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Reproductive technology and social justice: a view from Brazil
Debates on the practical and ethical dilemmas produced by the rapid changes in assisted reproductive technology (ART) are frequently focused on the consequences of new developments in Western Europe and North America. Discussions about ART in developing and middle-income countries tend to be centred on the use – and for some, the possible exploitation – of women's bodies as sources of biological materials and providers of services. They more rarely examine patterns of implementation of ART in these countries.Home monitoring of ovarian stimulation: an important step towards more patient-centred IVF
Since the early 1980s there has been constant evolution in the clinical management of IVF treatments. From the patient's perspective, significant innovations have included: (i) the replacement of oocyte retrieval through laparoscopy under general anaesthesia by ultrasound-guided out-patient transvaginal puncture; (ii) the introduction of GnRH analogues to suppress a premature rise in LH (avoiding the need for frequent LH peak monitoring); (iii) calibrated pens allowing patients to inject gonadotrophins themselves and avoiding dependency on nurses or hospital facilities; (iv) the introduction of milder and less complex stimulation protocols (significantly reducing side effects and the need for intense ovarian response monitoring and frequent hospital visits) (Nargund and Fauser, 2020); and (v) the recognition of the distinct burden of treatment and psychological stress associated with IVF (resulting in significant treatment drop out and reduced cumulative pregnancy chances per started IVF treatment).Fertility preservation during the COVID-19 pandemic: mitigating the viral contamination risk to reproductive cells in cryostorage
Reopening fertility care services across the world in the midst of a pandemic brings with it numerous concerns that need immediate addressing, such as the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the male and female reproductive cells and the plausible risk of cross-contamination and transmission. Due to the novelty of the disease the literature contains few reports confirming an association of SARS-CoV-2 with reproductive tissues, gametes and embryos. Cryobanking, an essential service in fertility preservation, carries the risk of cross-contamination through cryogenic medium and thus calls for risk-mitigation strategies.Reproduction, Technology and Society - a new section in RBMO
This issue sees the launch of Reproduction, Technology and Society (RTS), a new section of RBMO fully dedicated, as the name conveys, to issues at the interfaces between reproduction, technology, and society.A revolutionary joins the establishment: Reproductive Biomedicine Online turns 20
This commentary highlights the publishing revolution achieved by Robert Edwards in founding Reproductive Biomedicine Online. It corrects some inaccuracies in the account given by Roger Gosden in his recently published book Let There Be Life: An Intimate Portrait of Robert Edwards and His IVF Revolution.Preimplantation genetic testing as a component of root cause analysis of errors and reassignment of embryos in IVF
The risks of embryo/gamete mix-up are a threat to the integrity of the IVF process, with significant implications for affected families. The use of preimplantation genetic testing through single-nucleotide polymorphism array or next-generation sequencing technology can help to identify, characterize and ultimately help, in some cases, to find the root cause, and to mitigate the extent of these errors for a given patient or laboratory.Strong variation in progesterone production of the placenta in early pregnancy – what are the clinical implications?
We thank Dr Tesarik (Tesarik, 2020) for his interest in our study on the onset of placental progesterone production in patients receiving dydrogesterone for scheduling endometrial receptivity and for supporting early pregnancy in anovulatory (‘artificial’) frozen-thawed embryo transfer cycles (FET) (Neumann et al., 2020). In his letter, Dr Tesarik suggests that the luteo-placental shift can be delayed and that this delay could be a cause for miscarriage. Indeed, in our study a strong variation in placental progesterone production between individual singleton pregnancies can be observed (Figure 4A, Neumann et al., 2020).Can miscarriage caused by delayed luteoplacental shift be avoided?
