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Human reproduction 35건

  1. [해외논문]   Equipoise and the RCT   SCI SCIE

    Braakhekke, M. (Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Room Q3-119, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ) , Mol, F. (Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Room Q3-119, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ) , Mastenbroek, S. (Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Room Q3-119, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ) , Mol, B. Willem J. (Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, SA 5000, Australia ) , van der Veen, F. (Department of Obstetrics and Gynaecology, Centre for Reproductive Medicine, Room Q3-119, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands)
    Human reproduction v.32 no.2 ,pp. 257 - 260 , 2017 , 0268-1161 ,

    초록

    Clinical decisions in reproductive medicine are often made in uncertainty. To reduce uncertainty and to improve clinical decision-making, RCTs are increasingly called upon. A key concept underpinning the ethics of RCTs is equipoise. Here, we aimed to dissect the basic reasoning behind the concept of equipoise and we proposed a line of thinking delineating under which conditions it is ethical to design and execute an RCT. This might prevent a priori negative trials, reduce research waste and aid in the design of meaningful ones. It is these trials that will provide insight on how to safely and effectively assist subfertile couples.

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  2. [해외논문]   The Rotterdam criteria for polycystic ovary syndrome: evidence-based criteria?   SCI SCIE

    Wang, Rui (Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, SA 5006, Australia ) , Mol, Ben Willem J. (Discipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, SA 5006, Australia)
    Human reproduction v.32 no.2 ,pp. 261 - 264 , 2017 , 0268-1161 ,

    초록

    The Rotterdam criteria for polycystic ovary syndrome (PCOS) are used by a wide range of medical professionals and researchers. However, the development of these criteria was based on expert meetings and not on evidence-based treatment guidance. Over the last decade, the Rotterdam criteria have been useful in guiding research, and a number of clinical studies on PCOS have been published consequently. We plead to revisit the Rotterdam criteria based on the available evidence in prognostic studies and randomized controlled trials. In this opinion paper, we provide arguments of the strengths and limitations of the Rotterdam criteria in guiding treatment selections and predicting prognoses in women with infertility. While the Rotterdam criteria have shown their advantages in predicting reproductive prognosis, the next step is to evaluate whether they can guide treatment choices in infertility as well as other health aspects of the syndrome. Based on available data in clinical studies, we should be able to determine whether the Rotterdam criteria are evidence-based criteria.

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  3. [해외논문]   Factors associated with seminal impairment in HIV-infected men under antiretroviral therapy   SCI SCIE

    Jeró (Centro Sanitario Sandoval, Instituto de Investigacióíón Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain ) , nimo, A. (Centro Sanitario Sandoval, Instituto de Investigacióíón Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain ) , Baza, M.B. (Centro Nacional de Epidemiologóíóía, Instituto de Salud Carlos III (ISCIII), Madrid, Spain ) , Ró (Centro Sanitario Sandoval, Instituto de Investigacióíón Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain ) , í (Centro Nacional de Epidemiologóíóía, Instituto de Salud Carlos III (ISCIII), Madrid, Spain ) , o, I. (CIBER Epidemiologóíóíía y Salud Póíóííública, Madrid, Spain ) , Vera, M. (Centro Sanitario Sandoval, Instituto de Investigacióíón Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain ) , Hernando, V. (Centro Sanitario Sandoval, Instituto de Inv) , Castilla, J. , Rodriguez, C. , Del Romero, J.
    Human reproduction v.32 no.2 ,pp. 265 - 271 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION How do semen parameters of HIV-infected men under antiretroviral treatment compare with WHO parameters of normal semen, and what factors are associated with any differences? SUMMARY ANSWER Semen quality in most HIV-infected patients under antiretroviral treatment exceeds WHO limits, but the number falling below them is higher than would be expected in a healthy population. Exposure to efavirenz has a significant association with dysmotility. WHAT IS KNOWN ALREADY Dysmotility is the most frequently described sperm alteration related to HIV infection, and it has recently been linked to treatment with non-nucleoside reverse transcriptase inhibitors, particularly to efavirenz. STUDY DESIGN, SIZE, DURATION Prospective cohort study. Between March 2002 and December 2013, 139 HIV-infected men undergoing antiretroviral therapy were enrolled. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were male members of serodiscordant couples who attended a clinic for sexually transmitted infections (STIs) in Madrid and requested reproductive counselling. Sociodemographic, behavioural and clinical data were collected. CD4 + lymphocyte count, HIV viral load, serology/viral load of hepatitis B and C viruses, syphilis serology and other STIs diagnosis were performed. Semen parameters were assessed through standard sperm analysis and were compared with WHO 2010 reference values. Factors associated with impaired semen parameters were evaluated by bivariate and multivariate analysis. MAIN RESULTS AND THE ROLE OF CHANCE The median values of all assessed semen parameters were within a normal range, but in up to 19% of HIV-positive males, at least one parameter of semen quality was below the normal range. A significant association between treatment with efavirenz and the presence of dysmotility was detected in the multivariate analysis. LIMITATIONS, REASONS FOR CAUTION Our results cannot demonstrate a causal relationship between exposure to efavirenz and impaired motility. We do not have a real comparison group as the WHO cohort is international and may not reflect local variations in semen characteristics. Subjects who requested reproductive counselling might not be representative of HIV-positive men in general. WIDER IMPLICATIONS OF THE FINDINGS Since efavirenz is still widely used in current therapeutic regimens may be affecting fertility in seropositive men who desire procreation. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used for this study. The authors have no conflict of interest to declare.

