Oocyte Donation

卵母细胞捐赠
  • 文章类型: Journal Article
    背景:输精管结扎术是一种广泛使用的避孕方法。然而,有些男人可能有一段时间后再次成为亲生父亲的愿望。
    目的:通过使用睾丸精子提取获得的睾丸精子,研究输精管切除术后的时间和不同的男性合并症对卵胞浆内单精子注射周期活产率的影响。
    方法:这是一项对123对夫妇的回顾性研究,他们在输精管切除术后使用捐赠的卵母细胞进行了睾丸精子提取-卵胞浆内精子注射周期。根据输精管切除术后的时间将受试者分组,并评估男性危险因素。测量的主要结果是每次胚胎移植的活产率,每个卵母细胞捐献周期,和每一对夫妇。我们根据输精管切除术后的时间评估了累积活产率,并考虑了男性合并症:体重指数,高血压,糖尿病,血脂异常,和吸烟。
    结果:每对夫妇的总体活产率为59.3%(50.6-68.0)。考虑到胚胎移植和卵母细胞捐献周期的数量,活产率分别为34.1%(27.8-40.4)和44.5%(36.9-52.1),分别。两组之间的输精管切除术后的活产率没有统计学差异。因此,在考虑1~8个胚胎移植时,不同间隔时间的累积活产率相似(p=0.74).根据男性体重指数,各组之间的活产率和累积活产率没有统计学差异。吸烟,高血压,和血脂异常。然而,糖尿病男性患者每对夫妇的活产率(22.2%[4.94-49.4])明显低于非糖尿病患者(62.7%[53.7-71.8])(p=0.03),但不是他们的累计活产率。
    结论:在睾丸精子提取-卵胞浆内单精子注射周期中,输精管切除术后的时间似乎对活产率和累积活产率没有不利影响。男性糖尿病对每对夫妇的总体活产率产生负面影响,但不是累计活产率。这些结果可能对多学科患者定制咨询有用,关于怀孕的机会和促进生育专家的决策过程。
    BACKGROUND: Vasectomy is a widely used method of contraception. However, some men may have the desire to become biological fathers again after a period.
    OBJECTIVE: To explore the effect of time since vasectomy and different male comorbidities on live birth rates from intracytoplasmic sperm injection cycles using donated oocytes by using testicular spermatozoa obtained by testicular sperm extraction.
    METHODS: This was a retrospective study of 123 couples who underwent a testicular sperm extraction‒intracytoplasmic sperm injection cycle after vasectomy using donated oocytes. Subjects were divided into groups according to time since vasectomy and the male risk factor evaluated. The main outcomes measured were live birth rate per embryo transfer, per oocyte donation cycle, and per couple. We assessed the cumulative live birth rate according to the time since vasectomy and considered male comorbidities: body mass index, hypertension, diabetes mellitus, dyslipidemia, and smoking.
    RESULTS: The overall live birth rate per couple was 59.3% (50.6-68.0). Considering the number of embryo transfer and oocyte donation cycle, the live birth rates were 34.1% (27.8-40.4) and 44.5% (36.9-52.1), respectively. The live birth rate according to time since vasectomy was not statistically different between groups. Consequently, the cumulative live birth rate was similar between the different interval times when considering one to eight embryo transfers (p = 0.74). No statistical differences in live birth rate and cumulative live birth rate were found between groups clustered according to male body mass index, smoking, hypertension, and dyslipidemia. However, diabetic male patients had a significantly lower rate of live birth rate per couple (22.2% [4.94-49.4]) than non-diabetic patients did (62.7% [53.7-71.8]) (p = 0.03), but not in their cumulative live birth rate.
    CONCLUSIONS: The time since vasectomy seems to have no detrimental effects on the live birth rate and cumulative live birth rate in testicular sperm extraction‒intracytoplasmic sperm injection cycles with donated oocytes. Male diabetes negatively affects the overall live birth rate per couple, but not the cumulative live birth rate. These results could be useful for multidisciplinary patient-tailored counseling, regarding the chance of having a pregnancy and facilitating the decision-making process of the fertility specialists.