I read with interest the article by Neumann et al. (2020) which showed that in anovulatory frozen embryo transfer (FET) using dydrogesterone instead of progesterone for luteal phase support, a significant increase in trophoblastic progesterone production occurs 23–29 days after embryo transfer in pituitary-suppressed women. When ovarian activity is not suppressed, the onset of placental progesterone production is accompanied by luteolysis, a phenomenon known as luteoplacental shift (LPS).Empathetic application of machine learning may address appropriate utilization of ART
The value of artificial intelligence to benefit infertile patients is a subject of debate. This paper presents the experience of one aspect of artificial intelligence, machine learning, coupled with patient empathy to improve utilization of assisted reproductive technology (ART), which is an important aspect of care that is under-recognized. Although ART provides very effective options for infertile patients to build families, patients often discontinue ART when further treatment is likely to be beneficial and most of these patients do not achieve pregnancy without medical aid.Meet our new editor: Professor Laura Rienzi
Laura Rienzi is a Senior Clinical Embryologist and Laboratory Director at the GENERA Centres for Reproductive Medicine in Rome, Marostica, Umbertide and Naples in Italy. Laura has academic degrees in biology from the University of Rome 'La Sapienza' and in reproductive medicine from the University of Padua. Since 2016, she has been adjunct Professor of Biotechnology at the University of Urbino, Italy.Reproductive healthcare during a pandemic: a New York state of mind
The purpose of this Commentary is to assess whether the designation by New York State Department of Health of ‘sexual and reproductive health services as essential’ is consonant with the seemingly divergent objectives of providing patient-centred care and advancing national public health objectives in the resource-constrained setting of a global pandemic.Trends in ovarian hyperstimulation syndrome hospitalization rates in the USA: an ongoing concern
Ovarian hyperstimulation syndrome (OHSS) is a serious, almost exclusively, iatrogenic complication of ovarian stimulation. Many techniques have been developed over the past 25 years to decrease OHSS risks, and most have been in common use for 15–20 years. In view of these techniques, it could be hypothesized that severe OHSS rates would decrease or almost disappear. According to the US National ART Surveillance System, rates did not change significantly between 2000 and 2009, at 106 OHSS cases per 10,000 IVF cycles annually.SARS-CoV-2: diagnostic and design conundrums in the context of male factor infertility
The question of whether SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus-2 [SARS-CoV-2], leading to the COVID-19 infection) can be harboured in the testes and/or semen is currently unanswered. It is essential to understand the limitations of both antibody and real-time PCR tests in interpreting SARS-CoV-2 data in relation to analyses of semen and testicular tissue without appropriate controls. This article critically analyses the evidence so far on this, and the possible implications.Mild ovarian stimulation for IVF is the smartest way forward
The aim of IVF treatment is to achieve a healthy full-term baby, with minimal health risks to the woman and her child, and at reasonable cost to allow this treatment option to be within financial reach for many women around the world. Ovarian stimulation – which contributes a considerable proportion of the overall cost of IVF – aims to generate multiple follicle development, allowing for the retrieval of multiple oocytes to improve success rates. Complex ovarian stimulation regimens have become an integral part of most IVF programmes.Generating translatable evidence to improve patient care: the contribution of human factors
Generating translatable evidence to improve patient care has proved challenging in reproductive medicine, with many ‘add-on’ treatments in routine assisted conception clinical practice that have not been reliably tested. This has consequences for patient care; specifically, IVF pregnancy rates have not improved. A change of culture is required in our profession, from indiscriminately applying the latest ‘add-on’ to large-scale participation in generating reliable translatable evidence.Male fertility: a window on the health of this generation and the next
In this issue of RBMO Martín-Calvo and colleagues (Martín-Calvo et al., 2019) provide clinical data showing that higher paternal pre conception folate intake was significantly associated with a longer gestation time. Previous studies in mice have shown that manipulation of paternal dietary folate was associated with increased birth defects and identified marked changes in the sperm epigenome associated with health of the offspring (Lambrot et al., 2013). Whilst the potential epigenetic mechanisms remain to be elucidated fully in animals and are, at best, unclear in humans, this study puts the focus of examination on the contribution of the male to overall health of future generations.May the colleague who truly has no conflict of interest now please stand up!
