Oncological and Reproductive Outcomes of Fertility-sparing Surgery in Women with Early-stage Epithelial Ovarian Carcinoma:A Multicenter Retrospective Study

Summary:With delayed childbearing in women,preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma(EOC).Fertility-sparing surgery(FSS)can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life.In order to evaluate oncological safety,attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS,this multicenter retrospective study was conducted.Between January 2005 and December 2014,total of 87 young women with FIGO stage I EOC were included,with their clinicopathologic parameters in relation to disease-free survival(DFS)and overall survival(OS)assessed.Attitudes toward childbearing,ovarian function and fertility were studied in women undergoing FSS(n=36).As a result,in contrast to radical sur ery,FSS did not affect prognosis by Kaplan-Meier curves(log-rank test;DFS:P=0.484;OS:P=0.125).However,two of the three recurrence cases and both death cases were in FSS group stage IC.All women undergoing FSS resumed regular menstrual periods after chemotherapy.Only 16(44.44%)had tried to conceive,and 17 pregnancies occurred in 15(93.75%)women.Among 20 women who did not attempt conception,the most common reason was not being married(70%),followed by already having children(15%).In summary,FSS is considered safe in young women with stage IA EOC.Regular menstruation and good obstetric outcomes can be achieved.This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.

The effects of advanced paternal age on fertility

Modern societal pressures and expectations over the past several decades have resulted in the tendency for couples to delay conception. While women experience a notable decrease in oocyte production in their late thirties, the effect of age on spermatogenesis is less well described. While there are no known limits to the age at which men can father children, the effects of advanced paternal age are incompletely understood. This review summarizes the current state of knowledge regarding advanced paternal age and its implications on semen quality, reproductive success and offspring health. This review will serve as a guide to physicians in counseling men about the decision to delay paternity and the risks involved with conception later in life.

Association of the microbial culture of follicular fluid,vaginal swab and catheter tip with β-hCG IVF positive and negative

Objective:To find out the association of microbial contamination withβ-human chorionic gonadotropin(β-hCG)in-vitro fertilization(IVF)positive and negative.Methods:A total of 73 fresh IVF cycle women were included in the retrospective study.Vaginal swab culture samples were collected prior to ovum pick-up and embryo transfer.The follicular fluids were collected during ovum pick-up and catheter tip culture samples were collected after successful embryo transfer.After 14 days of the embryo transfer,women were classified intoβ-hCG IVF positive and negative.The comparative statistical analyses of aerobic microbial culture reports were done betweenβ-hCG IVF positive and negative women.Results:Out of 73 women,42(57.5%)were found to beβ-hCG IVF positive and 31(43.5%)were negative.In the aerobic culture of ovum pick-up vaginal swab,follicular fluid,embryo transplantation vaginal swab and catheter tip,Enterococcus faecalis was found to be higher compared to other bacteria(Streptococcus spp.,Candida,Escherichia coli and Klebsiella).Regarding the comparison between IVF positive and negative,the overall microbial infection rate of vaginal swab culture during ovum pick-up and embryo transplantation was found to be higher in IVF negative women than in IVF positive women(38.71%vs.28.57%);however,it was not statistically significant(P>0.05).The follicular fluid and catheter tip culture microbial infection rate was found to slightly higher in IVF positive women than in IVF negative women(54.76%vs.41.94%and 19.05%vs.9.68%,respectively),but there were not significant differences(P>0.05).Conclusions:The aerobic microbial culture reports of follicular fluid,vaginal swab culture,and catheter tip culture are not statistically significantly withβ-hCG IVF positive.

Placenta Accreta Spectrum:Conservative Management and Its Impact on Future Fertility

Placenta accreta spectrum is a complication of pregnancy,which poses a great risk on maternal health.Historically,hysterectomy was the modality of treatment of such condition,but an approach towards a more conservative management has been in the light recently.This includes several methods with varying rates of success and complications.Expectant management is effective in up to 78%–80%of the cases.The extirpative method is associated with a high risk of postpartum hemorrhage.The success of the onestep conservative procedure depends on the degree of placental invasion,and the triple-P procedure appears to be successful but requires and interdisciplinary approach.Adjuvant treatment options can be tailored according to individual cases,and these include methotrexate injection,uterine devascularization and hysteroscopic resection of retained placental tissues.Follow up after conservative management is crucial to detect complications early,and it can be done by ultrasound,Doppler examination,and trending b human chorionic gonadotropin levels.Conservative management of placenta accreta spectrum can preserve future fertility but should only be done in hospitals with enough experience as it carries a high risk of maternal complications.In the future,more research should be directed to achieve clear guidelines regarding this topic.

Sperm-specific protein ACTL7A as a biomarker for fertilization outcomes of assisted reproductive technology

Obtaining high-quality embryos is one of the key factors to improve the clinical pregnancy rate of assisted reproductive technologies(ART).So far,the clinical evaluation of embryo quality depends on embryo morphology.However,the clinical pregnancy rate is still low.Therefore,new indicators are needed to further improve the evaluation of embryo quality.Several studies have shown that the decrease of sperm-specific protein actin-like 7A(ACTL7A)leaded to low fertilization rate,poor embryo development,and even infertility.The aim of this study was to study whether the different expression levels of ACTL7A on sperm can be used as a biomarker for predicting embryo quality.In this study,excluding the factors of severe female infertility,a total of 281 sperm samples were collected to compare the ACTL7A expression levels of sperms with high and low effective embryo rates and analyze the correlation between protein levels and in-vitro fertilization(IVF)laboratory outcomes.Our results indicated that the ACTL7A levels were significantly reduced in sperm samples presenting poor embryo quality.Furthermore,the protein levels showed a significant correlation with fertilization outcomes of ART.ACTL7A has the potential to be a biomarker for predicting success rate of fertilization and effective embryo and the possibility of embryo arrest.In conclusion,sperm-specific protein ACTL7A has a strong correlation with IVF laboratory outcomes and plays important roles in fertilization and embryo development.