived by different types of ART,including in vitro fertilization,intracytoplasmic sperm injection(ICSI),preimplantation genetic diagnosis/screening,and in vitro maturation.The previous studies are analyzed in three sections:(1)cognitive,motor,and language developments,(2)behavior problems and socio-emotional development,and(3)parent-child relationship.We conclude that although the majority of the studies on cognitive,motor,and language developments reported comparable achievements in the ART group vs.the naturally conceived group,lower intelligence quotient(IQ)scores,worse visual-motor ability or locomotor development,and delayed receptive language competence were found in the ART group.The results on the socio-emotional development were reassuring.As for the behavior problems,a higher prevalence of behavior problems existed in ART children;moreover,ICSI children were found to be at a higher risk of autism than the general population.Meanwhile,ART parents tended to have positive parental attitudes and be more protective of their children.Some suggestions for further research are also given in this review.展开更多
The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity t...The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.展开更多
Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks...Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced.展开更多
Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms. Methods From Jun. 2007 to Aug. 2010,36 patients with 41 complex intracranial aneurysms were t...Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms. Methods From Jun. 2007 to Aug. 2010,36 patients with 41 complex intracranial aneurysms were treated by varient endovascular methods,including balloon, stent-assisted coiling and double microcatheter coilingtechniques. Results Among the展开更多
Objective:To detect common chromosomal aneuploidy variations in embryos from couples undergoing assisted reproductive technology and preimplantation genetic screening and their possible associations with embryo qualit...Objective:To detect common chromosomal aneuploidy variations in embryos from couples undergoing assisted reproductive technology and preimplantation genetic screening and their possible associations with embryo quality.Methods:In this study,359 embryos from 62 couples were screened for chromosomes 13,21,18,X,and Y by fluorescence insitu hybridization.For biopsy of blastomere,a laser was used to remove a significantly smaller portion of the zona pellucida.One blastomere was gently biopsied by an aspiration pipette through the hole.After biopsy,the embryo was immediately returned to the embryo scope until transfer.Embryo integrity and blastocyst formation were assessed on day 5.Results:Totally,282 embryos from 62 couples were evaluated.The chromosomes were normal in 199(70.57%)embryos and abnormal in 83(29.43%)embryos.There was no significant association between the quality of embryos and numerical chromosomal abnormality(P=0.67).Conclusions:Embryo quality is not significantly correlated with its genetic status.Hence,the quality of embryos determined by morphological parameters is not an appropriate method for choosing embryos without these abnormalities.展开更多
Anxiety is a common reaction of men undergoing assisted reproductive treatment.Our study aims to explore the risk factors of anxiety among men receiving assisted reproductive treatment.We found that the men who have p...Anxiety is a common reaction of men undergoing assisted reproductive treatment.Our study aims to explore the risk factors of anxiety among men receiving assisted reproductive treatment.We found that the men who have primary school education were more anxious than those who have higher level education including junior middle school(X^2=13.01,P<0.01),senior middle school(X^2=5.63,P=0.02),junior college(X^2=6.94,P=0.01)and higher education(X^2=13.78,P<0.01).Moreover,the men who have severe financial burden were more anxious than the men who have mild(X^2=9.54,P<0.01)or moderate(X^2=6.30,P=0.01)burden.For trait anxiety,the independent risk factor was financial burden of treatment.Therefore,we suggest that for men who prepare to receive assisted reproductive treatment,especially for men who had financial burden for treatment or only received primary education,pre-treatment counseling or psychological intervention should be provided.展开更多
