Our understanding of the composition of the microbial communities that inhabit the human body, known as the 'microbiome', is aided by the development of non-culture-dependent DNA sequencing. It is increasingly apparent that the balance of microbial species greatly affects the health of the host. Disturbances in the composition of bacterial communities have been shown to contribute to various disease states, and there is a growing body of evidence that the vaginal microbiota, which is unique to each woman, plays an important role in determining many facets of reproductive health. The purpose of this review is to investigate what is currently known about the composition of the vaginal microbiome, including what is considered 'normal' in terms of bacterial species and abundance. We will investigate the impact of vaginal microbiome composition on reproductive outcomes within the context of infertility treatments, and the implications this has been shown to have on assisted reproductive technology procedures.
BackgroundGonadotropins are used in ovulation induction (OI) for patients with anovulatory infertility. Pharmacologic OI is associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. Treatment protocols that minimize these risks by promoting monofollicular development are required. A starting dose of 37.5 IU/day follitropin alfa has been used in OI, particularly among women at high risk of multifollicular development and multiple pregnancy. A retrospective case series study was performed to evaluate rates of monofollicular development and singleton pregnancy following standard treatment with 37.5 IU/day follitropin alfa.MethodsSpanish centers that had performed at least five OI cycles during 2008 using 37.5 IU/day follitropin alfa as a starting dose were invited to participate. Data could be provided from any cycle performed in 2008 (up to a maximum of 12 consecutive cycles per site). Case report forms were collected during April-November 2009 and reviewed centrally. Descriptive statistics were obtained from all cases, and follicular development and clinical pregnancy rates assessed. Potential associations of age and body mass index with follicular development and clinical pregnancy were assessed using univariate correlation analyses.ResultsThirty centers provided data on 316 cycles of OI using a starting dose of 37.5 IU/day follitropin alfa. Polycystic ovary syndrome was the cause of anovulatory infertility in 217 (68.7%) cases. Follitropin alfa at 37.5 IU/day was sufficient to achieve ovarian stimulation in 230 (72.8%) cycles. A single follicle ≥16 mm in diameter developed in 193 cycles (61.1%; 95% confidence interval [CI] 55.7-66.4%). Seventy-eight women (24.7%; 95% CI 19.9-29.5%) became pregnant: 94.9% singleton and 5.1% twin pregnancies. Fourteen started cycles (4.4%) were cancelled, mainly due to poor response. Univariate correlation analyses detected weak associations.ConclusionsMonofollicular growth rate was comparable with optimal rates reported elsewhere and the pregnancy rate exceeded that in other studies of OI using gonadotropins. A starting dose of 37.5 IU/day follitropin alfa is an effective option in selected cases to prevent ovarian hyper-response without loss of efficacy. The analysis could not identify a single selection criterion for individuals who would benefit from this treatment approach; this merits further investigation in prospective studies.
Lactobacillus rhamnosus BPL5 (CECT 8800), is a probiotic strain suitable for the treatment of bacterial vaginosis. Here, we report its complete genome sequence deciphered by PacBio single-molecule real-time (SMRT) technology. Analysis of the sequence may provide insight into its functional activity.
Background: Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital are strategies to preserve fecundity.Methods: An online survey was sent to reproductive specialists and gynaecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients.Results: Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis.Conclusions: To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.
Study question Does the use of patient-centric, ML-prognostics counselling report (Univfy® PreIVF Report) affect assisted reproductive technology (ART) conversion (first ART cycle usage) and LB rate (LBR)? Summary answer The use of patient-centric, ML-prognostics counselling report (Univfy® PreIVF Report) by fertility specialists is associated with higher ART conversion and LBR among new patients. What is known already ART is a highly effective and safe treatment for clinical infertility. However, ART remains vastly underutilised resulting in missed opportunities to help more people build families. Commonly used age-based trends often do not address patients' perceived risks including their own ART success probability and ART cost burden as related to their personalised LB probabilities. We previously reported the use of artificial intelligence (AI)/ML to generate patient-centric counselling reports based on ART success prediction models developed and validated for each fertility centre to address their local patient populations in ways that are personalised, relevant and actionable. Study design, size, duration Retrospective cohort analysis. Eight fertility centres from 22 locations across 9 states (US) and Ontario, Canada contributed to the research design, compilation of outcomes data, and interpretation of results. Five centres provided ART utilisation and outcomes data for 15,289 new patients seen in each centre's study period when the Univfy® PreIVF Report was available and data were submitted for aggregated research analysis. Each centre provided 4-6 years of data within the period 2016-2022. Participants/materials, setting, methods The effect of Univfy or No-Univfy Group on ART conversion was analyzed by Chi square tests using aggregated data and separately for each centre's data, for 3 timed analyses, 180-Day, 360-Day and “Ever” (no restriction) after new patient visit. Patients who received the Univfy® PreIVF Report prior to IUI or ART conversion, or had no such conversion after receiving it were placed into the Univfy Group. The No-Univfy Group comprises patients who did not receive a report. Main results and the role of chance Univfy report usage was associated with higher conversions to Direct-ART (by 2.6-, 2.4-, 1.9-folds) and Any-ART (by 2.9-, 3.0-, 2.4-folds) in the aggregated data when analyzed for 180-Day, 360-Day and Ever, respectively; p-value < 0.001. Direct-ART is ART conversion without prior IUI(s); Any-ART conversion includes ART conversion with or without prior IUI(s). In the centre-specific analyses, the fold increase in Direct-ART and Any-ART conversions ranged from 1.8 to 4.5 and 2.2 to 4.7, respectively, in the 360-Day period; p-value <0.001. Univfy® PreIVF Report usage was associated with an increase in estimated LBR ranging from 2.1 to 1.3 folds for the Univfy Group compared to No-Univfy Group (360-Day analysis, p < 0.001) based on conservative versus liberal scenarios. Similar ART conversion and LBR results were observed for 180-Day and Ever analyses, p < 0.001. We used conservative to liberal assumptions for IUI-LBR and NC-LBR because IUI and NC outcomes were not readily available. (Conservative: IUI-LBR 15%, natural conception (NC)-LBR 5%; Liberal: IUI-LBR 25%, NC-LBR 20%). Estimated LBR for ART used clinical ongoing pregnancies and documented live births as LBs and the following LBR assumptions: freeze-all with no transfers yet (50%); gestational carrier ART (45%); ART with unknown outcomes (0%). Limitations, reasons for caution This study was not prospective or randomised. The intended report usage was to support physicians when counselling patients. Although we observed comparable report and ART usage across predicted ART-LB probabilities, there is potential unintentional bias towards higher report or ART utilisation among patients with more favorable clinical characteristics. Wider implications of the findings These results represent our retrospective experience in diverse geographies in North America. We endeavor to collaborate with additional centres to test the reproducibility of AI/ML-driven, validated personalized IVF prognostics on improved overall live birth outcomes and ART access when counselling patients about treatment options. Trial registration number not applicable
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