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  • 文章类型: Journal Article
    目标:2015年,辅助生殖技术(ART)占美国所有新生儿的1.7%,供体卵子占2015年开始周期的17000多个,供体精子占2014年开始周期的6.2%.随着供体配子作为一种辅助不孕症患者的方法的利用越来越多,每年利用配子捐赠出生的婴儿数量也将继续增加。这项研究旨在阐明影响捐赠决定的因素,代表全国人口。
    方法:使用符合HIPAA的SurveyMonkeyEnterprise通过互联网分发了一项调查。在每个人口统计学和个人特征与捐赠意愿之间进行单变量回归和频率。对数二项式和线性回归用于分类和连续变量,并计算了风险比。
    结果:在这项大型调查研究中,64%的男性和50%的女性表示他们愿意捐赠配子,大多数人希望得到金钱补偿。消费者金融保护局得分高的男性不太可能报告他们会考虑捐赠精子,而CFPB得分中等。没有其他财务指标与考虑捐赠精子有关。CFPB评分和卵子捐赠结果之间没有关联。与其他群体相比,黑人或非裔美国女性不太可能考虑捐赠卵子,更有可能想要>5000美元的补偿。
    结论:在这项大型调查研究中,一小部分参与者报告说,他们愿意捐赠给一个未知的不孕症患者用于生殖目的。高和非常高的CFPB分数与捐赠游戏的意愿有关,但不希望获得金钱补偿或金额。
    OBJECTIVE: In 2015, assisted reproductive technology (ART) accounted for 1.7% of all U.S. births, donor eggs accounted for over 17,000 started cycles in 2015, and donor sperm accounting for 6.2% of all cycles started in 2014. With increasing utilization of donor gametes as a method of assisting patients with infertility, the number of babies born each year utilizing gamete donation will also continue to increase. This study aimed to elucidate factors impacting decision to donate, amongst a representative national population.
    METHODS: A survey was distributed via the internet utilizing SurveyMonkey Enterprise with HIPAA compliance. Univariate regressions and frequencies were conducted between each demographic and personal characteristic and the willingness to donate. Log Binomial and linear regression was used categorical and continuous variables, and Risk ratios were calculated.
    RESULTS: In this large survey study, 64% of men and 50% of women reported they would be willing to donate gametes, with the majority desiring monetary compensation. Men with a high Consumer Financial Protection Bureau score were less likely to report that they would consider donating sperm compared to a medium high CFPB score. No other financial indicators were associated with considering donating sperm. There were no associations between CFPB score and egg donation outcomes. Black or African American women were less likely to consider donating their eggs compared to other groups, and more likely to desire > $5000 in compensation.
    CONCLUSIONS: In this large survey study, a small minority of participants reported they would be willing to donate to an unknown infertility patient for reproductive purposes. High and very high CFPB scores were associated with willingness to donate games, but not with desire for monetary compensation or amount.
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  • 文章类型: Journal Article
    这项研究试图调查身份释放卵母细胞捐赠(OD)后是否异性恋夫妇父母与青春期孩子,精子捐赠(SD)或标准试管婴儿在心理困扰方面有所不同,家庭功能,和父子关系。瑞典配子捐赠的前瞻性纵向研究包括在2005年至2008年之间从七家提供配子捐赠的瑞典大学医院开始治疗时招募的夫妇。这项研究涉及第五波数据收集,包括总共205名母亲和父亲,他们在OD(n=73)之后有青春期的孩子,SD(n=67),或IVF与自己的配子(n=65)。OD/SD父母使用了身份释放捐赠,大多数人都向他们的孩子透露了捐赠者的概念。父母回答了经过验证的测量焦虑和抑郁症(HADS)症状的仪器,家庭功能(GF6+)和亲子关系。结果发现,OD或SD后的父母在焦虑和抑郁症状方面与IVF父母没有显着差异,家庭功能,与孩子的亲密关系和冲突。无论治疗组如何,大多数父母在心理困扰和家庭功能方面都在正常范围内,并报告了积极的亲子关系。然而,与OD母亲相比,SD母亲在更大程度上报告了高于临界值的焦虑症状(31%vs.7.3%,p=0.018)。总之,本研究结果增加了以前的研究,包括身份释放卵母细胞和精子捐赠后有青春期儿童的家庭,他们中的大多数人都知道他们的捐赠者的概念。很大程度上,我们的结果证实,使用配子捐赠不会对母亲和父亲的心理健康和感知的家庭功能产生负面影响.