Objective: To explore the potential predictors of a live birth (LB) outcome among subfertile couples of Asian ethnicity undergoing the first fertility treatment cycle;to assess the cumulative live birth rates after su...Objective: To explore the potential predictors of a live birth (LB) outcome among subfertile couples of Asian ethnicity undergoing the first fertility treatment cycle;to assess the cumulative live birth rates after successive cycles;and to determine the incidence rate of spontaneous conception (SC).Methods:Subfertile couples were grouped according to treatment modalities at the first fertility treatment cycle: intrauterine insemination (IUI),in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and no treatment, and were followed-up for duration up to seven years. Multivariable logistic regression analysis was used for statistical analyses. Results: Age of female subjects [35-38 years, odds ratio (OR): 0.39;≥39 years, OR: 0.14], uterine factor subfertility (OR: 5.24), and treatment modalities (ORs: IUI 0.25, IVF 2.33 and ICSI 1.91) significantly predicted a LB outcome (P<0.05). The cumulative live birth rates were 11.7% IUI, 41.5% IVF, 27.5% ICSI and 22.6% from frozen embryo transfer cycles. The cumulative SC rate was 24.6% in the non-treated group and 10.7% in the treated group. All LBs from IVF cycles were delivered by the second cycle and within four years, compared to SC delivery of within five years in the non-treated group and six years in the treated group. Conclusions:Age of female subject, uterine factor and modalities of treatment are significant predictors for LB outcome at the first cycle. Higher delivery rates could be achieved following fewer successive IVF cycles and within a shorter duration compared to SC.展开更多
Objective To evaluate the risk of birth defects in children born following assisted reproductive technology (ART) and spontaneous conceptions. Methods This study carried out an updated systematic review to identify ...Objective To evaluate the risk of birth defects in children born following assisted reproductive technology (ART) and spontaneous conceptions. Methods This study carried out an updated systematic review to identify papers published by August 2013 with data relating to birth defects of children conceived using ART (IVF and for ICSI) compared with those spontaneously conceived and also compared birth defects between subgroups of lVF and ICSI. Results Totally 76 studies were identified for review. The individual relative risk (RR) estimated for these studies ranged from 0.44 to 5.51, a signifieantly increased risk of birth defects was observed (RR=l.36, 95%CI=1.25-1.47) in ART compared with the spontaneously conceived group, which was also evident in the subgroup analysis. Among these studies, 16 studies simultaneously gave data of birth defects comparing IVF and ICSI children, which showed no difference in risk of combined effects (RR=0.90, 95%CI=0.80 1.02), but ICSI had a higher risk in subgroups of clinical research (RR=O. 76, 95%CI=0.65-0.89) and crude RR value (RR=O. 78, 95%CI=0.67 0.91). Conclusion Pooled results from all suitable published studies suggested that children born following ART were at increased risk of birth defects compared with spontaneous conceptions. There is no difference in birth defect risk between children conceived by IVF or 1CS1 using a summative analysis, however, 1CS1 had a significant higher risk in birth defect risk comparing with 1VF when using subgroup analyses of sample size and RR value.展开更多
基金Supported by Science and Technology Development Project of Jilin Province,No.YDZJ202201ZYTS060。
摘要BACKGROUND Heterotopic pregnancy(HP)is a rare condition in which both ectopic and intrauterine pregnancies occur.HP is uncommon after natural conception but has recently received more attention due to the widespread use of assisted reproductive techniques(ART)such as ovulation promotion therapy.CASE SUMMARY Here,we describe a case of HP that occurred after ART with concurrent tubal and intrauterine singleton pregnancies.This was treated successfully with surgery to preserve the intrauterine pregnancy,resulting in the birth of a low-weight premature infant.This case report aims to increase awareness of the possibility of HP during routine first-trimester ultrasound examinations,especially in pregnancies resulting from ART and even if multiple intrauterine pregnancies are present.CONCLUSION This case alerts us to the importance of comprehensive data collection during regular consultations.It is important for us to remind ourselves of the possibility of HP in all patients presenting after ART,especially in women with an established and stable intrauterine pregnancy that complain of constant abdominal discomfort and also in women with an unusually raised human chorionic gonadotropin level compared with simplex intrauterine pregnancy.This will allow symptomatic and timeous treatment of patients with better results.
