Original investigations into the diagnosis and treatment of ejaculatory dysfunction Schellen T. Induction of ejaculation by electrovibration. Fertil Steril 1968;19(4):566–9.“The method employed is simple, harmless and—above all—not objectionable to patients. In cases such as those described, it is preferable to other therapeutic measures, which are too often both prolonged and useless.”Girgis SM, Etriby A, El-Hefnawy H, Kahil S. Aspermia: a survey of 49 cases. Fertil Steril 1968;19(4):580–8.“Retrograde ejaculation was associated with stricture of the urethra of long standing. A tight stricture may allow passage of urine but not semen, which is more viscid.”
Improving care for women with polycystic ovary syndrome Depression is one of the leading causes of global disease burden, with a prevalence of 3%–8% worldwide. In a 2016 survey reported by the National Institute of Mental Health, the prevalence of major depressive episodes was higher in females compared with males (8.5% vs. 4.5%) and highest in Caucasians and adults between 18 and 25 years of age (1). A significant proportion of adults (64%) reported impairment with a major depressive episode, and 34% received no treatment. Among adolescent females, the prevalence of depression was 19.4%, and 60% reported receiving no treatment.
Tubal anastomosis: once in a blue moon? Reflecting imparts the pleasant memory of something special, notable and memorable. In the past century, “blue moon” has been used to denote the moment where a second full moon occurs within a calendar month, which happens once in three years. However, two blue moons in a year is quite rare. Just this year, we had the unique opportunity to see blue moons in both January and March. Owing to the metonic cycle, we will not experience two of these in the same year again until 2037. As with the blue moon, we ask whether tubal anastomosis has become too infrequent of a distinctive event to be worth remembering, offering, or teaching?
First in vitro fertilization baby—this is how it happened On July 25, 1978, the first human was born following extracorporeal fertilization, an event that opened up a new medical science: expanding our knowledge of and developing novel treatments for infertility, radically changing the opportunities for families with inherited monogenic disorders, generating the new discipline of clinical embryology, and paving the way for studies into stem cell biology. In vitro fertilization (IVF), as it became known in its simplest form, went even further: it engaged the myriad of minds in human society.
Intergenerational effects—causation or confounding? One can get a glimpse into the early origins of long-term reproductive health by assessing pubertal onset. Studies of pubertal development not only provide insight into reproductive health but may also have broader implications. Reproductive health outcomes and infertility in both men and women have come to be recognized as a window into the overall health of an individual—shedding light on risk for later chronic health outcomes. For example, semen quality in men is predictive of mortality and general health, and gynecologic conditions in women have been linked to metabolic disorders and cardiovascular disease.
Elective oocyte cryopreservation: an ounce of prevention? The World Health Organization, the American Society for Reproductive Medicine, and most recently the American Medical Association rightfully recognize infertility as a disease. This has always been obvious to the patients experiencing infertility and providers who treat them, but the official acknowledgement of this condition as a disease implicitly suggests a role for prevention. Like the certainty of “death and taxes”, women face a guaranteed likelihood of infertility with advancing age. One in eight couples experience infertility, and diminished ovarian reserve and age-related embryonic aneuploidy represent significant contributing factors, which at advanced ages cannot be overcome by assisted reproductive technology (ART).
Pediatric ovarian tissue cryopreservation: time to lift the experimental label? As childhood cancer diagnoses increase and treatments improve survivorship, fertility preservation has emerged as an integral component of the comprehensive cancer treatment plan. The 5-year overall survival rate for childhood cancer has increased from 58% in patients diagnosed between 1975 and 1977 to 83% in those diagnosed between 2002 and 2008 (1). The American Society of Clinical Oncology recognizes fertility preservation as a key survivorship issue and utilizes fertility treatment as a quality care measure.
What do you see in Fertility and Sterility video articles? A top question underlying clinical research is, “How can we do better?” One of the easiest opportunities for advancing reproductive endocrinology and infertility (REI) is to take familiar procedures and slightly modify them in order to provide more efficient or effective care than previously achieved. Managing cervical ectopic pregnancy with methotrexate and potassium chloride through technique parallel to follicular aspiration allows safer and more effective treatment than with dilation and curettage or systemic methotrexate.
Moving the science forward on dietary patterns and male fertility Evidence linking a healthy diet to improved semen quality parameters continues to grow (1, 2). In this issue of Fertility and Sterility, Efrat and colleagues (3) add additional insight into this research area by investigating the association between four a priori defined dietary patterns: the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH), the Healthy Eating Index 2010 (HEI-2010), and the Alternative Healthy Eating Index 2010 (aHEI-2010) scores, in relation to semen quality parameters in a large cross-sectional study from Israel (3).