    This study sought to investigate if heterosexual-couple parents with adolescent children following identity-release oocyte donation (OD), sperm donation (SD) or standard IVF differed with regard to psychological distress, family functioning, and parent-child relationships. The prospective longitudinal Swedish Study on Gamete Donation consists of couples recruited when starting treatment between 2005 and 2008 from seven Swedish university hospitals providing gamete donation. This study concerns the fifth wave of data collection and included a total of 205 mothers and fathers with adolescent children following OD (n = 73), SD (n = 67), or IVF with own gametes (n = 65). OD/SD parents had used identity-release donation and most had disclosed the donor conception to their child. Parents answered validated instruments measuring symptoms of anxiety and depression (HADS), family functioning (GF6+) and parent-child relationship. Results found that parents following OD or SD did not differ significantly from IVF-parents with regard to symptoms of anxiety and depression, family functioning, and perceived closeness and conflicts with their child. Irrespective of treatment group, most parents were within normal range on psychological distress and family functioning and reported positive parent-child relationships. However, SD mothers to a larger extent reported anxiety symptoms above cut-off compared to OD mothers (31% vs. 7.3%, p = 0.018). In conclusion, the present results add to previous research by including families with adolescent children following identity-release oocyte and sperm donation, most of whom were aware of their donor conception. Largely, our results confirm that the use of gamete donation does not interfere negatively with mothers\' and fathers\' psychological well-being and perceived family functioning.
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  • 文章类型: Journal Article
    背景:卵母细胞捐献(OD)妊娠伴随着高血压并发症的高发生率,对母亲和孩子造成严重后果。最佳护理管理,涉及早期识别,优化合适的治疗方案,并可能最终预防,需求很高。预测OD中高血压并发症的患者特异性危险因素可以为此提供依据。本项目旨在建立首个OD妊娠高血压并发症风险预测模型。
    方法:本研究是在生殖中卵母细胞的DONation项目中进行的。对于这项多中心队列研究,将招募至少541例OD妊娠。将收集基线特征和产科数据。此外,将获得一份分娩后的母体外周血和脐带血样本或儿童的唾液样本,为了确定胎儿-母体人类白细胞抗原错配的数量。收集数据后,将为二元结局高血压并发症\'是\'和\'否\'建立多变量逻辑回归模型.预测模型风险偏差评估工具将被用作指南,以最大程度地降低偏差风险。该研究将按照“个人预后或诊断多变量预测模型的透明报告”指南进行报告。将确定鉴别和校准以评估模型性能。将使用引导方法执行内部验证。外部验证将使用“生殖个体参与者数据中卵母细胞的DONation”数据集进行。
    背景:这项研究得到了医学伦理委员会LDD的批准(莱顿,DenHaag,代尔夫特),方案编号P16.048和一般评估注册(ABR)编号NL56308.058.16。进一步的结果将通过同行评审的期刊和国际会议分享。
    BACKGROUND: Oocyte donation (OD) pregnancy is accompanied by a high incidence of hypertensive complications, with serious consequences for mother and child. Optimal care management, involving early recognition, optimisation of suitable treatment options and possibly eventually also prevention, is in high demand. Prediction of patient-specific risk factors for hypertensive complications in OD can provide the basis for this. The current project aims to establish the first prediction model on the risk of hypertensive complications in OD pregnancy.
    METHODS: The present study is conducted within the DONation of Oocytes in Reproduction project. For this multicentre cohort study, at least 541 OD pregnancies will be recruited. Baseline characteristics and obstetric data will be collected. Additionally, one sample of maternal peripheral blood and umbilical cord blood after delivery or a saliva sample from the child will be obtained, in order to determine the number of fetal-maternal human leucocyte antigen mismatches. Following data collection, a multivariate logistic regression model will be developed for the binary outcome hypertensive complication \'yes\' and \'no\'. The Prediction model Risk Of Bias ASsessment Tool will be used as guide to minimise the risk of bias. The study will be reported in line with the \'Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis\' guideline. Discrimination and calibration will be determined to assess model performance. Internal validation will be performed using the bootstrapping method. External validation will be performed with the \'DONation of Oocytes in Reproduction individual participant data\' dataset.
