SARS-CoV-2对生育的影响

近年严重急性呼吸综合征冠状病毒2（severe acute respiratory syndrome corona virus 2,SARS-CoV-2）大流行对人类健康造成了威胁。研究表明,SARS-CoV-2对人类生育能力有潜在影响,对男性生育力的影响远大于女性。目前研究表明接种疫苗可能不会对人类的生育能力存在不利影响。感染SARS-CoV-2会不会发生性传播、垂直传播及母婴传播,从而对下一代产生影响,目前暂不清楚。尚需要从生殖医学科、传染病学科角度探讨SARS-CoV-2及其疫苗对生育的影响,并讨论可能存在的性传播、垂直传播和母婴传播,以提高对SARS-CoV-2及其疫苗的认识。     

Unique challenges and outcomes of young women with breast cancers from a tertiary care cancer centre in India

BackgroundYoung (≤40 years) breast cancers (YBC) are uncommon, inadequately represented in trials and have unique concerns and merit studying.MethodsThe YBC treated with a curative intent between 2015 and 2016 at our institute were analysed.ResultsThere were 1228 patients with a median age of 36 (12–40) years; 38 (3.1%) had Stage I, 455 (37.1%) - II, 692 (56.3%) –III, and remaining 43 (3.5%) Stage IV (oligo-metastatic) disease; 927 (75.5%) were node positive; 422 (34.4%) were Triple negatives (TNBC), 331 (27%) were HER-2 positive. There were 549 (48.2%) breast conservations and 591 (51.8%) mastectomies of which 62 (10.4%) underwent breast reconstruction. 1143 women received chemotherapy, 617 (53.9%) received as neoadjuvant and 142 (23.1%) had pathological complete response; 934 (81.9%) received adjuvant radiotherapy. At the median follow-up of 48 (0–131) months, 5-year overall and disease-free survival was 79.6% (76.8–82.5) and 59.1% (55.8–62.6). For stage I, II, III and IV, the 5-year overall-survival was 100%, 86.7% (82.8–90.6), 77.3% (73.4–81.2), 69.7% (52.5–86.9) and disease-free survival was 94% (85.9–100), 65.9% (60.3–71.5), 55% (50.5–59.5), and 29.6% (14–45.2) respectively. On multivariate analysis, TNBC and HER-2+ subgroups had poorer survival (p = 0.0035). 25 patients had BRCA mutations with a 5-year DFS of 65.1% (95% CI:43.6–86.6). Fertility preservation was administered in 104 (8.5%) patients; seven women conceived and 5 had live births. Significant postmenopausal symptoms were present in 153 (13%) patients.ConclusionMore than half of the YBC in India were diagnosed at an advanced stage with aggressive features leading to suboptimal outcomes. Awareness via national registry and early diagnosis is highly warranted. Menopausal symptoms and fertility issues are prevalent and demand special focus.     

When laparoscopy for fertility preservation prior to gonadotoxic treatment of an anterior mediastinal mass is a dilemma: A case report

IntroductionThe management of anterior mediastinal masses is a challenge for anesthesiologists. Recommendations for their management in the context of diagnostic or curative surgery are well described. The added risk of laparoscopic surgery for fertility preservation has however never been discussed in the literature.Presentation of caseWe present the case of a 32-year-old female patient with a large malignant anterior mediastinal mass. She was referred for anesthesia evaluation before laparoscopic ovarian tissue harvesting as part of fertility preservation prior to gonadotoxic treatment. The patient presented dyspnea at rest. Chest computed tomography revealed a tracheal deviation and a partial obstruction of the left mainstem bronchus. Transthoracic echocardiography showed a pericardial effusion. Proceeding to high risk anesthesia for a non-curative surgery in a patient with a highly symptomatic mass was considered unacceptable and the procedure was postponed. The patient received a single cycle of neoadjuvant chemotherapy. Clinical and radiological improvement were shown after this single dose and laparoscopic surgery was performed under general anesthesia without complications.ConclusionIn the context of an anterior mediastinal mass and fertility preservation a thorough benefit-risk analysis must be undertaken before non-curative laparoscopic surgery. In case of severe symptoms, surgery should be postponed until the patient’s condition improves after the minimum necessary chemotherapy treatment. So far it is impossible to say whether the risk exceeds the expected benefit in this difficult situation. Further studies need to be conducted in this area.     