基金supported by the Health High-Level Talent Training Project (Innovative Talents)the Health Commission of Zhejiang Province (File [2021] 40)+1 种基金the 151 Talent Project (Second Level)Zhejiang Province Human Resources and Social Security Department (File [2018] 126), China。
摘要The global outbreak of the coronavirus disease 2019(COVID-19) led to the suspension of most treatments with assisted reproductive technique(ART). However, with the recent successful control of the pandemic in China, there is an urgent public need to resume full reproductive care. To determine whether the COVID-19 pandemic had any adverse effects on female fertility and the pregnancy outcomes of women undergoing ART, a systematic review and meta-analysis was conducted using the electronic Chinese and English databases. Dichotomous outcomes were summarized as prevalence, and odds ratios(ORs)and continuous outcomes as standardized mean difference(SMD) with 95% confidence interval(CI). The risk of bias and subgroup analyses were assessed using Stata/SE 15.1 and R 4.1.2. The results showed that compared with women treated by ART in the pre-COVID-19 time frame, women undergoing ART after the COVID-19 pandemic exhibited no significant difference in the clinical pregnancy rate(OR 1.07, 95% CI 0.97 to 1.19;I2=0.0%), miscarriage rate(OR 0.95, 95% CI 0.79 to1.14;I2=38.4%), embryo cryopreservation rate(OR 2.90, 95% CI 0.17 to 48.13;I2=85.4%), and oocyte cryopreservation rate(OR 0.30, 95% CI 0.03 to 3.65;I2=81.6%). This review provided additional evidence for gynecologists to guide the management of women undergoing ART treatment during the COVID-19 pandemic timeframe.
摘要Having children in African and indeed Nigerian is very important;there are numerous reaosns why people have children,in fact,the stability or otherwise of marraige is often anchored on the presence and number of children in each home.Consequently,there are lots of attendant problems in marraiges where there are no children,such as emotional and psychological truma,disquietedness,neglect,deprivatoion,and many other challenges.Indeed there is a very high negative impact of childlessness on marriage in Africa.Modernity has however,brought some cure to childlessness through the Assisted Reproductive Techniques(ART)whose main aim is to establish pregnancy through scientific methods aside the natural means.ART in spite of its success rate has equally brought alongside some issues within the customary law regime particularly when the treatment options require donor gametes which removes consanguinity and affinity between the child and the parent.This paper using the doctrinal method,therefore examines the interference,impact and challenges of ART on marriage,succession,and some other aspects of customary law and institutions.
摘要Reproductive medicine has been transformed by assisted reproductive technologies(ART),providing multiple options for infertile couples to conceive biological offspring.The medical and legal frameworks,governing the practice of embryologists in ART,focus on the ethical and safe handling of gametes and embryos.Embryologists play a crucial role in the success of ART procedures,requiring technical expertise and a thorough understanding of legal and ethical considerations.The importance of quality control,safety protocols,and sterility in ART laboratories is essential to ensure optimal embryo development and patient well-being.The legal responsibilities of an embryologist under the Assisted Reproductive Technology(Regulation)Act,2021 in India are required.This review emphasizes the importance of record-keeping,patient confidentiality,informed consent,and adherence to legal and ethical standards to minimize the risk of malpractice claims.Overall,this narrative review provides a detailed overview of the medical,legal,and ethical frameworks governing embryologists'practice in ART,underscoring the significance of responsible and ethical conduct in this rapidly advancing field.
摘要The rapidly evolving environment of assisted reproductive technology(ART)requires consideration of how new innovations are reshaping clinical practice as much as research.In particular,there are three key areas that,while full of promise,also present significant challenges:the use of artificial intelligence(AI)in embryo selection,the impact of personalized medicine on ART success rates,and the ethical considerations of genetic screening of embryos[1].This letter is meant to provoke further discussion and highlight the need for harmonized global guidelines as these advances continue to reshape the reproductive medicine environment.
基金Supported by Funding from the Jiangsu Provincial Science and Technology Plan Special Foundation,No.BE2022712The Special Research Project on The Development Plan of Traditional Chinese Medicine Technology in Jiangsu Province,No.ZT202120.
