Fertility and sterility
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Fertility and sterility · Apr 2021
ReviewInfection precautions for severe acute respiratory syndrome coronavirus 2 in assisted reproduction centers: dodging an invisible bullet.
The coronavirus disease 2019 pandemic has resulted in many changes in how we interact in society, requiring that we protect ourselves and others from an invisible, airborne enemy called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Until a vaccine is developed, and it reaches high levels of distribution, everyone must continue to be diligent to limit the viral spread. The practice of assisted reproduction during this pandemic presents unique challenges in addition to the risks identified in general clinical care. ⋯ Several professional fertility societies have created guidelines for the best practices in patient care during the coronavirus disease 2019 pandemic. As we learn more about SARS-CoV-2, updates have been issued to help adapt infection-control and -prevention protocols. This review discusses what is currently known about SARS-CoV-2 infection risks in assisted reproductive centers and recommends the implementation of specific mitigation strategies.
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Fertility and sterility · Jun 2020
ReviewIntegrity of randomized controlled trials: challenges and solutions.
There has been increasing concern about compromised integrity in randomized controlled trials (RCTs) because it undermines the authority of this top-level evidence-generating method and puts patients at risk. Compromised RCTs also jeopardize the validity of systematic reviews and meta-analyses when they are included. The publication-driven research environment is responsible for the emergence of integrity issues in RCTs, which has been facilitated by insufficient efforts to prevent, identify, and disclose research misconduct. ⋯ It is important to strictly implement the prospective registration policy and the Consolidated Standards of Reporting Trials (CONSORT) statement for RCT publication, but more effort needs to be devoted to developing and validating statistical methods that identify different patterns of data manipulation. Ideally the system of submission, review, and publication would be reformed in a way that allows the timely investigation and retraction of compromised RCTs. Authors of systematic reviews should be aware of the uncertainty posed by compromised RCTs to the quality of synthesized evidence, and they should participate in the campaign to fight compromised integrity.
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Fertility and sterility · Jun 2020
Prior and novel coronaviruses, Coronavirus Disease 2019 (COVID-19), and human reproduction: what is known?
To summarize current understanding of the effects of novel and prior coronaviruses on human reproduction, specifically male and female gametes, and in pregnancy. ⋯ Coronavirus Disease 2019 infection may affect adversely some pregnant women and their offspring. Additional studies are needed to assess effects of SARS-CoV-2 infection on male and female fertility.
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Fertility and sterility · Apr 2020
Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review.
This review sought to evaluate the current literature on reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer (stage IA1-IB1) including cold-knife conization/simple trachelectomy, vaginal radical trachelectomy, abdominal radical trachelectomy, and laparoscopic radical trachelectomy with or without robotic assistance. A systematic review using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist to evaluate the current literature on fertility-sparing surgery for early stage cervical cancer and its subsequent clinical pregnancy rate, reproductive outcomes, and cancer recurrence was performed. Sixty-five studies were included encompassing 3,044 patients who underwent fertility-sparing surgery, including 1,047 pregnancies with reported reproductive outcomes. ⋯ Fertility-sparing surgery is a reasonable alternative to traditional radical hysterectomy for early-stage cervical cancer in women desiring fertility preservation. Vaginal radical trachelectomy had the highest clinical pregnancy rate, and minimally invasive approaches to fertility-sparing surgery had equivalent oncologic outcomes compared with an abdominal approach. The results of our study allow for appropriate patient counseling preoperatively and highlight the importance of a multidisciplinary approach to achieve the best outcomes for each patient.
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Fertility and sterility · Jul 2019
Review Comparative StudyLive versus deceased donor in uterus transplantation.
Uterus transplantation to treat absolute uterine factor infertility is a rapidly evolving field still at its early clinical experimental stage. Most human uterus transplantation attempts and live births have been after transplantation with uteri from live donors, who, in most cases, are closely related to the recipient. However, successful transplant with live births after uterus transplantation from deceased donors has also been reported. This article discusses the pros and cons in relation to live and deceased donors for uterus transplantation.