Conception rates in women desiring pregnancy after levonorgestrel 52 mg intrauterine system (Liletta®) discontinuation

ObjectiveEvaluate reproductive function in nulligravid and gravid women after levonorgestrel 52 mg intrauterine system (IUS) discontinuation based on time to pregnancy.Study designWe evaluated women participating in the ACCESS IUS multicenter, Phase 3, open-label clinical trial of the Liletta(®) levonorgestrel 52 mg IUS who discontinued the IUS within 60 months of use and desired pregnancy. Study staff contacted participants every three months after IUS discontinuation for up to 12 months to determine whether pregnancy occurred. We excluded women who opted to stop attempting to conceive before 12 months. We evaluated 12-month conception rates in participants 16–35 years at IUS placement, comparing dichotomous outcomes using Fisher’s exact test. We performed a multivariable analysis to assess the association of baseline characteristics, age at discontinuation, duration of IUS use, and positive sexually transmitted infection testing during IUS use with conception.ResultsAmong 165 women who attempted to conceive, 142 (86.1%) did so within 12 months with a median time to conception of 92 days. The 12-month conception rates did not differ between nulligravid (66/76 [86.8%]) and gravid (76/89 [85.4%]) women (p = 0.83) and nulliparous (78/90 [86.7%]) and parous (64/75 [85.3%]) women (p = 0.83). In multivariable analysis, only obesity (aOR 0.3 [95% CI 0.1–0.8]) was associated with ability to conceive.ConclusionsAfter levonorgestrel 52 mg IUS discontinuation, women have rapid return of fertility in the year post-removal. Fertility rates after IUS removal do not vary based on gravidity, parity, age at discontinuation, or duration of IUS use.ImplicationsThis contemporary IUS study included a large population of nulligravid and nulliparous women. IUS use over many years does not effect spontaneous fertility after IUS discontinuation, regardless of gravidity or parity. Providers and patients should have no concern about the impact of IUS use on future fertility.     

Fertility and digital technology: narratives of using smartphone app ‘Natural Cycles’ while trying to conceive

Fertility awareness apps, which help to identify the ‘fertile window’ when conception is most likely, have been hailed as ‘revolutionising’ women’s reproductive health. Despite rapidly growing popularity, little research has explored how people use these apps when trying to conceive and what these apps mean to them. We draw on in‐depth, qualitative interviews, adopting a critical digital health studies lens (a sub‐field of science and technology studies), to explore the experiences of cisgender women and partners with one such app, Natural Cycles, in the context of their daily lives. We found that many women valued the technology as a ‘natural’, inobtrusive alternative to biomedical intervention, and a means of controlling and knowing their bodies, amid a dearth of fertility‐related education and care. Yet this technology also intervened materially and affectively into the spaces of their lives and relationships and privileged disembodied metrics (temperature) over embodied knowledge. Meanwhile, app language, advertising and cost have contributed to characterising ‘typical’ users as white, heterosexual, affluent, cisgender women without disabilities. In the context of neoliberal shifts towards bodily self‐tracking, technologies appealing as novel, liberating and ‘natural’ to individuals who can access them may nevertheless reproduce highly gendered reproductive responsibilities, anxieties and broader health and social inequalities.     

Natural fertility in northeastern Mexico

BACKGROUND: The aims of this study were as follows: 1) to describe the fertility of a sample of Mexican women (> or =45 years of age, married, not using any family planning methods, and residing in the Mexican state of Nuevo León); 2) to determine whether or not the distribution of completed family size fits the negative binomial distribution, as in other populations studied in the world, and 3) to assess the association between fertility and 10 explanatory variables. METHODS: A sample of 410 women was interviewed at and selected from seven medical units of the Instituto Mexicano del Seguro Social (IMSS). The women were grouped by their year of birth (1896-1925 and 1926-1955) and birthplace [persons whose four grandparents were born in northeastern Mexico (NE) and outside northeastern Mexico (Not-NE)]. A binomial negative distribution analysis was assessed. Multiple linear regression was used to assess association between fertility (transformed by the use of inverse hyperbolic sines) and 10 explanatory variables, including age at marriage, heterozygosity, individual admixture, wife's education, husband's education, wife's occupation, husband's occupation, and couple's residence zone, birth year, and birthplace. RESULTS: Completed fertility was only associated with age at marriage. This population showed a fertility pattern similar to those described in Venezuelan and Brazilian populations in 1950 and 1940, respectively. CONCLUSIONS: We conclude that before worldwide family planning programs, fertility was determined mainly by natural selection forces.     