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  4. [해외논문]   Stability of the human sperm DNA methylome to folic acid fortification and short-term supplementation   SCI SCIE

    Chan, D. (Departments of Pediatrics and of Human Genetics of McGill University, Montreal Children's Hospital and Research Institute of the McGill University Health Centre, Glen Site, 1001 Décarie Boulevard Block E- Room EM0.2236 Montreal, QC H4A 3J1, Canada ) , McGraw, S. (Department of Obstetrics and Gynaecology, Biochemistry and Molecular Medicine of Universitéé) , Klein, K. (de Montréééal, Research Center of the Sainte-Justine University Hospital, Montreal, QC H3T 1C5, Canada ) , Wallock, L.M. (Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC H3T 1E2, Canada ) , Konermann, C. (Department of Biological Sciences, Diablo Valley College, Pleasant Hill, CA 94523, USA ) , Plass, C. (Department of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany ) , Chan, P. (Department of Epigenomics and Cancer Risk Factors, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany ) , Robaire, B. (Royal Victoria Hospital of the McGill University Health Centre and Department of Surgery) , Jacob, R.A. , Greenwood, C.M.T. , Trasler, J.M.
    Human reproduction v.32 no.2 ,pp. 272 - 283 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION Do short-term and long-term exposures to low-dose folic acid supplementation alter DNA methylation in sperm? SUMMARY ANSWER No alterations in sperm DNA methylation patterns were found following the administration of low-dose folic acid supplements of 400 μg/day for 90 days (short-term exposure) or when pre-fortification of food with folic acid and post-fortification sperm samples (long-term exposure) were compared. WHAT IS KNOWN ALREADY Excess dietary folate may be detrimental to health and DNA methylation profiles due to folate's role in one-carbon metabolism and the formation of S-adenosyl methionine, the universal methyl donor. DNA methylation patterns are established in developing male germ cells and have been suggested to be affected by high-dose (5 mg/day) folic acid supplementation. STUDY DESIGN, SIZE, DURATION This is a control versus treatment study where genome-wide sperm DNA methylation patterns were examined prior to fortification of food (1996–1997) in men with no history of infertility at baseline and following 90-day exposure to placebo ( n = 9) or supplement containing 400 μg folic acid/day ( n = 10). Additionally, pre-fortification sperm DNA methylation profiles ( n = 19) were compared with those of a group of post-fortification (post-2004) men ( n = 8) who had been exposed for several years to dietary folic acid fortification. PARTICIPANTS/MATERIALS, SETTING, METHODS Blood and seminal plasma folate levels were measured in participants before and following the 90-day treatment with placebo or supplement. Sperm DNA methylation was assessed using the whole-genome and genome-wide techniques, MassArray epityper, restriction landmark genomic scanning, methyl-CpG immunoprecipitation and Illumina HumanMethylation450 Bead Array. MAIN RESULTS AND THE ROLE OF CHANCE Following treatment, supplemented individuals had significantly higher levels of blood and seminal plasma folates compared to placebo. Initial first-generation genome-wide analyses of sperm DNA methylation showed little evidence of changes when comparing pre- and post-treatment samples. With Illumina HumanMethylation450 BeadChip arrays, no significant changes were observed in individual probes following low-level supplementation; when compared with those of the post-fortification cohort, there were also few differences in methylation despite exposure to years of fortified foods. LARGE SCALE DATA Illumina HumanMethylation450 BeadChip data from this study have been submitted to the NCBI Gene Expression Omnibus under the accession number GSE89781. LIMITATIONS, REASONS FOR CAUTION This study was limited to the number of participants available in each cohort, in particular those who were not exposed to early (pre-1998) fortification of food with folic acid. While genome-wide DNA methylation was assessed with several techniques that targeted genic and CpG-rich regions, intergenic regions were less well interrogated. WIDER IMPLICATIONS OF THE FINDINGS Overall, our findings provide evidence that short-term exposure to low-dose folic acid supplements of 400 μg/day, over a period of 3 months, a duration of time that might occur during infertility treatments, has no major impact on the sperm DNA methylome. STUDY FUNDING/COMPETING INTERESTS This work was supported by a grant to J.M.T. from the Canadian Institutes of Health Research (CIHR: MOP-89944). The authors have no conflicts of interest to declare.