摘要BACKGROUND Acupuncture,an ancient practice,is gaining recognition as a complementary and alternative medicine,especially in assisted reproductive technology.It plays a crucial role in enhancing embryo transfer success rates.Research indicates that acupuncture can improve blood flow,increase endometrial receptivity regulate pressure,and affect neuroendocrine activities in the ovaries and uterus during embryo implantation,therefore improving pregnancy outcomes.AIM To highlight recent developments related to acupuncture's influence on embryo transfer and elucidating the precise mechanisms by which acupuncture influences embryo transfer.METHODS We searched database including PubMed,Cochrane Library up to September 2024 for relevant studies and patents to evaluate the effects of acupuncture on women undergoing in vitro fertilization(IVF).The experimental design included an intervention group using needling,and a control group consisting of no needling or sham needling.The main outcome is clinical pregnancy rate(CPR),while secondary includes live birth rate(LBR)and biochemical pregnancy rate(BPR).We examined the influence of adjunctive needling on pregnancy outcomes by analyzing variations in the main outcomes.RESULTS A total of 145 randomized controlled trials involving 27748 participants were analyzed.Data revealed that the overall CPR was significantly elevated in all acupuncture cohorts compared to the control group[relative risk(RR):1.21,95%CI:1.07-1.38,P=0.01].In contrast,the aggregated LBR did not exhibit a corresponding increase,and notable statistical heterogeneity was observed among the studies.Acupuncture-assisted frozen-thawed embryo transfer enhanced the BPR(RR:1.51,95%CI:1.21-1.89,P=0.03)and improved endometrial morphology(RR:1.41,95%CI:1.13-1.75,P=0.01).Furthermore,IVF outcomes were significantly superior in the acupuncture group when acupuncture was administered during controlled ovarian hyperstimulation(RR:1.71,95%CI:1.08-2.13,95%CI:1.08-4.21,P=0.03).CONCLUSION We find that acupuncture positively influences pregnancy rates in women receiving IVF treatment.Nonetheless,there are no established guidelines for optimal acupuncture protocols.Considering the methodological limitations identified in current research,there is a need for larger,methodologically rigorous studies.
摘要BACKGROUND Hepatocellular carcinoma(HCC)is the most common primary liver malignancy.It typically develops in patients with advanced chronic liver disease and only rarely occurs during pregnancy.CASE SUMMARY We report the case of a 46-year-old woman with HBeAg-negative chronic hepatitis B virus(HBV)infection,persistently low HBV DNA levels,and normal aminotransferase values,who developed HCC in a non-cirrhotic liver during a pregnancy achieved through assisted reproduction techniques.Antiviral therapy with Entecavir was initiated shortly before conception because of an increase in HBV DNA levels and was subsequently switched to Tenofovir during pregnancy.Despite a spontaneous miscarriage,alpha-fetoprotein levels continued to rise,prompting magnetic resonance imaging,which revealed a solitary hepatic nodule measuring 18 mm.The patient underwent hepatic resection,and histological examination confirmed a moderately differentiated HCC.Despite complete surgical resection,two early recurrences occurred within 15 months.Tumour and non-tumour liver tissues were collected intra-operatively,snap-frozen,and processed for molecular analyses to assess total HBV DNA,covalently closed circular DNA and HBV RNA levels.CONCLUSION HBV infection and pregnancy-related immunological imbalance may contribute to HCC development,underscoring the need for careful surveillance in HBsAg-positive women.
