Reproductive biomedicine online
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Reprod. Biomed. Online · Feb 2013
ReviewDo assisted-reproduction twin pregnancies require additional antenatal care?
Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. ⋯ Overall, our review indicates that some antenatal complications are more frequent in assisted-conception twin pregnancies than in spontaneous twin pregnancies but their prevalence is low and thus their impact on the morbidity and mortality of an individual assisted-conception twin pregnancy is limited. Assisted reproduction treatment has become available to older women with pre-existing maternal medical conditions such as chronic hypertension and diabetes. The increased obstetrical risks in this population must be considered prior to attempts at assisted conception, and the transfer of more than one embryo should be avoided in women with a pre-existing maternal medical condition.
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Reprod. Biomed. Online · Dec 2012
Review Meta AnalysisEndometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis.
Mechanical endometrial injury (biopsy/scratch or hysteroscopy) in the cycle preceding ovarian stimulation for IVF has been proposed to improve implantation in women with unexplained recurrent implantation failure (RIF). This is a systematic review and meta-analysis of studies comparing the efficacy of endometrial injury versus no intervention in women with RIF undergoing IVF. All controlled studies of endometrial biopsy/scratch or hysteroscopy performed in the cycle preceding ovarian stimulation were included and the primary outcome measure was clinical pregnancy rate. ⋯ Furthermore, scratching of the lining was 2-times more likely to result in a clinical pregnancy compared with telescopic evaluation of the lining of the womb. This study suggests that in women with RIF, inducing local injury to the womb lining in the cycle prior to starting ovarian stimulation for IVF can improve pregnancy outcomes. However, large studies are required before this can be warranted in routine clinical practice.
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Reprod. Biomed. Online · Dec 2012
Review Meta AnalysisEndometrial injury to overcome recurrent embryo implantation failure: a systematic review and meta-analysis.
Mechanical endometrial injury (biopsy/scratch or hysteroscopy) in the cycle preceding ovarian stimulation for IVF has been proposed to improve implantation in women with unexplained recurrent implantation failure (RIF). This is a systematic review and meta-analysis of studies comparing the efficacy of endometrial injury versus no intervention in women with RIF undergoing IVF. All controlled studies of endometrial biopsy/scratch or hysteroscopy performed in the cycle preceding ovarian stimulation were included and the primary outcome measure was clinical pregnancy rate. ⋯ Furthermore, scratching of the lining was 2-times more likely to result in a clinical pregnancy compared with telescopic evaluation of the lining of the womb. This study suggests that in women with RIF, inducing local injury to the womb lining in the cycle prior to starting ovarian stimulation for IVF can improve pregnancy outcomes. However, large studies are required before this can be warranted in routine clinical practice.
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Reprod. Biomed. Online · Sep 2011
ReviewSocial egg freezing: the prospect of reproductive 'immortality' or a dangerous delusion?
Until recently there was little to offer young women with cancer facing chemotherapy, radiotherapy or surgery and the probability of premature menopause and sterility. The first 'frozen egg' baby was born in 1986, but success rates were so low that egg freezing was neglected. Three technological developments in assisted reproduction treatment (intracytoplasmic sperm injection, dehydro-cryoprotectants and vitrification) have transformed this picture and now young women with frozen eggs have the same probability of a live birth per embryo transfer as women undergoing conventional IVF. ⋯ Donor eggs are not an option for many because of supply constraints and ethical and cultural concerns. Freezing a woman's eggs at age 30 literally 'freezes in time' her fertility potential and gives her the chance of a healthy pregnancy at a time of her choosing. This paper discusses the role of oocyte cryopreservation in the context of social egg freezing.
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Reprod. Biomed. Online · Jul 2011
Review Meta AnalysisMeta-analysis of letrozole versus clomiphene citrate in polycystic ovary syndrome.
The aim of this study was to systematically compare the clinical efficacy and safety of letrozole with clomiphene citrate for ovulation induction in women with polycystic ovary syndrome (PCOS). The Cochrane Central Register of Controlled Trials, PubMed, EMbase, CBMdisc and CNKI were searched for eligible randomized controlled trials (RCT) comparing letrozole with clomiphene citrate in PCOS patients. Two reviewers independently extracted information and evaluated methodological quality according to the Cochrane Handbook 5.0. ⋯ There were no significant differences in pregnancy rate (relative risk (RR) 0.97; 95% CI 0.79 to 1.18), abortion rate (RR 1.38; 95% CI 0.48 to -3.96) and multiple pregnancy rate (RR 0.34; 95% CI 0.07 to -1.72) between the two groups. The evidence from ovulation rates was not enough to support either letrozole or clomiphene citrate. In conclusion, letrozole is as effective as clomiphene citrate for ovulation induction in patients with PCOS.