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  5. [해외논문]   Pregnancy and live birth rates after microsurgical vasoepididymostomy for azoospermic patients with epididymal obstruction   SCI SCIE

    Peng, Jing , Zhang, Zhichao , Yuan, Yiming , Cui, Wanshou , Song, Weidong
    Human reproduction v.32 no.2 ,pp. 284 - 289 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION Can microsurgical vasoepididymostomy (MVE) be an effective treatment for azoospermic men with epididymal obstruction? SUMMARY ANSWER MVE is an effective treatment for epididymal obstruction, with overall patency and live birth rates of 76.3% and 34.8%, respectively. WHAT IS KNOWN ALREADY We showed that MVE was an effective treatment for non-vasectomized patients with epididymal obstruction and prior failed sperm retrieval for ICSI. ICSI is the preferred treatment for obstructive azoospermia in some reproductive centers. Some small studies documented that MVE could achieve high patency and pregnancy rates. STUDY DESIGN, SIZE, DURATION This retrospective study was designed to investigate the natural pregnancy and live birth rates after MVE and to identify possible predictors of pregnancy. From January 2011 to July 2013, 241 patients underwent MVE for epididymal obstruction in our andrology center. PARTICIPANTS/MATERIALS, SETTING, METHODS All patients underwent scrotal exploration and MVE. Semen was analyzed every 3 months postoperatively until pregnancy was achieved. Patency, pregnancy and live birth rates were evaluated. Preoperative and intraoperative data were compared between patent and non-patent groups to identify factors affecting the patency rate. Predictors of pregnancy were identified by univariate and multivariate analyses with Cox regression models. MAIN RESULTS AND THE ROLE OF CHANCE Data from 198 males (82.2%) were analyzed. The mean (±SD) age of males and female partners was 31.0 ± 5.8 and 28.4 ± 4.4 years, respectively. Sperm was present in the ejaculate of 151 patients (76.3%) postoperatively. Patency rates were increased for patients with bilateral anastomosis, distant anastomosis and motile sperm in epididymal fluid. Overall, 81/198 males (40.9%) reported pregnancy in partners and 73 newborns were delivered. The overall live birth rate was 34.8%. Male age (hazard ratio (HR) [95% CI] 0.407 [0.203–0.816], P = 0.011), sperm concentration (HR [95% CI] 4.988 [2.777–8.957], P < 0.001) and forward motility (HR [95% CI] 1.751 [1.042–2.945], P = 0.035) were predictors of pregnancy. LIMITATIONS, REASONS FOR CAUTION A randomized control trial comparing pregnancy rates, live birth rates, risks and medical costs of MVE and IVF/ICSI is needed. The sample size of females >35 years old was small, so we could not determine whether female age was a predictor of pregnancy. WIDER IMPLICATIONS OF THE FINDINGS MVE is an effective therapy for azoospermic patients with epididymal obstruction. Sperm concentration and forward motility may predict pregnancy after the procedure. Microsurgical reconstruction could be a first choice for epididymal obstruction. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received. The authors have no competing interests. TRIAL REGISTRATION NUMBER Not applicable.

