On March 17, 2020 an expert ASRM task force recommended the temporary suspension of new, non-urgent fertility treatments during an ongoing world-wide pandemic of Covid-19. We surveyed at the time of ...resumption of fertility care the psychological experience and coping strategies of patients pausing their care due to Covid-19 and examined which factors were associated and predictive of resilience, anxiety, stress and hopefulness.
Cross sectional cohort patient survey using an anonymous, self-reported, single time, web-based, HIPPA compliant platform (REDCap). Survey sampled two Northeast academic fertility practices (Yale Medicine Fertility Center in CT and Montefiore's Institute for Reproductive Medicine and Health in NY). Data from multiple choice and open response questions collected demographic, reproductive history, experience and attitudes about Covid-19, prior infertility treatment, sense of hopefulness and stress, coping strategies for mitigating stress and two validated psychological surveys to assess anxiety (six-item short-form State Trait Anxiety Inventory (STAl-6)) and resilience (10-item Connor-Davidson Resilience Scale, (CD-RISC-10).
Seven hundred thirty-four patients were sent invitations to participate. Two hundred fourteen of 734 (29.2%) completed the survey. Patients reported their fertility journey had been delayed a mean of 10 weeks while 60% had been actively trying to conceive > 1.5 years. The top 5 ranked coping skills from a choice of 19 were establishing a daily routine, going outside regularly, exercising, maintaining social connection via phone, social media or Zoom and continuing to work. Having a history of anxiety (p < 0.0001) and having received oral medication as prior infertility treatment (p < 0.0001) were associated with lower resilience. Increased hopefulness about having a child at the time of completing the survey (p < 0.0001) and higher resilience scores (p < 0.0001) were associated with decreased anxiety. Higher reported stress scores (p < 0.0001) were associated with increased anxiety. Multiple multivariate regression showed being non-Hispanic black (p = 0.035) to be predictive of more resilience while variables predictive of less resilience were being a full-time homemaker (p = 0.03), having received oral medication as prior infertility treatment (p = 0.003) and having higher scores on the STAI-6 (< 0.0001).
Prior to and in anticipation of further pauses in treatment the clinical staff should consider pretreatment screening for psychological distress and provide referral sources. In addition, utilization of a patient centered approach to care should be employed.
Intracytoplasmic sperm injection (ICSI) was originally designed to overcome barriers due to male factor infertility. However, a surveillance study found that ICSI use in non-male factor infertility ...increased from 15.4% to 66.9% between 1996 and 2012. Numerous studies have investigated fertilization rate, total fertilization failure, and live birth rate per cycle (LBR), comparing the use of ICSI versus conventional in vitro fertilization (IVF) for non-male factor infertility. The overwhelming conclusion shows no increase in fertilization rate or LBR per cycle with the use of ICSI for non-male factor infertility. The overuse of ICSI is likely related to the desire to avoid a higher rate of total fertilization failure in IVF. However, data supporting the benefit of using ICSI for non-male factor infertility is lacking, and 33 couples would need to be treated with ICSI unnecessarily to avoid one case of total fertilization failure. Such practice increases the cost to the patient, increases the burden on embryologist’s time, and is a misapplication of resources. Additionally, there remains conflicting data regarding the safety of offspring conceived by ICSI and potential damage to the oocyte. Thus, the use of ICSI should be limited to those with male factor infertility or a history of total fertilization factor infertility due to uncertainties of potential adverse impact and lack of proven benefit in non-male factor infertility.
Cervical stenosis is a challenging clinical entity that requires prompt identification and management in order to avoid iatrogenic injury at the time of endocervical canal cannulation.
The aim of ...this study was to identify cervical stenosis and discuss associated etiologies, risk factors, and review medical and surgical approaches for overcoming cervical stenosis.
Computerized searches of MEDLINE and PubMed were conducted using the key words "cervix", "cervical stenosis," "embryo transfer," "hysteroscopy complications," "misoprostol," and "ultrasound." References from identified sources were manually searched to allow for a thorough review. Data from relevant sources were compiled to create this review.
Transcervical access to the uterine cavity is frequently required for procedures such as hysteroscopy, dilation and curettage, endometrial biopsy, sonohysterogram, hysterosalpingogram, intrauterine insemination, embryo transfer in those undergoing in vitro fertilization, and insertion of intrauterine devices. These procedures can become complicated when difficult cannulation of the endocervical canal is encountered. Management strategies include preprocedural use of cervical-ripening agents or osmotic dilators, ultrasound guidance, no-touch vaginoscopy, manual dilatation, and hysteroscopic resection of the obstructed endocervical canal.