    BACKGROUND: This study is approved by the Medical Ethics Committee LDD (Leiden, Den Haag, Delft), with protocol number P16.048 and general assessment registration (ABR) number NL56308.058.16. Further results will be shared through peer-reviewed journals and international conferences.
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  • 文章类型: Journal Article
    目标:比利时育龄妇女对去核卵子捐赠的态度如何?妇女捐赠去核卵子或全卵的意愿是否不同?
    方法:2022年,对比利时1000名18-50岁妇女的代表性样本进行了在线调查。关于匿名捐赠去核卵子的意愿被分为愿意捐赠和不愿意捐赠或不确定的人。
    结果:捐赠去核卵和全卵(无论是匿名还是可识别)的意愿之间没有统计学上的显着差异。匿名,然而,影响了捐赠的意愿,愿意捐赠的女性要少得多。如果他们捐赠去核卵子,受访者对他们的父母身份存在分歧,不到一半(44%)的人不认为自己是遗传母亲。与其他人相比,愿意匿名捐赠去核卵子的女性不太可能将自己视为孩子的遗传母亲。不到五分之一的人认为该技术不可接受,因为由此产生的孩子将携带三人的遗传物质。
    结论:普通人群中的女性并没有表现出比全卵更愿意捐赠去核卵。受访者在是否认为自己是孩子的遗传母亲方面存在强烈分歧,这一事实可以解释这一结果。其他因素,比如孩子的潜在高风险,也可能导致意愿降低。
    OBJECTIVE: What is the attitude of Belgian women of reproductive age towards enucleated egg donation? Does the willingness of women to donate differ when they would donate enucleated or whole eggs?
    METHODS: In 2022, an online survey was conducted among a representative sample of 1000 women in Belgium aged 18-50 years. The item on willingness to anonymously donate enucleated eggs was dichotomized into those willing to donate and those not willing to donate or uncertain.
    RESULTS: No statistically significant difference was found between the willingness to donate enucleated eggs and whole eggs (whether anonymously or identifiably). Anonymity, however, affected the willingness to donate, with considerably fewer women willing to donate identifiably. The respondents were divided about their parental status if they were to donate enucleated eggs, with less than one-half (44%) not considering themselves to be a genetic mother. Women willing to donate enucleated eggs anonymously were less likely to view themselves as a genetic mother of the child compared with others. Fewer than one in five considered the technique unacceptable because the resulting child would carry genetic material of three persons.
    CONCLUSIONS: Women in the general population did not show a greater willingness to donate enucleated eggs than whole eggs. The fact that the respondents were strongly divided on whether or not they would consider themselves to be a genetic mother of the resulting child may explain this result. Other factors, such as the potential high risk for the child, may also have contributed to less willingness.
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  • 文章类型: Journal Article
    背景和目的:我们单中心队列研究的目的是确定子宫内灌洗粒细胞集落刺激生长因子(G-CSF)对植入失败病史超过40岁的患者临床妊娠率的影响。材料和方法:该研究于2018年5月至2020年6月在布拉格SEFerticare进行。总的来说,115名患者被分成两臂,有48名受试者在实验中,67名受试者在控制臂中。所有女性都有过不孕症治疗失败的历史,他们自己的遗传物质和至少一个无效周期与捐赠的卵母细胞。在胚胎移植前120至48小时,实验臂接受了0.5mL纯G-CSF的子宫内灌洗。结果:实验组的临床妊娠率为63.3%,对照组为47.8%(Pearsonsχ2p=0.097,Fisher精确检验p=0.133)。然而,胚胎移植当天的平均子宫内膜厚度没有统计学差异(p=0.139).只有子宫内膜厚度增长的差异有统计学意义(p=0.023)。怀孕率的提高对未来来说仍然令人鼓舞,即使它并不重要。结论:我们的研究表明,在胚胎移植前120-48小时内,宫内G-CSF灌洗后妊娠率有增加的趋势。
    Background and Objectives: The aim of our single-center cohort study was the determination of the influence of the intrauterine lavage of granulocyte colony-stimulating growth factor (G-CSF) on clinical pregnancy rate in patients with a history of implantation failure older than 40 years. Materials and Methods: The study was conducted in Ferticare Prague SE between May 2018 and June 2020. Overall, 115 patients were distributed into two arms, with 48 subjects in the experimental and 67 in the control arm. All women have had a previous history of unsuccessful history of infertility treatment with their own genetic material and at least one ineffective cycle with the donated oocytes. The experimental arm underwent the intrauterine lavage of 0.5 mL of pure G-CSF from 120 to 48 h prior to embryo transfer. Results: The clinical pregnancy rate was 63.3% in the experimental arm and 47.8% in the control arm (p = 0.097 for Pearsonߣs χ2, and p = 0.133 for Fisher\'s exact test). However, the mean endometrial thickness on the day of embryo transfer did not appear to be statistically different (p = 0.139). Only the difference in endometrium thickness growth was statistically significant (p = 0.023). The increase in pregnancy rate is still encouraging for the future, even if it is not significant. Conclusion: Our study suggests the trend of increased pregnancy rate after the intrauterine G-CSF lavage in the interval of 120-48 h prior to embryo transfer.