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  6. [해외논문]   Diethylstilbestrol activates CatSper and disturbs progesterone actions in human spermatozoa   SCI SCIE

    Zou, Qian-xing (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , Peng, Zhen (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , Zhao, Qing (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , Chen, Hou-yang (Reproductive Medical Center, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi 330006, PR China ) , Cheng, Yi-min (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , Liu, Qing (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , He, Yuan-qiao (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , Weng, Shi-qi (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 330031, PR China ) , Wang, Hua-feng (Institute of Life Science and School of Life Science, Nanchang University, Nanchang, Jiangxi 33) , Wang, Tao , Zheng, Li-ping , Luo, Tao
    Human reproduction v.32 no.2 ,pp. 290 - 298 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION Is diethylstilbestrol (DES), a prototypical endocrine-disrupting chemical (EDC), able to induce physiological changes in human spermatozoa and affect progesterone actions? SUMMARY ANSWER DES promoted Ca 2+ flux into human spermatozoa by activating the cation channel of sperm (CatSper) and suppressed progesterone-induced Ca 2+ signaling, tyrosine phosphorylation and sperm functions. WHAT IS KNOWN ALREADY DES significantly impairs the male reproductive system both in fetal and postnatal exposure. Although various EDCs affect human spermatozoa in a non-genomic manner, the effect of DES on human spermatozoa remains unknown. STUDY DESIGN, SIZE, DURATION Sperm samples from normozoospermic donors were exposed in vitro to a range of DES concentrations with or without progesterone at 37°C in a 5% CO 2 incubator to mimic the putative exposure to this toxicant in seminal plasma and the female reproductive tract fluids. The incubation time varied according to the experimental protocols. All experiments were repeated at least five times using different individual sperm samples. PARTICIPANTS/MATERIALS, SETTING, METHODS Human sperm intracellular calcium concentrations ([Ca 2+ ] i ) were monitored with a multimode plate reader following sperm loading with Ca 2+ indicator Fluo-4 AM, and the whole-cell patch-clamp technique was performed to record CatSper and alkalinization-activated sperm K + channel (KSper) currents. Sperm viability and motility parameters were assessed by an eosin–nigrosin staining kit and a computer-assisted semen analysis system, respectively. The ability of sperm to penetrate into viscous media was examined by penetration into 1% methylcellulose. The sperm acrosome reaction was measured using chlortetracycline staining. The level of tyrosine phosphorylation was determined by western blot assay. MAIN RESULTS AND THE ROLE OF CHANCE DES exposure rapidly increased human sperm [Ca 2+ ] i dose dependently and even at an environmentally relevant concentration (100 pM). The elevation of [Ca 2+ ] i was derived from extracellular Ca 2+ influx and mainly mediated by CatSper. Although DES did not affect sperm viability, motility, penetration into viscous media, tyrosine phosphorylation or the acrosome reaction, it suppressed progesterone-stimulated Ca 2+ signaling and tyrosine phosphorylation. Consequently, DES (1–100 μM) significantly inhibited progesterone-induced human sperm penetration into viscous media and acrosome reaction. LARGE SCALE DATA N/A. LIMITATIONS, REASONS FOR CAUTION Although DES has been shown to disturb progesterone actions on human spermatozoa, this study was performed in vitro , and caution must be taken when extrapolating the results in practical applications. WIDER IMPLICATIONS OF THE FINDINGS The present study revealed that DES interfered with progesterone-stimulated Ca 2+ signaling and tyrosine phosphorylation, ultimately inhibited progesterone-induced human sperm functions and, thereby, might impair sperm fertility. The non-genomic manner in which DES disturbs progesterone actions may be a potential mechanism for some estrogenic endocrine disruptors to affect human sperm function. STUDY FUNDING/COMPETING INTEREST(S) National Natural Science Foundation of China (No. 31400996); Natural Science Foundation of Jiangxi, China (No. 20161BAB204167 and No. 20142BAB215050); open project of National Population and Family Planning Key Laboratory of Contraceptives and Devices Research (No. 2016KF07) to T. Luo; National Natural Science Foundation of China (No. 81300539) to L.P. Zheng. The authors have no conflicts of interest to