摘要Backgrounds:Adverse childhood experiences(ACEs)can increase the likelihood of developing insecure attachment patterns,which in turn may heighten economic concerns and couple dissatisfaction—both generally and particularly in the context of assisted reproduction treatments(ART).These processes together elevate the risk of postpartum depression(PPD).Methods:This study examined psychosocial and relational predictors of PPD in a sample of 149 Spanish women up to 12 months postpartum following ART.(8.1%=artificial insemination with a sperm donor;12.1%=artificial insemination without a sperm donor;67.1%=in vitro fertilization;20.8%=intracytoplasmic sperm injection;12.8%=egg donation;22.1%=frozen-thawed embryo transfer).Predictors included subdomains of ACEs(abuse and household dysfunction),maternal self-efficacy,romantic attachment(anxiety/avoidance),couple satisfaction(ad hoc item,0–10),and financial concerns(ad hoc item,0–10).Results:Hierarchical regression analyses showed that economic worry and low maternal self-efficacy accounted for 29%of the variance in PPD in the final step.Mediation models revealed that attachment anxiety partially mediated the association between childhood abuse and PPD.(?=0.018,95%CI[0.0002,0.0396]),whereas avoidance did not emerge as a significant pathway.There was a lack of association between family dysfunction and attachment dimensions,which should be interpreted cautiously due to the subscale’s limited reliability in this sample.Furthermore,maternal self-efficacy partially mediated the link between financial concerns and PPD(?=0.096,95%CI[0.0003,0.2533]),indicating that economic strain increases depressive symptoms partly by undermining maternal confidence.Conclusion:For women conceiving through ART,the relevance of maternal self-efficacy and socioeconomic stress are highlighted as key targets for prevention and intervention.The role of attachment anxiety is,as well,underscored as a mechanism linking early adversity to PPD.
摘要Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology (ART) improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection (ICSI), and accounted for 870 cycles (438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy). There was a significant increase in the clinical pregnancy rates (OR = 1.59, 95% CI. 1.19-2.12, 12 = 25%) and live birth rates (OR = 2.17, 95% CI: 1,55-3.06, I^2 = 0%) in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes.
基金supported by the Foundation of Shanghai Municipal Health Commission(No.202140340)National Natural Science Foundation of China(No.82171603)Foundation of Science and Technology Commission of Shanghai Municipality(No.17JC1400902,No.20Z21900402).
摘要Obtaining high-quality embryos is one of the key factors to improve the clinical pregnancy rate of assisted reproductive technologies(ART).So far,the clinical evaluation of embryo quality depends on embryo morphology.However,the clinical pregnancy rate is still low.Therefore,new indicators are needed to further improve the evaluation of embryo quality.Several studies have shown that the decrease of sperm-specific protein actin-like 7A(ACTL7A)leaded to low fertilization rate,poor embryo development,and even infertility.The aim of this study was to study whether the different expression levels of ACTL7A on sperm can be used as a biomarker for predicting embryo quality.In this study,excluding the factors of severe female infertility,a total of 281 sperm samples were collected to compare the ACTL7A expression levels of sperms with high and low effective embryo rates and analyze the correlation between protein levels and in-vitro fertilization(IVF)laboratory outcomes.Our results indicated that the ACTL7A levels were significantly reduced in sperm samples presenting poor embryo quality.Furthermore,the protein levels showed a significant correlation with fertilization outcomes of ART.ACTL7A has the potential to be a biomarker for predicting success rate of fertilization and effective embryo and the possibility of embryo arrest.In conclusion,sperm-specific protein ACTL7A has a strong correlation with IVF laboratory outcomes and plays important roles in fertilization and embryo development.
摘要Since 1992, assisted reproductive technology (ART) has been reported as a viable means of helping HIV-1 serodiscordant couples achieve pregnancy while theoretically reducing the risk for viral transmission. While the sum of the evidence suggests that ART is effective and safe, numerous controversies still exist, The follow- ing review addresses several of the important issues involved in the use of ART for HIV-serodiscordant couples, including patient selection, semen processing techniques, post-process HIV testing, the use of lUI vs IVF-ICSI.