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  • 文章类型: Journal Article
    目的:评估是否可以改善卵巢内注射富血小板血浆(PRP)的反应不良者的卵巢储备参数和卵母细胞回收。
    方法:前瞻性队列研究。我们包括148名在2021年10月至2022年12月期间接受PRP注射的不良反应者,比较PRP前后卵巢功能。此外,与之前的治疗相比,在干预后研究了一组患者的IVF结局.
    结果:观察到卵巢储备与以前的值有关:FSH(13.57vs.11.32,p=0.11),AMH(0.39vs.0.48,p=0.06),窦卵泡计数(3.98vs.5.75,p<0.001);以及更多的卵母细胞回收(2.63vs.3.65,p=0.01)和产生的胚胎(1.64vs.2.22,p=0.03);对怀孕率没有很大影响。
    结论:虽然是实验性的,卵巢内PRP可恢复卵巢功能,对于不接受该治疗的低卵巢储备患者,可替代卵母细胞捐献.缺乏支持这些发现的随机对照试验。
    OBJECTIVE: To evaluate if it possible to improve ovarian reserve parameters and oocyte retrieval in poor responders who undergo intraovarian injection of platelet-rich plasma (PRP).
    METHODS: Prospective cohort study. We included 148 poor responders who underwent PRP injection between October 2021 and December 2022 in our institution, comparing pre and post PRP ovarian function. In addition, the IVF outcomes of a subgroup of patients was studied after the intervention in contrast with the previous treatment.
    RESULTS: An improvement in ovarian reserve was observed in relation to previous values: FSH (13.57 vs. 11.32, p=0.11), AMH (0.39 vs. 0.48, p=0.06), antral follicle count (3.98 vs. 5.75, p<0.001); as well as a higher number of oocytes retrieved (2.63 vs. 3.65, p=0.01) and produced embryos (1.64 vs. 2.22, p=0.03); without a great impact on pregnancy rates.
    CONCLUSIONS: Although experimental, intraovarian PRP could restore ovarian function and be postulated as an alternative to oocyte donation in patients with low ovarian reserve who do not accept this treatment. There is a lack of randomized controlled trials to support these findings.
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  • 文章类型: Journal Article
    背景:配子和胚胎供体面临着影响其健康和生活质量的复杂挑战。医疗保健提供者需要获得结构良好、以证据为基础,以及基于需求的指导,以照顾配子和胚胎捐献者。因此,本系统综述旨在综合目前关于捐赠者管理和护理的辅助生殖指南和第三方生殖指南.