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  7. [해외논문]   Previous miscarriages and GLI2 are associated with anorectal malformations in offspring   SCI SCIE

    van de Putte, Romy (Department for Health Evidence (133), Radboud Institute for Health Sciences, Radboud University Medical Center (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, the Netherlands ) , Wijers, Charlotte H.W. (Department for Health Evidence (133), Radboud Institute for Health Sciences, Radboud University Medical Center (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, the Netherlands ) , de Blaauw, Ivo (Department of Surgery-Pediatric Surgery, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands ) , Marcelis, Carlo L.M. (Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands ) , Sloots, Cornelius E.J. (Department of Pediatric Surgery, Sophia's Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands ) , Brooks, Alice S. (Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands ) , Broens, Paul M.A. (Department of Surgery, Division of Pediatric Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands ) , Roeleveld, Nel (Department for Health Evidence (133), Radboud Institute for Health Sciences,) , van der Zanden, Loes F.M. , van Rooij, Iris A.L.M.
    Human reproduction v.32 no.2 ,pp. 299 - 306 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION Are anorectal malformations (ARMs) associated with previous miscarriages or single nucleotide polymorphisms (SNPs) in the Bone Morphogenetic Protein 4 ( BMP4 ) and GLI family zinc finger 2 ( GLI2 ) genes? SUMMARY ANSWER The SNP rs3738880 in GLI2 and miscarriages were associated with ARM, especially in patients with multiple congenital anomalies (MCA). WHAT IS KNOWN ALREADY ARM are one of the most common birth defects of the gastrointestinal tract. The etiology is likely to be multifactorial, involving both environmental and genetic factors. SNPs in BMP4 and GLI2 genes were associated with ARM in non-Caucasian populations. During a patient information day, several mothers of ARM patients reported their concerns about previous miscarriages. STUDY DESIGN, SIZE, DURATION A case-control study was performed among 427 ARM patients and 663 population-based controls. PARTICIPANTS/MATERIALS, SETTING, METHODS We examined the associations of ARM with SNPs in GLI2 and BMP4 using DNA samples of the children and associations with previous miscarriages using parental questionnaires. In addition, gene–gene and gene–environment interaction analyses were performed. MAIN RESULTS AND THE ROLE OF CHANCE The SNP rs3738880 in GLI2 was associated with ARM, especially in patients with MCA (homozygous GG -genotype: odds ratio (OR): 2.1; 95% CI: 1.2, 3.7). We identified previous miscarriages as a new risk factor for ARM, especially when occurring in the pregnancy directly preceding the index pregnancy and in patients with MCA (OR: 2.1; 95% CI: 1.3, 3.5). No association with rs17563 in BMP4, nor gene–gene or gene–environment interactions were found. LIMITATIONS, REASONS FOR CAUTION The possibility of recall errors for previous miscarriage, but we expect these errors to be limited, as a miscarriage is a major life event. In addition, potential misclassification regarding miscarriages and stillbirth, but sensitivity analyses showed that this did not influence our results. WIDER IMPLICATIONS OF THE FINDINGS This study showed associations of ARM with rs3738880 in GLI2 and with previous miscarriages. Both associations were stronger in patients with MCA, showing the importance of stratifying the analyses by patients with isolated ARM or MCA. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Radboudumc. The authors have no conflict of interest to disclose.

