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Current Trends and Controversies in Reproductive Medicine

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Reproductive Medicine & Andrology".

Deadline for manuscript submissions: closed (25 April 2023) | Viewed by 13147

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Special Issue Editors

Dr. Kanna Jayaprakasan

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Guest Editor

Derby Fertility Unit, Royal Derby Hospital, Derby DE22 3NE, UK
Interests: assisted reproduction; fertility treatment; reproductive surgery; gynaecology; early pregnancy; reproductive endocrinology

Dr. Lukasz Polanski

E-Mail Website
Guest Editor

North West Anglia NHS Foundation Trustdisabled, Peterborough, UK
Interests: assisted reproduction; endometrial receptivity; gynaecological and early pregnancy ultrasound; reproductive surgery; paediatric and adolescent gynaecology

Special Issue Information

Dear colleagues,

Assisted reproductive techniques (ARTs) result in a live birth in approximately one-third of the treatment cycles, with outcomes stable over the past few years. Various new modalities have been employed in the field with limited success and a moderate improvement in outcomes. With rising maternal age at first pregnancy, the development of techniques that allow maximisation of ovarian reserve potential through choice of appropriate controlled ovarian stimulation protocols, selection of a genetically normal embryo, improvement of endometrial receptivity, and provision of an optimal uterine environment for pregnancy development is essential. Fertility awareness is increasing as demonstrated by a rising uptake of fertility preservation procedures; patients that only a few years ago could not hope for biologically own children now can have that opportunity. The economic impact of infertility is significant, and in the prospect of an aging population, optimisation of ART success rates is of paramount importance.

There are multiple publications detailing the initial assessment of the infertile couple along with the routine treatments that can be instigated, with a vast majority of couples falling within routine care. The outliers, however, form the challenge of modern ART. This in particularly includes men and women with genetic conditions predisposing them to premature ovarian and testicular failure, hyper-responders, poor-ovarian-reserve patients, recurrent implantation failure patients, and women with a uterine component to their infertility. Improvement in various ‘omics’ provides an insight into previously unknown aspects of human reproduction, providing hope for an increase in ART success rates over the coming years. Utilisation of machine learning and artificial intelligence will also aid in optimisation of outcome.

This Issue will cover the topics of promising, emerging modalities within the field of ART and address some controversies regarding management and care of infertile patients through a combination of original research and review papers.

Topics theme will include:

Fertility in patients with disorders of sexual development (DSD) controversies and recent developments;
Fertility preservation for social and cancer related reasons—current state of affairs;
Protocols for ovarian stimulation and endometrial preparation for ART;
Uterine factors and ART outcomes (adenomyosis, uterine fibroids, polyps, myometrial contractions);
Role of add-ons in ART (time lapse imaging, non-invasive embryo testing, embryo glue, etc.);
Genetics of endometrial receptivity;
Natural killer cells and the endometrium;
Uterine and vaginal microbiome and ART outcomes;
Artificial intelligence in the field or ART;
Uterine transplantation for total uterine infertility;
Recent advances in managing male infertility.

Dr. Kanna Jayaprakasan
Dr. Lukasz Polanski
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

assisted reproduction treatment
in vitro fertilisation
live births
fertility preservation
endometrial receptivity
embryo
ovarian stimulation

Published Papers (6 papers)

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Research

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11 pages, 699 KiB

Open AccessArticle

Outcomes of Social Egg Freezing: A Cohort Study and a Comprehensive Literature Review

by Pragati Kakkar, Joanna Geary, Tania Stockburger, Aida Kaffel, Julia Kopeika and Tarek El-Toukhy

J. Clin. Med. 2023, 12(13), 4182; https://doi.org/10.3390/jcm12134182 - 21 Jun 2023

Cited by 1 | Viewed by 2439

Abstract

The purpose of this study is to evaluate the live birth outcome following oocyte thaw in women who underwent social egg freezing at Guy’s Hospital, alongside a detailed published literature review to compare published results with the current study. A retrospective cohort study was conducted between January 2016 and March 2022 for all women who underwent egg freezing during this period. Overall, 167 women had 184 social egg freezing cycles. The mean age at freeze was 37.1 years and an average of 9.5 eggs were frozen per retrieval. In total, 16% of the women returned to use their frozen eggs. The mean egg thaw survival rate post egg thaw was 74%. The mean egg fertilisation rate was 67%. The pregnancy rate achieved per embryo transfer was 48% and the live birth rate per embryo transfer was 35%. We also noted that irrespective of age at freezing, a significantly high live birth rate was achieved when the number of eggs frozen per patient was 15 or more. Despite the rapid increase in social egg freezing cycles, the utilisation rate remains low. Pregnancy and live birth rate post thaw are encouraging if eggs are frozen at a younger age and if 15 eggs or more were frozen per patient. Full article

(This article belongs to the Special Issue Current Trends and Controversies in Reproductive Medicine)