    方法:ISI的数据库,PubMed,Scopus,使用“第三方生殖”关键字搜索与辅助生殖相关的组织网站,“配子捐赠”,“胚胎捐赠”,\"指南\",“委员会意见”,和“最佳实践”,没有时间限制到2023年7月。研究中包括了以英语编写的关于配子和胚胎供体的管理和护理的所有临床或伦理指南以及最佳实践声明。使用AGREEII工具进行质量评估。审查了包含的文件,并对提取的数据进行了叙述合成。
    结果:在本系统综述中,对14个相关文件进行了综述,其中8个是指南,三个是执业守则,三个是委员会意见。在美国开发了五份文件,三个在加拿大,两个在英国,一个在澳大利亚,还有一个在澳大利亚和新西兰。此外,发现了欧洲人类生殖和胚胎学学会制定的两项指南。为捐助者提供的管理和护理分为四类,包括筛查,咨询,信息提供,和道德考虑。
    结论:虽然目前的指南包括一些关于在筛查中配子/胚胎供体的管理和护理的建议,咨询,信息提供,和道德考虑,然而,一些缺点需要解决,包括捐助者的心理社会需求,捐赠的长期影响,捐赠者的后续护理,以及捐赠的法律和人权方面。因此,需要进行强有力和精心设计的研究,以填补有关配子和胚胎供体需求的知识空白,通过制定循证指南来告知当前的做法。配子和胚胎供体面临着影响其健康和生活质量的复杂挑战。为了应对这些挑战,医疗保健提供者需要基于证据和捐赠者实际需求的指南。为了制定满足捐助者需求的全面准则;重要的是审查当前的准则。所以,在这项研究中,我们回顾了目前关于供体管理和护理的辅助生殖指南和第三方生殖指南.我们搜索了数据库和相关网站,发现了14个相关文献。这些指南中建议管理和照顾捐赠者的主要主题包括筛查,咨询,信息提供,和道德考虑。我们认识到,这些文件忽略了一些捐助者的需求,包括捐助者的社会心理需求,捐赠对捐赠者的长期影响,他们的后续关怀,以及捐赠的法律和人权方面。因此,需要进一步研究,以根据捐助者未满足的需求制定指导方针。
    BACKGROUND: Gamete and embryo donors face complex challenges affecting their health and quality of life. Healthcare providers need access to well-structured, evidence-based, and needs-based guidance to care for gamete and embryo donors. Therefore, this systematic review aimed to synthesize current assisted and third-party reproduction guidelines regarding management and care of donors.
    METHODS: The databases of ISI, PubMed, Scopus, and websites of organizations related to the assisted reproduction were searched using the keywords of \"third party reproduction\", \"gamete donation\", \"embryo donation\", \"guidelines\", \"committee opinion\", and \"best practice\", without time limit up to July 2023. All the clinical or ethical guidelines and best practice statements regarding management and care for gamete and embryo donors written in the English language were included in the study. Quality assessment was carried using AGREE II tool. Included documents were reviewed and extracted data were narratively synthesized.
    RESULTS: In this systematic review 14 related documents were reviewed of which eight were guidelines, three were practice codes and three were committee opinions. Five documents were developed in the United States, three in Canada, two in the United Kingdom, one in Australia, and one in Australia and New Zealand. Also, two guidelines developed by the European Society of Human Reproduction and Embryology were found. Management and care provided for donors were classified into four categories including screening, counseling, information provision, and ethical considerations.
    CONCLUSIONS: While the current guidelines include some recommendations regarding the management and care of gamete/embryo donors in screening, counseling, information provision, and ethical considerations, nevertheless some shortcomings need to be addressed including donors\' psychosocial needs, long-term effects of donation, donors\' follow-up cares, and legal and human rights aspects of donation. Therefore, it is needed to conduct robust and well-designed research studies to fill the knowledge gap about gamete and embryo donors\' needs, to inform current practices by developing evidence-based guidelines.
    Gamete and embryo donors face complex challenges affecting their health and quality of life. To manage these challenges, healthcare providers need guidelines that are based on evidence and donors’ real needs. In order to develop a comprehensive guideline that meets the needs of donors; it is important to review the current guidelines. So, in this study we reviewed the current assisted and third-party reproduction guidelines regarding management and care of donors. We searched databases and relevant websites and found 14 related documents. The main topics recommended for management and care of donors in these guidelines included screening, counseling, information provision, and ethical considerations. We recognized that some of donors’ needs are neglected in these documents including donors’ psychosocial needs, long-term effects of donation on donors, their follow-up cares, and legal and human rights aspects of donation. Therefore, there is need for further research to develop guidelines based on donors’ unmet needs.