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  8. [해외논문]   Inter-observer and intra-observer agreement between embryologists during selection of a single Day 5 embryo for transfer: a multicenter study   SCI SCIE

    Storr, Ashleigh (IVFAustralia, Sydney, NSW, Australia ) , Venetis, Christos A. (IVFAustralia, Sydney, NSW, Australia ) , Cooke, Simon (IVFAustralia, Sydney, NSW, Australia ) , Kilani, Suha (IVFAustralia, Sydney, NSW, Australia ) , Ledger, William (IVFAustralia, Sydney, NSW, Australia)
    Human reproduction v.32 no.2 ,pp. 307 - 314 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION What is the inter-observer and intra-observer agreement between embryologists when selecting a single Day 5 embryo for transfer? SUMMARY ANSWER The inter-observer and intra-observer agreement between embryologists when selecting a single Day 5 embryo for transfer was generally good, although not optimal, even among experienced embryologists. WHAT IS KNOWN ALREADY Previous research on the morphological assessment of early stage (two pronuclei to Day 3) embryos has shown varying levels of inter-observer and intra-observer agreement. However, single blastocyst transfer is now becoming increasingly popular and there are no published data that assess inter-observer and intra-observer agreement when selecting a single embryo for Day 5 transfer. STUDY DESIGN, SIZE, DURATION This was a prospective study involving 10 embryologists working at five different IVF clinics within a single organization between July 2013 and November 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS The top 10 embryologists were selected based on their yearly Quality Assurance Program scores for blastocyst grading and were asked to morphologically grade all Day 5 embryos and choose a single embryo for transfer in a survey of 100 cases using 2D images. A total of 1000 decisions were therefore assessed. For each case, Day 5 images were shown, followed by a Day 3 and Day 5 image of the same embryo. Subgroup analyses were also performed based on the following characteristics of embryologists: the level of clinical embryology experience in the laboratory; amount of research experience; number of days per week spent grading embryos. The agreement between these embryologists and the one that scored the embryos on the actual day of transfer was also evaluated. Inter-observer and intra-observer variability was assessed using the kappa coefficient to evaluate the extent of agreement. MAIN RESULTS AND THE ROLE OF CHANCE This study showed that all 10 embryologists agreed on the embryo chosen for transfer in 50 out of 100 cases. In 93 out of 100 cases, at least 6 out of the 10 embryologists agreed. The inter-observer and intra-observer agreement among embryologists when selecting a single Day 5 embryo for transfer was generally good as assessed by the kappa scores (kappa = 0.734, 95% CI: 0.665–0.791 and 0.759, 95% CI: 0.622–0.833, respectively). The subgroup analyses did not substantially alter the inter-observer and intra-observer agreement among embryologists. The agreement when Day 3 images were included alongside Day 5 images of the same embryos resulted in a change of mind at least three times by each embryologist (on average for <10% of cases) and resulted in a small decrease in inter-observer and intra-observer agreement between embryologists (kappa = 0.676, 95% CI: 0.617–0.724 and 0.752, 95% CI: 0.656–808, respectively). The assessment of the inter-observer agreement with regard to morphological grading of Day 5 embryos showed only a fair-to-moderate agreement, which was observed across all subgroup analyses. The highest overall kappa coefficient was seen for the grading of the developmental stage of an embryo (0.513; 95% CI: 0.492–0.538). The findings were similar when the individual embryologists were compared with the embryologist who made the morphological assessments of the available embryos on the actual day of transfer. LIMITATIONS, REASONS FOR CAUTION All embryologists had already completed their training and were working under one organization with similar policies between the five clinics. Therefore, the inter-observer agreement might not be as high between embryologists working in clinics with different policies or with different levels of training. WIDER IMPLICATIONS OF THE FINDINGS The generally good, although not optimal uniformity between parti