Polycystic ovary syndrome and mental health: a call to action Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in adult women (1). It can't be cured, but thanks to many years of fruitful research and intensive investigation, multiple modalities to help manage the condition throughout a woman's lifetime have emerged. Those of us who have been in practice for more than a decade or two have likely had the experience of managing mothers and daughters with the condition. Many of us have supported our PCOS patients through an adolescence complicated by acne and hair growth, an early adulthood complicated by infertility and irregular menses, and late reproductive age complicated by the new emergence of regular menstrual cyclicity, the latter a source of complete puzzlement (not to mention inconvenience) for our patient! Most of us have learned by now to carefully screen our patients with PCOS and initiate preventive therapy to avoid long-term and life-threatening complications of the disorder such as type 2 diabetes, heart disease, and endometrial cancer.
Chronic endometritis and the plasma cell, fact versus fiction The concept of chronic endometritis as relates to infertility has been documented in the literature since the 19th century. However while the disease process of chronic endometritis is clinically important, a definitive definition has been elusive. One can argue that the following statement by Drs. Archibald Donald and W. Fletcher Shaw (1) in 1911, is as relevant today, as it was back then.In the whole domain of gynecology there are no cases so common as those which generally go by the name of “chronic endometritis.” This term has been commonly used to denote a class of cases which are well known clinically but difficult to define.
Luteal phase support after gonadotropin-releasing hormone agonist triggering: does it still matter? Despite the increasing utilization of freeze-only IVF protocols, there is still a need for adequate management of the luteal phase after GnRH agonist trigger for patients who desire a fresh embryo transfer. Two approaches, intensive luteal support with E2 and P, and the use of adjuvant low-dose hCG either at the time of GnRH agonist trigger (dual trigger) or at the time of oocyte retrieval, have been shown to be effective in maintaining adequate pregnancy outcomes. The addition of low-dose hCG should be used with caution, because it may increase the risk of ovarian hyperstimulation syndrome.
Clinical utility of ovarian-stimulation intrauterine insemination In this issue, Huang et al. (1) provide their experience treating 8,583 couples with unexplained infertility using what has now become a standard approach using up with 3 cycles of ovarian-stimulation and intrauterine insemination (OS-IUI). They found that IUI live birth rates were significantly higher with stimulated cycles using clomiphene citrate (50–100 mg), letrozole (2.5–5.0 mg), or gonadotropins (75 IU) compared with natural cycles for couples with unexplained or mild male-factor infertility.
Oral dydrogesterone for luteal phase support in fresh in vitro fertilization cycles: a new standard? Oral dydrogesterone has been used for luteal phase support on an empirical basis since the early days of in vitro fertilization (IVF) treatment. Systematic comparisons of oral dydrogesterone with vaginal progesterone, so far considered to be the standard of care, started to appear in the middle 2000s. Recently, a large, randomized, double-blind, double-dummy phase III trial on the use of daily 30 mg oral dydrogesterone versus daily 600 mg micronized vaginal progesterone for LPS in IVF was published.
Time to think about neonatal outcome in assisted reproductive technology Assisted reproductive technology (ART), originally called in vitro fertilization (IVF), has been with us for forty years. During all this time efforts have mainly been targeted at increasing outcome, first expressed as pregnancy rates and more recently, as overall ART yield or live-birth rates. Of all the steps taken for improving ART outcome, the introduction of ovarian stimulation (OS) nearly from the inception of ART has been the single most effective measure ever implemented. Originally, fears existed that OS might alter oocyte quality, as it leads to recuperate, and inseminate, oocytes bound for atresia.
Erratum In the article by Cui et al., “Antimüllerian hormone: correlation with age and androgenic and metabolic factors in women from birth to postmenopause” (Fertil Steril 2016;105:481-5), the unit of AMH should be μg/L instead of mg/L. The number values in the article are correct. The authors apologize for the error.
Fibroids: when should they be removed to improve in vitro fertilization success? Uterine fibroids are extremely common smooth muscle tumors found in women of reproductive age. Over 75% of women will develop fibroids prior to menopause. A continued challenge is determining when fibroids are problematic and involved in the etiology of infertility, rather than an incidental finding. Fibroids are classified based on their size and location within the uterus (1). Fibroids that are intracavitary (i.e., entirely within the uterine lumen) or that project into the cavity and significantly distort its shape have been clearly associated with infertility.
Recognizing and eliminating bias in those with elevated body mass index in women's health care My worst healthcare experience was with a new OB/GYN at my appointment to confirm my first pregnancy. I was elated and couldn't wait to have the doctor congratulate me, but instead she told me that I was a detriment to my unborn child because I was going to be an overweight mother, and that my baby deserved better. I left the office crushed and heartbroken. If I hadn't needed to seek medical treatment to ensure a healthy pregnancy, I would have never returned. I requested a new doctor and filed a complaint with the hospital, but I never heard anything back from them.
Programming the endometrium for deferred transfer of cryopreserved embryos: hormone replacement versus modified natural cycles Over the last decade the use of frozen–thawed embryo transfer has substantially increased, and currently up to one in two embryos transferred has been cryopreserved. To support implantation, endometrial and embryo maturity are required to be synchronized. This can be achieved in various ways. The most commonly applied endometrial preparation methods are the “natural cycle,” in which the sequential estrogen and P necessary for endometrial maturation are derived from the developing follicle, and the “artificial” cycle, in which these are sequentially administered.