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  • 文章类型: Journal Article
    目标:许多患有特纳综合征(TS)的女性会考虑生育选择和怀孕。我们希望在大型单中心队列中检查接受卵母细胞捐赠(OD)治疗或自发性妊娠的TS女性的生育力和妊娠结局。一般人群参考数据或特发性早熟卵巢功能不全患者的数据用作比较。
    方法:回顾性单中心横断面研究。
    方法:74名患有TS的妇女接受了OD治疗,总共105次怀孕,31名TS女性有71个自发概念。生育结局包括临床妊娠和活产率。妊娠结局包括流产率,高血压患病率,妊娠期糖尿病,下段剖宫产术(LSCS),小于胎龄(SGA),TS的早产和垂直传播。
    结果:在有TS的人中,与自发性妊娠相比,OD妊娠与LSCS和SGA的发生率增加相关;LSCS(OR:4.19,95%CI:1.6-10.8,p=.003)和SGA(OR:2.92,95%CI:1.02-8.38,p=.04)。没有记录的心脏事件,但发现了5例(17.2%)女儿中TS的垂直传播。与POI女性相比,TS患者的OD与每个周期开始的活产率较低相关(OR:0.53,95%CI:0.34-0.84,p=.008),流产率较高(40%vs.26.2%,p=.04)。
    结论:我们表明,患有TS的女性怀孕,无论是OD还是自发受孕,有产科风险,因此,有TS的女人,考虑到怀孕,应接受全面的孕前咨询和最佳的产科护理。
    OBJECTIVE: Many women with Turner syndrome (TS) will consider fertility options and pregnancy. We wished to examine the fertility and pregnancy outcomes in women with TS undergoing oocyte donation (OD) treatment or spontaneous pregnancy in a large single-centre cohort. General population reference data or data from those with idiopathic premature ovarian insufficiency were used as comparators.
    METHODS: A retrospective single-centre cross-sectional study.
    METHODS: Seventy-four women with TS underwent OD treatment with a total of 105 pregnancies, and 31 women with TS had 71 spontaneous conceptions. Fertility outcomes included clinical pregnancy and live birth rate. Pregnancy outcomes included miscarriage rate, prevalence of hypertension, gestational diabetes, lower segment caesarean section (LSCS), small for gestational age (SGA), prematurity and vertical transmission of TS.
    RESULTS: In those with TS, OD pregnancies were associated with increased rates of LSCS and SGA compared to spontaneous pregnancies; LSCS (OR: 4.19, 95% CI: 1.6-10.8, p = .003) and SGA (OR: 2.92, 95% CI: 1.02-8.38, p = .04). There were no recorded cardiac events but 5 (17.2%) cases of vertical transmissions of TS in daughters were identified. OD in those with TS was associated with a lower live birth rate per cycle started (OR: 0.53, 95% CI: 0.34-0.84, p = .008) and a higher rate of miscarriage compared to women with POI (40% vs. 26.2%, p = .04).
    CONCLUSIONS: We show that pregnancy in women with TS, whether OD or spontaneously conceived, carries obstetric risks, and therefore, women with TS, considering pregnancy, should receive comprehensive pre-pregnancy counselling and optimal obstetric care.
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  • 文章类型: Journal Article
    生殖医学专业人员开展了大量工作,以提高人们对生育力保存(FP)技术的认识,尤其是对女性来说,并确保FP包括在治疗癌症或需要性腺毒性治疗的病理的年轻人的护理中。如果我们学科发展的重要性是显而易见的,我们支持FP的战斗性和我们的情绪预测不能让我们忘记医学思维不仅要逐案进行,权衡利益-风险平衡,但也不要忘记,用自己的配子怀孕一个孩子并不是一个至关重要的问题。与后代遗传联系的文化重要性可能会偏向患者和医生的决定,虽然存在其他实现父母身份的方法,而且往往更有效。应提供关于FP技术存在的系统信息,但这不应该导致它们的系统实施,也不应掩盖早期信息也将使患者开始选择替代方案成为父母的事实。
    A great deal of work has been carried out by professionals in reproductive medicine in order to raise awareness about fertility preservation (FP) techniques, particularly for women, and to ensure that FP is included in the care of young adults treated for cancer or a pathology requiring gonadotoxic treatment. If the importance of the development of our discipline is obvious, our militancy in favour of FP and our emotional projections must not make us forget that medical thinking must be carried out not only on a case-by-case basis, weighing up the benefit-risk balance, but also without losing sight that conceiving a child with one\'s own gametes is not a vital issue. The cultural importance given to the genetic link with offspring may bias patients\' and physicians\' decisions, while other ways of achieving parenthood exist, and are often more effective. Systematic information should be provided on the existence of FP techniques, but this should not lead to their systematic implementation, nor should it obscure that early information will also allow patients to begin projecting themselves in alternative options to become parents.
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