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  9. [해외논문]   World Endometriosis Society consensus on the classification of endometriosis   SCI SCIE

    Johnson, Neil P. (World Endometriosis Society, Vancouver, Canada ) , Hummelshoj, Lone (World Endometriosis Society, Vancouver, Canada ) , Adamson, G. David (World Endometriosis Research Foundation, London, England ) , Keckstein, Jorg (KABEG Landeskrankenhaus, Villach, Austria ) , Taylor, Hugh S. (Yale School of Medicine, New Haven, USA ) , Abrao, Mauricio S. (World Endometriosis Society, Vancouver, Canada ) , Bush, Deborah (Endometriosis New Zealand, Christchurch, New Zealand ) , Kiesel, Ludwig (World Endometriosis Society, Vancouver, Canada ) , Tamimi, Rulla (Harvard TH Chan School of Public Health, Boston, USA ) , Sharpe-Timms, Kathy L. (World Endometriosis Society, Vancouver, Canada ) , Rombauts, Luk (World Endometriosis Society, Vancouver, Canada ) , Giudice, Linda C. (World Endometriosis Society, Vancouver, Canada)
    Human reproduction v.32 no.2 ,pp. 315 - 324 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION What is the global consensus on the classification of endometriosis that considers the views of women with endometriosis? SUMMARY ANSWER We have produced an international consensus statement on the classification of endometriosis through systematic appraisal of evidence and a consensus process that included representatives of national and international, medical and non-medical societies, patient organizations, and companies with an interest in endometriosis. WHAT IS KNOWN ALREADY Classification systems of endometriosis, developed by several professional organizations, traditionally have been based on lesion appearance, pelvic adhesions, and anatomic location of disease. One system predicts fertility outcome and none predicts pelvic pain, response to medications, disease recurrence, risks for associated disorders, quality of life measures, and other endpoints important to women and health care providers for guiding appropriate therapeutic options and prognosis. STUDY DESIGN, SIZE, DURATION A consensus meeting, in conjunction with pre- and post-meeting processes, was undertaken. PARTICIPANTS/MATERIALS, SETTING, METHODS A consensus meeting was held on 30 April 2014 in conjunction with the World Endometriosis Society's 12th World Congress on Endometriosis. Rigorous pre- and post-meeting processes, involving 55 representatives of 29 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. MAIN RESULTS AND THE ROLE OF CHANCE A total of 28 consensus statements were made. Of all, 10 statements had unanimous consensus, however none of the statements was made without expression of a caveat about the strength of the statement or the statement itself. Two statements did not achieve majority consensus. The statements covered women's priorities, aspects of classification, impact of low resources, as well as all the major classification systems for endometriosis. Until better classification systems are developed, we propose a classification toolbox (that includes the revised American Society for Reproductive Medicine and, where appropriate, the Enzian and Endometriosis Fertility Index staging systems), that may be used by all surgeons in each case of surgery undertaken for women with endometriosis. We also propose wider use of the World Endometriosis Research Foundation Endometriosis Phenome and Biobanking Harmonisation Project surgical and clinical data collection tools for research to improve classification of endometriosis in the future, of particular relevance when surgery is not undertaken. LIMITATIONS, REASONS FOR CAUTION This consensus process differed from that of formal guideline development, although based on the same available evidence. A different group of international experts from those participating in this process may have yielded subtly different consensus statements. WIDER IMPLICATIONS OF THE FINDINGS This is the first time that a large, global, consortium–representing 29 major stake-holding organizations, from 19 countries – has convened to systematically evaluate the best available evidence on the classification of endometriosis and reach consensus. In addition to 21 international medical organizations and companies, representatives from eight national endometriosis organizations were involved, including lay support groups, thus generating and including input from women who suffer from endometriosis in an endeavour to keep uppermost the goal of optimizing quality of life for women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The World Endometriosis Society convened and hosted the consensus meeting. Financial support for participants to attend the meeting was provided by the organizations that they represented. There was no other specific funding fo

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  10. [해외논문]   Total circulating microparticle levels are increased in patients with deep infiltrating endometriosis   SCI SCIE