基金supported by Cultivating Youth Training Programme Fund in the First Affiliated Hospital of Anhui Medical University(2015KJ03)Reserve talented person fund in the First Affiliated Hospital of Anhui Medical University(310100J001165)
摘要Assisted reproductive technology (ART) is an important treatment for infertile people of reproductive age and is also known as fertility treatment. The processes of ART involves the isolation, handling and culture of early embryos, which may result in alterations in genomic methylation at specific loci and influence the proper establishment and maintenance of genomic imprints. Recent studies have identified an increased incidence of imprinting disorders via ART. In this article, we reviewed that the ART may be prone to induction of imprinting methylation errors during embryonic development. Further studies are necessary to elucidate the safety of ART in this field.
基金Project supported by the National Basic Research Program(973)of China(No.2012CB944901)the National Natural Science Foundation of China(Nos.81070532 and 81070541)the Zhejiang Provincial Natural Science Foundation of China(Nos.Y2100822 andLZ13H040001)
摘要Over the course of the past 35 years,assisted reproductive technologies(ARTs)have been increasingly used worldwide,while debates on their safety have been generated.Birth defects and imprinting disorders were reported in previous research.Thus,the psychological development of children born following ARTs has become a major concern nowadays.This review gives a systematic view of psychological well-being of children conceived by different types of ART,including in vitro fertilization,intracytoplasmic sperm injection(ICSI),preimplantation genetic diagnosis/screening,and in vitro maturation.The previous studies are analyzed in three sections:(1)cognitive,motor,and language developments,(2)behavior problems and socio-emotional development,and(3)parent-child relationship.We conclude that although the majority of the studies on cognitive,motor,and language developments reported comparable achievements in the ART group vs.the naturally conceived group,lower intelligence quotient(IQ)scores,worse visual-motor ability or locomotor development,and delayed receptive language competence were found in the ART group.The results on the socio-emotional development were reassuring.As for the behavior problems,a higher prevalence of behavior problems existed in ART children;moreover,ICSI children were found to be at a higher risk of autism than the general population.Meanwhile,ART parents tended to have positive parental attitudes and be more protective of their children.Some suggestions for further research are also given in this review.
摘要The advent of innovative techniques for addressing infertility has made for exciting times in the arena of andrology. The success of microTESE for retrieving sperm has enabled azoospermic men to have the opportunity to father biological children when it was previously impossible. The ability to offer a variety of assisted reproductive techniques that includes intracytoplasmic sperm injection has opened the door for couples with male factor infertility who were otherwise untreatable. With the multitude of options available to infertile couples, however, comes an unsurprising degree of controversy regarding what treatments should be offered and when. Complicating the picture is the question of if and when varicocele repair should be undertaken, and the financial implications of the treatment decisions that are made. The infertile couple with varicocele warrants careful consideration. The overall efficacy of varicocele repair as well as cost-effectiveness of repair compared to immediate microTESE in azoospermic men and assisted reproductive technology in men with suboptimal semen parameters will be reviewed.
基金Project supported by the National Basic Research Program (973) of China (No. 2012CB944901)the National Natural Science Foundation of China (Nos. 81070532 and 81200475)
摘要Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced.
摘要Objective To investigate the application of assisted coiling techniques in the treatment of complex intracranial aneurysms. Methods From Jun. 2007 to Aug. 2010,36 patients with 41 complex intracranial aneurysms were treated by varient endovascular methods,including balloon, stent-assisted coiling and double microcatheter coilingtechniques. Results Among the
摘要Objective:To detect common chromosomal aneuploidy variations in embryos from couples undergoing assisted reproductive technology and preimplantation genetic screening and their possible associations with embryo quality.Methods:In this study,359 embryos from 62 couples were screened for chromosomes 13,21,18,X,and Y by fluorescence insitu hybridization.For biopsy of blastomere,a laser was used to remove a significantly smaller portion of the zona pellucida.One blastomere was gently biopsied by an aspiration pipette through the hole.After biopsy,the embryo was immediately returned to the embryo scope until transfer.Embryo integrity and blastocyst formation were assessed on day 5.Results:Totally,282 embryos from 62 couples were evaluated.The chromosomes were normal in 199(70.57%)embryos and abnormal in 83(29.43%)embryos.There was no significant association between the quality of embryos and numerical chromosomal abnormality(P=0.67).Conclusions:Embryo quality is not significantly correlated with its genetic status.Hence,the quality of embryos determined by morphological parameters is not an appropriate method for choosing embryos without these abnormalities.