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10 pages, 813 KiB

Open AccessArticle

The Relationship between Number of Supernumerary Blastocysts Cryopreserved and Probability of a Live Birth Outcome after Single Fresh Blastocyst Transfer: Analysis of over 10 Thousand Cycles

by Yusuf Beebeejaun, Timothy Copeland, Lukasz Polanski and Tarek El Toukhy

J. Clin. Med. 2023, 12(13), 4172; https://doi.org/10.3390/jcm12134172 - 21 Jun 2023

Viewed by 830

Abstract

The ability to predict the likelihood of a live birth after single fresh embryo transfer is an important part of fertility treatment. While past studies have examined the likelihood of live birth based on the number of oocytes retrieved and cleavage-stage embryos available, the odds of a live birth based on the number of supernumerary blastocysts cryopreserved following a fresh embryo transfer has not been rigorously studied. We performed a retrospective analysis, stratified by age, on patients undergoing their first fresh autologous single day 5 blastocyst transfer to assess relationship between the likelihood of a live birth and number of supernumerary blastocysts cryopreserved. In patients aged <35 years and 35–39 years old, the likelihood of a live birth increased linearly between 1 and 6 supplementary blastocysts and non-linearly if 10 or more blastocysts were cryopreserved. When aged 40 years and above, the likelihood of a live birth increased linearly up to 4 cryopreserved blastocysts and then non-linearly if 10 or more blastocysts were cryopreserved. The present study demonstrated a non-linear relationship between the number of supernumerary blastocysts cryopreserved and the likelihood of a live birth after single blastocyst transfer in the first autologous fresh IVF/ICSI cycle across different age groups. Full article

(This article belongs to the Special Issue Current Trends and Controversies in Reproductive Medicine)

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8 pages, 586 KiB

Open AccessArticle

Female BMI and Body Weight Is Not Associated with Oocyte Yield and Maturation in hCG, Agonist or Dual Trigger Cycles: A Large Observational Study including 5000 Cycles

by Valeria Donno, Sandra García-Martínez and Nikolaos P. Polyzos

J. Clin. Med. 2023, 12(9), 3249; https://doi.org/10.3390/jcm12093249 - 01 May 2023

Cited by 1 | Viewed by 1271

Abstract

Background. Triggering final oocyte maturation is a key step of ovarian stimulation. Although previous studies demonstrated a negative association between female BMI and serum hCG levels, little evidence is available regarding the association between oocyte yield and patients’ BMI. The scope of the current study was to examine whether the efficiency of the r-hCG and triptorelin to trigger final oocyte maturation may be associated with patients’ BMI or weight. Methods. This is a retrospective observational study including 5190 ovarian stimulation cycles performed between January 2019 and September 2022 in the Reproductive Medicine Department of Dexeus University Hospital. Cycles were analyzed according to the type of trigger (triptorelin vs. r-hCG vs. dual). The primary outcome measures were oocyte maturation rate (MII/oocytes) and FOI (oocytes/AFC); secondary outcomes were oocyte and MII yield. Results. Multivariable regression analysis, adjusting for confounding factors, demonstrated that BMI was not associated with oocyte maturation rate (OR: 1.00 [95%CI: 0.99; 1.01]), FOI (Beta 0.52 [95%CI: −0.49; 1.54]), number of oocytes (Beta 0.02 [95%CI: −0.08; 0.13]) or MIIs (Beta 0.01 [95%CI: −0.08; 0.10]) retrieved. Similarly, all analyses conducted considering patients’ weight failed to reveal any association. Conclusion. Our study demonstrates that, independent of the type of trigger, patients’ BMI and weight are not associated with oocyte yield, maturation, or FOI. Full article

(This article belongs to the Special Issue Current Trends and Controversies in Reproductive Medicine)

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10 pages, 2315 KiB

Open AccessArticle

Safe Service Delivery of a Complex Early Pregnancy Problem: Caesarean Scar Pregnancy

by Hanine Fourie, Ahmad El-Zibdeh, Victoria Heppell, Ingrid Granne, Lee Nai Lim and Prasanna Raj Supramaniam

J. Clin. Med. 2022, 11(23), 7063; https://doi.org/10.3390/jcm11237063 - 29 Nov 2022

Viewed by 1293

Abstract

Caesarean Scar Pregnancy (CSP) is an ectopic pregnancy with implantation into the niche of the uterine scar. We aimed to describe the local management of consecutive cases of CSP to develop a standard operating procedure (SOP). Between December 2019 and June 2022, there were 19,100 maternities. Of these, 23 were CSPs in 19 patients. Median BMI was 29 (range 20.5–52), median number of Caesarean deliveries (CS) was 2 (range 1–4) and 7/23 (30%) were cigarette smokers. At diagnosis, 9/23 were live pregnancies, 3/23 were retained products of conception (RPOC), 9/23 were pregnancies of uncertain viability (PUV), and 2/23 were non-viable. In six, the initial management was expectant, surgical suction evacuation with transrectal ultrasound guidance in 16, and one had a hysterectomy. The median blood loss was 100 mL (range 50–2000 mL). Two patients (9%) required a blood transfusion. Median hospital stay was 1 day (range 0–4). At follow-up after 10 weeks, no patients had an ongoing haematoma, and one had significant RPOC electing hysterectomy. Eight women were known to have 9 subsequent pregnancies (recurrent CSP n = 4, livebirth n = 2, miscarriage n = 2, tubal ectopic n = 1). Outcomes as rated by low blood loss, short hospital stay, and rare need for further intervention were favorable. Factors associated included prompt ultrasonographic diagnosis, availability of transrectal ultrasound guided surgery, and specialist follow-up, which form the basis of the SOP. Full article

