Free Access Articles
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).Response: transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women's health than menopause hormone therapy?
We want to thank Von Wolff and colleagues for their correspondence (von Wolff et al., 2015) concerning our recent paper (Yding Andersen and Kristensen, 2015) in which we describe a novel way of postponing menopause by transplanting the woman's own ovarian tissue cryostored during earlier reproductive years. Freezing of ovarian tissue is now technically available and increasingly used in connection with fertility preservation for young women receiving gonadotoxic treatment. The question posed is whether it is advisable to also use this technique for postponing menopause?Transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women's health than menopause hormone therapy?
The recent article in RBM Online entitled ‘Novel use of the ovarian follicular pool to postpone menopause and delay osteoporosis’ (Yding Andersen and Kristensen, 2015) addresses a very innovative topic. However there is one essential question which also needs to be addressed: is the physiological, endogenous hormone production induced by transplanted ovarian tissue – tissue menopause hormone therapy (THT) – more advantageous for women's health than a conventional menopause hormone therapy (MHT)?HFEA response to ‘A plea for caution and more research in the “experimental” use of ionophores in ICSI’
I am writing in response to the recent article in Reproductive Biomedicine Online, by van Blerkhom et al. (2015), which helpfully highlights the work of the Human Fertilisation and Embryology Authority's (HFEA) Scientific and Clinical Advances Advisory Committee (SCAAC) in this area but appears to misunderstand the committee's role.Accidentally delayed oocyte pickup – a challenge to the current paradigm
Textbooks indicate that human ovulation occurs 38–39 hours after the administration of human chorionic gonadotrophin (HCG) in the setting of IVF. This known wisdom leads to the current practice of oocyte retrieval no later than 37 hours after HCG administration. The issue of the timing of HCG administration in relation to follicular size and hormonal response has received much attention (Chen et al., 2014), whereas only a few studies have been performed to examine the difference between the retrieval of oocytes earlier than 36 h following HCG administration, or later than 36 h but prior to 38 h (Garor et al., 2015; Raziel et al., 2006).Response: Another consideration in minilaparotomy for myomectomy
First of all we would like to thank Dr Kim and colleagues for their interest in our article (Palomba et al., 2015) and for their comments. In common with all papers submitted for publication in peer-reviewed journals, the published version of our paper incorporates suggestions and feedback received from referees. Thanks to the advice of two independent and, we assume, suitably qualified referees, we structured the data analysis and the discussion so that our article was well balanced with respect to different surgical techniques for myomectomy.Another consideration in minilaparotomy for myomectomy
When we read the recent article by Palomba and colleagues (Palomba et al., 2015), we found that their systematic review did not compare all the risks and benefits of minilaparotomy versus laparoscopic minimally invasive surgery for myomectomy. Gynecologists are interested in surgical techniques for treatment of uterine disorders (Jeong, 2014), and should consider the advantages and safety of minilaparotomy for myomectomy. When laparoscopy-assisted hysterectomy was developed, gynecologists compared laparoscopy and laparotomy for hysterectomy.To pill or not to pill in GnRH-antagonist cycles: still an open debate
We read with interest the commentary by Griesinger and colleagues (Griesinger et al., 2015) concerning our recent mini-review in RBMOnline (Garcia-Velasco and Fatemi, 2015). Although we fully agree with the authors' last sentence (‘randomized studies should be performed to prove or disprove…’), we would like to clarify that apart from the well-known methodological explanations about pooling data in a meta-analysis, and even considering that it is the most convincing tool in evidence-based medicine, unless it is a solid study we cannot take it as the ultimate truth.International harmonization and mitochondrial replacement
The UK's decision to allow mitochondrial replacement continues to stir an already active debate. Tetsuya Ishii (2014) has analysed a number of arguments for and against this technique. He emphasizes that lifting the ban on mitochondrial replacement, and thus on germline gene modification, may have a global impact. He sees two types of slippery slope: one that will lead towards eugenic/enhancement and/or non-medical applications, and one that will lead other countries to become more permissive towards germline modification.How and why mitochondrial replacement gets our vote
In a recent commentary, Tetsuya Ishii argues for a number of requirements to be met before the UK legalises the clinical use of mitochondrial replacement techniques in humans (Ishii, 2014). In our view, the requirements he sets out are, without exception, either unreasonable or already met, as detailed below.Concerning Tetsuya Ishii's article: Potential impact of human mitochondrial replacement on global policy regarding germline gene modification
Tetsuya Ishii's recent article (Ishii, 2014) raises a number of important ethical issues that were considered by the Nuffield Council on Bioethics in their review of new techniques for the prevention of mitochondrial DNA disorders (Nuffield Council on Bioethics, 2012). This review was intended to assist with wide public debate about the social and ethical aspects of this novel therapy and also to help inform a review of this area carried out by the UK's Human Fertilisation and Embryology Authority (HFEA, 2011, 2013).Hysteroscopy prior to a first IVF treatment cycle: the need for well-performed RCT
In their recent meta-analysis, Pundir et al. (2014) concluded that, in asymptomatic women, hysteroscopy prior to a first IVF cycle could improve treatment outcome. In absence of well-performed randomized controlled trials on the subject, we plead for caution.The overlooked endometrial injury underlying hysteroscopy procedures
We read with great interest the systematic review from Pundir et al. (2014), which shows a small-to-moderate benefit of hysteroscopy performed before the first IVF cycle. However, the authors did not clearly state that this procedure poses a certain degree of endometrial injury, which has been shown to have a larger beneficial effect when performed in women with previous IVF failures (Nastri et al., 2012, 2013a,b). Some authors are even considering hysteroscopy as a kind of endometrial scratching with a slightly smaller beneficial effect (Potdar et al., 2012).Response: Hysteroscopy prior to a first IVF treatment cycle: the need for well-performed RCT