Cervical stenosis is associated with iatrogenic complications that can result in significant patient morbidity. In patients undergoing in vitro fertilization, difficult embryo transfer is associated with lower pregnancy rates. The clinician should carefully consider the patient's menopausal status, risk factors, and symptoms in order to anticipate difficult navigation of the endocervical canal. Various medical and surgical management strategies, including hysteroscopic resection, can be used to overcome the stenotic cervix.
Summary
Alteration of flow and thermal regimes is a key consequence of human use of river and floodplain ecosystems, and these impacts result from a range of interacting ecological mechanisms. ...Environmental flow regimes are a management strategy to restore or maintain ecologically important aspects of river hydrology. However, inadequate understanding of the processes that determine the effects of flow on population dynamics of biota hinders the maximum benefits of environmental flows.
Spawning and recruitment of riverine fish is mediated by temperature, access to nursery habitat and the timing and availability of resources. Differences in population sizes between regulated and unregulated rivers are often attributed to the effect of flow and thermal regime change on population dynamics.
Dams and extraction of water have altered the flow and thermal regimes of rivers in the northern Murray–Darling Basin, Australia. Combining three studies, we (i) examined differences in the recruitment of fish and patterns of potential prey availability between a regulated and unregulated river, (ii) studied the relationships between patterns of flow and temperature on spawning of fish in two rivers with contrasting regulated flow regimes and (iii) experimentally tested the effects of environmental flow releases in a regulated river on fish spawning and recruitment by comparing patterns over time against two unregulated rivers.
Comparisons between regulated and unregulated rivers indicated that the significantly lower recruitment of Macquaria ambigua in the regulated river was linked with large differences in available prey. Species‐specific differences in the abundance of fish larvae between two regulated rivers indicated that different reproductive strategies determine population‐level responses to flow regulation. Finally, the experimental flow releases in a regulated reach during late spring did not result in a change in spawning and recruitment of fish, although influences of antecedent flow and temperature on larval and juvenile assemblage composition were significant.
These findings indicate that the responses of fish spawning and recruitment to flow regime change and restoration are dependent on the conditions that determine the success of these critical life‐history processes. Specifically, key effects of flow regulation are reduced summer water temperatures due to hypolimnetic discharge from dams, and the reduced frequency and duration of low flows. Reduced water temperatures limit opportunities for fish to spawn, and sustained base flows were associated with lower densities of potential prey sources in conjunction with potential flushing of larvae and juveniles, thereby influencing recruitment.
The benefits of environmental flow programmes can be enhanced if flow regimes are modified to ensure that abiotic and biotic conditions that support persistence of biota are provided. In conjunction with flow pulses and floods, low flows are a natural and ecologically important component of flow regimes, particularly in dryland rivers. Understanding the interactive and mechanistic effects of flow and thermal regimes on population viability and patterns of biodiversity is critical to maximising the value of environmental flows.
Ovulation Induction for the General Gynecologist Lindheim, Steven R.; Glenn, Tanya L.; Smith, Megan C. ...
Journal of obstetrics and gynaecology of India,
08/2018, Letnik:
68, Številka:
4
Journal Article
Recenzirano
Odprti dostop
The practice of ovulation induction often falls to the reproductive endocrinology and infertility specialist. However, attitudes toward the evaluation and treatment of infertility has shifted among ...general obstetrician-gynecologists (OB-GYN). This review discusses the underlying scientific basis of anovulation and clinical guidelines regarding the use of different medications for the purpose of promoting follicular recruitment and ovulation for the general OB-GYN.
To examine the changes in AMH levels longitudinally over time and their relationship with both body composition, particularly abdominal adiposity, and milestones of pubertal development in female ...children.
Secondary analysis of a prospective, longitudinal study.
University affiliated research center and laboratories.
Eighty-nine females were examined between 1990 and 2015 to study child growth and development.
Demographic, anthropometric, growth, and pubertal milestone data with serum samples stored and subsequently analyzed for AMH.
Longitudinal change in AMH and predicted AMH levels based on body composition, age, and pubertal milestones including, pubarche, thelarche, and menarche.
Natural log-transformed AMH (AMHlog) levels appeared to have a nonlinear relationship with age, decreasing between 10 and 14 years of age, increasing until 16 years. A mixed effect linear model demonstrated that increased abdominal adiposity (waist/height ratio, WHtR) was significantly associated with the predicted increased AMHlog levels (β=1.37). As females progressed through the Tanner stages, the model predicted decreasing AMHlog values when adjusting for age and WHtR.
Declining AMH levels during puberty may not be reflective of diminished ovarian reserve as observed in adults, but may suggest a permissive role of AMH in the activation of the hypothalamic-pituitary-ovarian axis.
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