    Munró (Department of Gynecology, Institut Clóíàínic of Gynecology, Obstetrics and Neonatology, Hospital Clóíàíínic of Barcelona –) , s, J. (Institut d{acute}Investigacions Biomóíàííèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain ) , Martó (Department of Gynecology, Institut Clóíàínic of Gynecology, Obstetrics and Neonatology, Hospital Clóíàíínic of Barcelona –) , í (Institut d{acute}Investigacions Biomóíàííèdiques August Pi i Sunyer (IDIBAPS), Faculty of Medicine, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain ) , nez-Zamora, M.A. (Department of Hemotherapy and Hemostasis, Hospital Clóíàííèínic of Barcelona, Villarroel 170, 08036 Barcelona, Spain ) , Tó (Department of Gynecology, Inst) , í , à , ssies, D. , Coloma, J.L. , Torrente, M.A. , Reverter, J.C. , Carmona, F. , Balasch, J.
    Human reproduction v.32 no.2 ,pp. 325 - 331 , 2017 , 0268-1161 ,

    초록

    STUDY QUESTION Are the levels of total circulating cell-derived microparticles (cMPs) and circulating tissue factor-containing microparticles (cMP-TF) increased in patients with endometriosis? SUMMARY ANSWER The levels of total cMP, but not cMP-TF, were higher in patients with endometriosis, and these were attributed to higher levels in patients with deep infiltrating endometriosis (DIE). WHAT IS KNOWN ALREADY Previous studies have reported elevated levels of total cMP in inflammatory conditions as well as higher levels of other inflammatory biomarkers in endometriosis. Increased expression of tissue factor (a transmembrane receptor for Factor VII/VIIa) in eutopic and ectopic endometrium from patients with endometriosis has been described. There is no previous data regarding total cMP and cMP-TF levels in patients with endometriosis. STUDY DESIGN, SIZE, DURATION A prospective case–control study including two groups of patients was carried out. The E group included 65 patients with surgically confirmed endometriosis (37 with DIE lesions) and the C group comprises 33 women without surgical findings of any form of endometriosis. Patients and controls were recruited during the same 10-month period. Controls were the next patient without endometriosis undergoing surgery, after including two patients with endometriosis. PARTICIPANTS/MATERIALS, SETTING, METHODS Venous blood samples for total cMP and cMP-TF determinations were obtained at the time of surgery, before anesthesia at a tertiary care center. To assess total cMP, an ELISA functional assay was used and cMP-TF activity in plasma was measured using an ELISA kit. MAIN RESULTS AND THE ROLE OF CHANCE Total cMP levels in plasma were higher in the E group compared with the C group ( P < 0.0001). The subanalysis of endometriosis patients with DIE or with ovarian endometriomas without DIE showed that total cMP levels were higher in the DIE group ( P = 0.001). There were no statistically significant differences in cMP-TF levels among the groups analyzed. LIMITATIONS, REASONS FOR CAUTION This is a preliminary study in which the sample size was arbitrarily decided, albeit in keeping with previous studies analyzing cMP in other inflammatory diseases and other biomarkers in endometriosis. The control group included patients with other pathologies as well as healthy controls, and blood samples were taken at different phases of the cycle. WIDER IMPLICATIONS OF THE FINDINGS Elevated total cMP levels in DIE patients may reflect an inflammatory and/or procoagulant systemic status in these patients. Further studies are warranted to confirm our findings and to assess the role of cMP levels in the pathophysiology of DIE. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by a grant from FIS-PI11/01560 and FIS-PI11/00977 within the ‘Plan Nacional de I + D + I’ and co-funded by the ‘ISCIII-Subdireccióíàííèíón General de Evaluacióíàííèíóón’ and ‘Fondo Europeo de Desarrollo Regional (FEDER)’ and by the grant ‘Premi Fi de Residóíàííèíóóència Emili Letang 2015’ from the Hospital Clóíàííèíóóèínic of Barcelona. The authors have no competing interests to disclose.

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