基金Hubei Provincial Health Research Fund(WJ2019Q048)Hubei Provincial Health and Family Planning Research Fund(WJ2018H0007)。
摘要Anxiety is a common reaction of men undergoing assisted reproductive treatment.Our study aims to explore the risk factors of anxiety among men receiving assisted reproductive treatment.We found that the men who have primary school education were more anxious than those who have higher level education including junior middle school(X^2=13.01,P<0.01),senior middle school(X^2=5.63,P=0.02),junior college(X^2=6.94,P=0.01)and higher education(X^2=13.78,P<0.01).Moreover,the men who have severe financial burden were more anxious than the men who have mild(X^2=9.54,P<0.01)or moderate(X^2=6.30,P=0.01)burden.For trait anxiety,the independent risk factor was financial burden of treatment.Therefore,we suggest that for men who prepare to receive assisted reproductive treatment,especially for men who had financial burden for treatment or only received primary education,pre-treatment counseling or psychological intervention should be provided.
摘要Objective: To explore the potential predictors of a live birth (LB) outcome among subfertile couples of Asian ethnicity undergoing the first fertility treatment cycle;to assess the cumulative live birth rates after successive cycles;and to determine the incidence rate of spontaneous conception (SC).Methods:Subfertile couples were grouped according to treatment modalities at the first fertility treatment cycle: intrauterine insemination (IUI),in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) and no treatment, and were followed-up for duration up to seven years. Multivariable logistic regression analysis was used for statistical analyses. Results: Age of female subjects [35-38 years, odds ratio (OR): 0.39;≥39 years, OR: 0.14], uterine factor subfertility (OR: 5.24), and treatment modalities (ORs: IUI 0.25, IVF 2.33 and ICSI 1.91) significantly predicted a LB outcome (P<0.05). The cumulative live birth rates were 11.7% IUI, 41.5% IVF, 27.5% ICSI and 22.6% from frozen embryo transfer cycles. The cumulative SC rate was 24.6% in the non-treated group and 10.7% in the treated group. All LBs from IVF cycles were delivered by the second cycle and within four years, compared to SC delivery of within five years in the non-treated group and six years in the treated group. Conclusions:Age of female subject, uterine factor and modalities of treatment are significant predictors for LB outcome at the first cycle. Higher delivery rates could be achieved following fewer successive IVF cycles and within a shorter duration compared to SC.
摘要Objective To evaluate the risk of birth defects in children born following assisted reproductive technology (ART) and spontaneous conceptions. Methods This study carried out an updated systematic review to identify papers published by August 2013 with data relating to birth defects of children conceived using ART (IVF and for ICSI) compared with those spontaneously conceived and also compared birth defects between subgroups of lVF and ICSI. Results Totally 76 studies were identified for review. The individual relative risk (RR) estimated for these studies ranged from 0.44 to 5.51, a signifieantly increased risk of birth defects was observed (RR=l.36, 95%CI=1.25-1.47) in ART compared with the spontaneously conceived group, which was also evident in the subgroup analysis. Among these studies, 16 studies simultaneously gave data of birth defects comparing IVF and ICSI children, which showed no difference in risk of combined effects (RR=0.90, 95%CI=0.80 1.02), but ICSI had a higher risk in subgroups of clinical research (RR=O. 76, 95%CI=0.65-0.89) and crude RR value (RR=O. 78, 95%CI=0.67 0.91). Conclusion Pooled results from all suitable published studies suggested that children born following ART were at increased risk of birth defects compared with spontaneous conceptions. There is no difference in birth defect risk between children conceived by IVF or 1CS1 using a summative analysis, however, 1CS1 had a significant higher risk in birth defect risk comparing with 1VF when using subgroup analyses of sample size and RR value.