(This article belongs to the Special Issue Current Trends and Controversies in Reproductive Medicine)

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10 pages, 494 KiB

Open AccessArticle

Frozen Blastocyst Embryo Transfer: Comparison of Protocols and Factors Influencing Outcome

by Aikaterini Eleftheriadou, Abraham Francis, Mark Wilcox and Kanna Jayaprakasan

J. Clin. Med. 2022, 11(3), 737; https://doi.org/10.3390/jcm11030737 - 29 Jan 2022

Cited by 9 | Viewed by 4050

Abstract

Background: Various factors, including treatment protocols, can influence the outcomes of frozen embryo transfers (FETs). The study objectives were to compare different endometrial preparation protocols of FET cycles and to evaluate the factors, including the endometrial thickness (ET), that affect outcomes. Methods: This observational cohort study involved 5037 women undergoing FETs at eight tertiary clinics in the UK between January 2016 and March 2019. The endometrial preparation protocols used were natural cycle (NC-FETs), artificial hormone support cycle with oestradiol valerate but without pituitary downregulation (AC-FETs) and artificial hormone support cycle with agonist downregulation (ACDR-FETs). Results: The mean (±SD) ages across NC-FET, AC-FET and ACDR-FET groups were 36.5 (±4.2), 35.9 (±5.0) and 36.4(±4.9) years, respectively. LBRs were comparable (40.7%, 175/430; 36.8%, 986/2658; and 36.7%, 716/1949, respectively) across the three groups. Clinical pregnancy, implantation, multiple pregnancies, miscarriage and ectopic pregnancy rates were also similar. In the regression analysis of variables including age, duration of infertility, number of embryos transferred, protocol type and endometrial thickness, age was the only significant predictor of LBRs, although its predictive ability was poor (AUC: 0.55). With the overall LBR of the study population being 37.1%, the post-test probability of a live birth at an ET of <5 mm was 0%, and at 5–5.9, 6–6.9, 7–7.9 and 8–8.9 mm, the probabilities were 16.7%, 33.8%, 36.7% and 37.7%, respectively. The LBR remained above 35% up to the 14–14.9 mm range and then declined gradually to 23% for the 17–25 mm range. Conclusions: The FET outcomes were similar for the three protocols used for endometrial preparation. The protocol type and endometrial thickness were not predictive of FET outcomes; age was the only predictive variable, despite its low predictive ability. Full article

(This article belongs to the Special Issue Current Trends and Controversies in Reproductive Medicine)

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11 pages, 2341 KiB

Open AccessCase Report

HRT in Women Undergoing Pelvic Clearance for Endometriosis—A Case Report and a National Survey

by Saad Amer and Subul Bazmi

J. Clin. Med. 2023, 12(1), 336; https://doi.org/10.3390/jcm12010336 - 01 Jan 2023

Cited by 1 | Viewed by 2112

Abstract

The optimal hormone replacement therapy (HRT) in women who have undergone pelvic clearance for endometriosis remains uncertain with insufficient evidence. The purpose of this case report and the national survey was to highlight the potential HRT-related risks and to establish current HRT practice in this group of women. The case was a 45-year-old woman presenting with recurrence of severe chronic pelvic pain while on oestrogen-only HRT (EO-HRT) for five years after subtotal hysterectomy and bilateral oophorectomy for severe endometriosis. MRI revealed multiple peri-cervical endometriomas and severe right hydroureter/hydronephrosis with complete right renal parenchymal loss. The survey was a 21-item questionnaire administered electronically using SurveyMonkey. It was reviewed and approved by British Menopause Society and British Society of Gynaecological endoscopy and was sent to their members as well as NHS Gynaecologists. A total of 216 physicians responded including 120 (55.6%) Gynaecology Consultants and 96 (44.4%) GPs/Nurses in Menopause clinics. Overall, 68.6% of responders prescribe combined HRT (C-HRT), 11.1% tibolone, 13.0% EO-HRT and 7.8% varied HRT. Fifty-one percent prescribe the progestogen component of C-HRT indefinitely, 22% for 3–6 months and 27% for varied durations. In conclusion, this study highlights the real risk of endometriosis recurrence in EO-HRT users after pelvic clearance for endometriosis. The survey revealed that only two thirds of Gynecologists/Menopause practitioners prescribe combined HRT in this group of women. Full article

(This article belongs to the Special Issue Current Trends and Controversies in Reproductive Medicine)

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