We thank Smit et al. (2014) for their interest in our article and agree with their cautious approach to the data presented. Our study (Pundir et al., 2014) was a systematic attempt to summarize existing literature rather than to endorse a certain practice. In our review, we highlighted the methodological and statistical shortcomings and clinical heterogeneity of the included studies and advised cautious interpretation of the study results, despite the widespread availability and documented safety of office hysteroscopy.Response: The overlooked endometrial injury underlying hysteroscopy procedures
We thank Nastri et al. (2014) for their interest in our study. They, rightly, refer to the potential role of endometrial scratching in improving IVF outcome. In our review (Pundir et al., 2014), we have underscored clearly the possibility that the proposed benefit of hysteroscopy in improving IVF outcome could be related, among other factors, to the endometrial scratching effect associated with office hysteroscopy. We have indeed referred to the study of Doldi et al. (2005) as an example of how both techniques could be synergistic.Zooming in on the definition of ‘recurrent implantation failure’
We read with great interest the comprehensive review by Coughlan et al. (2014) on recurrent implantation failure (RIF). The authors begin their article by discussing the controversy surrounding the definition of this clinical entity.Response: The definition of ‘recurrent implantation failure’
We thank Vlachadis et al. (2014) for their thoughtful comments on the definition of recurrent implantation failure (Coughlan et al., 2014). We do appreciate that there is still a lack of consensus on the terminology used.Impact of adenomyosis on pregnancy rates in IVF treatment
We have read with interest the paper by Salim et al. (2012) in the September issue of this journal, which prospectively linked the presence of ultrasound-diagnosed adenomyosis with a decrease in pregnancy rates in patients undergoing traditional down-regulation IVF treatment. To the best of our knowledge, Maubon et al. (2010) were the first to conclusively link thickening of the uterine junctional zone on MRI, a cardinal feature of adenomyosis, with a reduction in successful implantation of embryos during IVF treatment.Response: Impact of adenomyosis on pregnancy rates in IVF treatment
We are grateful for the comments in the letter from Tremellen and Thalluri. They report the data from their retrospective analysis of women undergoing IVF in the presence of ultrasound-detectable adenomyosis. Their data support our original finding of poor reproductive performance in women with adenomyosis who undergo IVF (Salim et al., 2012). They provide additional information on embryo quality and include outcomes from women who have blastocyst transfer. While their data add to the evidence for this pathology and its impact on reproductive outcomes, we believe our study, which is a prospective screening and outcome study in women with ultrasound evidence of adenomyosis and its impact on IVF, provides the most robust data available to date on this subject.Editors’ response: The uses and abuses of bibliometrics
The suggestion that this journal should provide information to readers on the geographical distribution of its published papers is under discussion with our publisher. The distribution by continent of papers published in Reproductive Biomedicine Online in 2011 is shown in Figure 1 below.The uses and abuses of bibliometrics
The editorial management of scientific journals is not an easy task. The metrics currently used to assess their impact are mainly focused on their visibility to other researchers. In fact, the five bibliometric parameters proposed by the editorial team of Reproductive BioMedicine Online (Editorial, 2012) are designed in the same direction. However, as a researcher I am also interested in communicating my research to a wider audience. May I suggest that among the proposed parameters, the journal also includes a statistic of the countries that are using this venue to publish their work? I believe that this information will not only be of interest to the readers but it may also generate fruitful collaborations that may be published on your prestigious journal.Response: Predictors of azoospermia and sperm recovery in patients with cancer
We appreciate the comments from Bahadur et al. (2012) about the predictors of azoospermia and sperm recovery in patients with cancer. In their comments the authors recalled their previously published results about sperm recovery after cancer treatment, but sperm recovery was not the main objective of our study (Bizet et al. 2012). Indeed, the purpose of our retrospective study was to comprehensively analyse cryopreservation activity in patients referred before cancer therapy. The principal aims were to examine pre-freeze semen parameters, sperm banking feasibility and straw utilization and destruction.Intensive luteal-phase support with oestradiol and progesterone after GnRH-agonist triggering: does it help?
We read with interest the recent review by Humaidan et al. (2012) which discussed comprehensively the literature concerning the luteal phase after GnRH-agonist (GnRHa) triggering of ovulation, including suggested modification of luteal-phase support. We agree with the authors’ conclusion that the most plausible reason for the luteal-phase defect seen in cycles triggered with GnRHa seems to be a lack of endogenous LH activity during the early to mid-luteal phase, an assumption that might be seen to be supported by the beneficial effect of adding HCG (Humaidan et al., 2010) or recombinant LH (Papanikolaou et al., 2011) to the luteal-phase support.Response: Intensive luteal phase support with oestradiol and progesterone after GnRH agonist triggering: does it help?
I would like to thank Professor Orvieto for his interest in our latest review (Humaidan et al., 2012) in which we discuss the luteal phase insufficiency seen after GnRH agonist (GnRHa) trigger and the various trials that have been performed to assess the most optimal luteal support in relation to GnRHa trigger. We conclude that although more research is needed, GnRHa trigger is now an alternative to HCG trigger, combining a significant reduction in, or total elimination of, ovarian hyperstimulation syndrome (OHSS) with high ongoing pregnancy rates.