A vividly remembered conversation from quite a few years ago with someone influential in Dutch society began ‘I am sure you academics do very important scientific work, but the problem is that we as society notice so little health benefits resulting from these discoveries. Since universities are primarily paid by tax payers' money, what's our return on this investment?’ It took quite some time to get to grips with this message, but it did lead to the profound realization of how far away from mainstream society we often operate.Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis
The aim of assisted reproduction technology (ART) is to help an infertile couple have a healthy baby born at term. Multifollicular growth induced by ovarian stimulation can lead to the collection of multiple oocytes, which, in turn, seems to increase pregnancy chances after ART. Hence, clinicians have for years been trying to obtain an adequate number of oocytes while minimizing the risk of ovarian hyperstimulation syndrome. Some have advocated that a higher number of collected oocytes is associated with improved outcomes (Baker et al., 2015; Macklon et al., 2006; van der Gaast et al., 2006).The female post-cancer fertility-counselling clinic: looking beyond the freezer. A much needed addition to oncofertility care
The number of girls and young women surviving cancer is increasing. It has been estimated that each year 43 new cancer cases are diagnosed per 100,000 people of both sexes between the ages of 20 and 39 years. Cancer is more common in women than men (Fidler et al, 2017). The consequences of being diagnosed with a malignant disease are serious, not just for the individual but also at a societal and economic level. While treatment is often successful, the impact of the disease on the life course is significant, as multiple long-term side effects of cancer treatment, and the psychological fallout of facing such a diagnosis at a young age, continue to resonate in later life.Advanced fibroid study: paying homage to John Sampson
A recent article supports our longstanding view that all intramural fibroids can cause disturbance of uterine function. This may be reflected in the symptom of menorrhagia or fertility-related issues, as well as pregnancy losses at all gestational stages. However, it was disappointing that there was no reference to either the mechanism by which fibroids disturb uterine function nor to the gynaecologist who described this more than 100 years ago, namely John Sampson. In fact, Sampson's findings about the unique venous drainage mechanism from the endometrium explains how menstrual loss is contained in normal physiology, but which can be excessive when the protective ‘anaemic’ zone is disturbed.GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis
This meta-analysis aimed to evaluate the efficacy and safety of glucagon-like peptide 1 (GLP-1) receptor agonists for women with polycystic ovary syndrome (PCOS) by comparing their effect with that of metformin. Electronic databases (PubMed, EMBASE, Cochrane Library, WanFang Database, CNKI) dating from their establishment to June 2018 were searched to find all randomized controlled trials (RCTs) reporting the efficacy of GLP-1 receptor agonists versus metformin for patients with PCOS. Therapeutic variables included menstrual cycle, sex hormone and clinical manifestations, glucose metabolism and other metabolic indexes.Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era?
Advances in oocyte and embryo cryopreservation for assisted reproduction prompted new approaches to ovarian stimulation. Attention has been paid to progesterone and its derivatives to block the LH surge, as oocyte vitrification removes possible harmful effects of progestins on endometrial receptivity. This review summarizes the current status of progestin use to inhibit ovulation during ovarian stimulation compared with conventional ovarian stimulation. Progestin-primed ovarian stimulation is shown to effectively inhibit spontaneous ovulation, without affecting the number of retrieved oocytes and embryo quality.A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF
Polycystic ovary syndrome (PCOS) is one of the most common and complex hormonal disorders seen in women and is considered to be a significant public health issue (Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group, 2004). PCOS has a negative effect on women's health across the lifespan, leading to, for example, anxiety, depression, insulin resistance, abdominal obesity, hypertension and dyslipidaemia (Teede et al., 2010); it is also an important cause of infertility in women of reproductive age because of the associated anovulation (Homburg and Crawford, 2014).Chief editor’s 2018 annual report
We have completed yet another exciting year at RBMO. Most importantly the broad scope of the journal's content and the close interaction between the editorial office staff and the editors and the authors remains a constant strength. In addition, we completely updated the layout of the journal: both the artwork and logo on the cover and also the layout of the papers themselves. We are very proud of the new look and feel of RBMO, which is now completely in line with the identity of the journal, the growth of the field and our level of ambition! During summer, the editorial office moved to Bourn Hall, Cambridge, UK, a most fitting location.Influence of oral vitamin and mineral supplementation on male infertility: a meta-analysis and systematic review
This meta-analysis and systematic review investigated evidence of the effect of oral micronutrient supplementation on male fertility. Following searches of PubMed, Ovid/Ovid Medline(r) and Embase, 18 randomized, double-blind, placebo-controlled trials were included in the meta-analysis (seven studies) and/or the systematic review (12 studies). The meta-analysis showed significant improvement in semen parameters for selenium (200µg/day and 100µg/day) (standard mean difference [SMD] 0.64 for oligozoospermia, 1.39 for asthenozoospermia), L-carnitine (2 g/day) and acetyl-L-carnitine (LAC; 1 g/day) combined (SMD 0.57 for asthenozoospermia), and co-enzyme Q10 (200 and 300 mg/day) (SMD 0.95 for oligozoospermia, 1.48 for asthenozoospermia, 0.63 for teratozoospermia).