Impact of Varying Stages of Endometriosis on the Outcome of In Vitro Fertilization–Embryo Transfer

Purpose: The impact of severity of endometriosis on the outcome of in vitro fertilization (IVF) was analyzed in an uncontrolled, retrospective study in an academic IVF program. Methods: Sixty-one patients with a primary diagnosis of endometriosis undergoing 85 cycles of IVF were included in the study. Patients were divided according to the severity of disease based on the revised American Fertility Society (AFS) classification into groups A (stages I/II, or minimal/mild) and B (stages III/IV, or moderate/severe). Group A included 32 patients undergoing 45 IVF-embryo transfer (ET) cycles; group B included 29 patients undergoing 40 IVF cycles. Exclusion criteria were age older than 40 years, basal day 3 follicle stimulating hormone (FSH) greater than 20 IU/L, male-factor infertility, assisted hatching, and gamete intrafallopian transfer cases. Stimulation for IVF cycles was standard using pituitary down-regulation with gonadotropin-releasing hormone agonist in a midluteal protocol. Controlled ovarian hyperstimulation (COH) was achieved using a combination of FSH and human menopausal gonadotropin. Outcomes assessed included response to COH and number, maturity, and quality of oocytes retrieved. Fertilization, implantation, and pregnancy rates after IVF-ET were also analyzed. Results: The response to COH and the number, maturity, and quality of the oocytes was comparable between patients with varying severity of endometriosis. Fertilization rates for oocytes of patients in group B (stages III/IV) were significantly impaired compared to those in group A (stages I/II) (P = 0,004). The rates for implantation, clinical pregnancy, and miscarriage were comparable between the two groups. Conclusions: The reduced fertilization potential of the oocytes obtained from patients with severe endometriosis in the absence of male-factor infertility suggests an adverse biological impact of the advanced disease on the oocytes. The outcome of IVF-ET, however, is unaffected by increasing severity of endometriosis. This suggests that IVF may compensate for or overcome this reduction in the biological potential of the oocytes associated with severe disease, thus accounting for a comparable outcome irrespective of the severity of endometriosis.     

壬基酚对小鼠生育力的影响研究

目的 研究壬基酚（NP）经口染毒对昆明种小鼠生育力的影响,并评价其生殖和发育毒性.方法 选择健康性成熟的清洁级的昆明种小鼠128只,体重22～26 g,随机分为24、60、120 mg/kg NP染毒组和1个花生油溶剂对照组,每组32只,雌雄各半.进行小鼠生育力试验.结果 从60 mg/kg组开始,精子计数、活精率、生育指数、妊娠率均随染毒剂量增加而下降,精子畸形率随剂量增加而升高（P＜0.05或P＜0.01）;交配指数仅在120mg/kg组下降（P＜0.05）;从24mg/kg组开始,平均每窝黄体数、着床数、活胎数均随染毒剂量升高而下降,存在明显的剂量-效应关系（P＜0.05或P＜0.01）;而着床前死亡率、吸收胎率、死胎率均随染毒剂量增加而升高（P＜0.05或P＜0.01）.结论 经口染毒壬基酚对小鼠产生明显的生殖和发育毒性.     

冷冻应激对Wistar雌性大鼠生殖周期与生育能力的影响

目的为观察低温应激对大鼠生殖周期与生育能力的影响及人参多糖对其调节,本实验研究了Wistar雌性大鼠生殖周期与生育能力的变化规律及人参多糖的生物学效应。方法将Wistar大鼠分16℃对照组、4℃低温应激实验组与4℃低温应激人参多糖实验组,生殖器官的发育和生殖周期变化采用称重法与观察法。LH与FSH水平检测采用放免分析法。结果对照组、4℃低温应激实验组与4℃低温应激人参多糖实验组的卵巢重量分别为(36±1.20)g、(24±1.31)g和(27±1.14)g;子宫重量为(0.64±0.03)g、(0.45±0.01)g和(0.49±0.02)g;开口率为68%、39%和43%;LH和FSH为(0.28±0.04)ng/ml、(0.11±0.07)ng/ml和(0.14±0.05)ng/ml与(0.35±0.01)ng/ml、(0.17±0.03)ng/ml和(0.21±0.02)ng/ml;与对照组比较P<0.05。动情周期、怀孕率及生仔数,与对照组比较P<0.05。结论低温应激抑制大鼠生殖器官发育,使动情期延长,怀孕率降,LH与FSH分泌水平降低,人参多糖对其有上调作用。