Is hope on the horizon for premature ovarian insufficiency? Few conditions in reproductive medicine have greater potential to destroy the hope and dreams of parenthood than premature ovarian failure or insufficiency. Patients often view this diagnosis as an insurmountable obstacle on their path to achieving pregnancy. Even when they are counseled regarding the potential for pregnancy, they report a hopeless loss of control. Previous authors have stressed the inaccuracy of the term ovarian “failure” describing it as medically misleading and even offensive and psychologically hurtful, with patients experiencing feelings akin to learning about the death of a family member when given this diagnosis.
What is a person with depression who wants to have a baby to do? It is well established that infertility, and the process of going through fertility treatment, is associated with psychological distress, and with depression in particular (1). Of course, one of the primary methods used to treat depression is medication. In the U.S. antidepressants are one of the most frequently prescribed types of mediation, with selective serotonin reuptake inhibitors (SSRIs) being the most common class. This begs the question, should fertility treatment patients (or pregnant women) struggling with depression be treated with antidepressant medications? What are the risks versus the benefits?
Non-coding RNAs: an important regulatory mechanism in pathogenesis of uterine fibroids Uterine fibroids (UFs; also known as leiomyomas) are the most common benign neoplastic threat to women's health in U.S. and worldwide, with annual health care costs estimated in the hundreds of billions of dollars. UF-caused morbidities negatively impacts women of all ethnicities, but disproportionately affect African-American women, who have a 3- to 4-fold higher incidence rate and relative risk of UFs than Caucasian women. These tumors can grow and cause severe adverse health outcomes such as excessive vaginal bleeding, pelvic pain, as well as urinary and bowel compression with a major negative effects on women's quality of life (1).
Better together than alone: the cumulus benefits The sperm, the lesser regarded gamete in embryology since intracytoplasmic sperm injection (ICSI) was introduced in the 1990s, has not attracted sufficient attention in the last 20 years (1). With the increasing proportion of cycles undergoing ICSI, why is ICSI used so widely? Can we justify the increased trust in ICSI over conventional in vitro fertilization (IVF)? The natural selection of sperm in conventional IVF is attractive. Can the ICSI process be improved by accounting for this natural selection?
Big data approach to evaluation of birth defects and assisted reproductive technology: the Chinese linkage cohort In the article by Hui-ting et al. (1) a regional registry is utilized to define a cohort of over 2 million births. By using China's national identifier of individual parents, this regional registry links to detailed clinical information from a single large in vitro fertilization (IVF) center, providing conception and birth outcomes on more than 6,000 assisted reproductive technology (ART) births. We commend the authors for managing an extensive database and analyzing a formidable amount of patient information.
Old insights, same questions The thing that hath been, it is that which shall be; and that which is done is that which shall be done: and there is no new thing under the sun.—Ecclesiastes 1:9, King James Bible
Introduction The increasing utilization of a gonadotropin-releasing hormone agonist ovulation trigger and the widespread use of artificial cycles for the transfer of frozen–thawed or donated embryos has renewed interest in the luteal phase in assisted reproductive technology. The “luteal phase defect” phenomenon is now understood as a continuum: there is less impairment with milder stimulation than with more intense ovarian stimulation, and less impairment after controlled ovarian stimulation and human chorionic gonadotropin ovulation triggering than after gonadotropin-releasing hormone agonist ovulation triggering, the latter being associated with rapid luteolysis.
Erratum In the article by Maggiore et al., “Obstetrical complications of endometriosis, particularly deep endometriosis” (Fertil Steril 2017;108: 895-912), several of the authors’ affiliations are listed incorrectly. The correct affiliations are as follows:
Marijuana and reproduction: time to raise the evidence bar to a new high In 2016, 20.8% of 18–25-year olds and 7.2% of adults ≥26 years reported using marijuana in the past month, making it the most commonly used recreational drug in the United States (1). Public support for legal recreational use of marijuana in the United States increased fivefold between 1969 and 2017 (from 12%–61%) and nearly doubled between 2000 and 2017 (from 31%–61%) (2), concurrent with a growing perception that marijuana poses no health hazards. During a comparable period (2002 to 2014), self-reported use of marijuana during the past month increased by 62% (from 2.4%–3.9%) among pregnant women and by 47% (from 6.3%–9.3%) among nonpregnant women of reproductive age (3).
Dietary patterns are positively associated with semen quality To study association of semen quality with a priori whole dietary pattern indexes, which reflect real-world dietary practices and the numerous combinations by which foods are consumed: Healthy Eating Index (HEI), Dietary Approaches to Stop Hypertension (DASH), alternate Mediterranean Diet score (aMED), and Alternative Healthy Eating Index (AHEI).
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