Management of Infertility

Myers, Evan R.; Eaton, Jennifer L.; McElligott, Kara A.; Moorman, Patricia G.; Chatterjee, Ranee; Zakama, Arthurine; Goldstein, Kenneth M.; Strauss, Jennifer; Coeytaux, Remy R; Goode, Adam P.; Borre, Ethan D.; Swamy, Geeta K.; McBroom, Amanda J; Lallinger, Kathryn R; Schmidt, Robyn; Davis, J. Kelly; Hasselblad, Victor; Sanders, Gillian D

doi:10.23970/ahrqepccer217

2019

DOI: 10.23970/ahrqepccer217

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Management of Infertility

Evan R. Myers¹,

Jennifer L. Eaton²,

Kara A. McElligott³

et al.

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Cited by 3 publications

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“…2 In addition to the typical symptoms of depressive disorders (eg, feeling hopeless, loss of interest in activities that used to be enjoyed, withdrawing from friends and family), other symptoms in the perinatal period may include persistent doubt of the ability to take care of the infant, trouble bonding with the infant, and thoughts of selfharm or harm of the infant. 3 Risk factors that can be used to identify individuals at risk for perinatal depression include a history of depression, [4][5][6][7] history of physical or sexual abuse, 5 unplanned or unwanted pregnancy, 8 stressful life events, 1,5,9 intimate partner violence, 10,11 and complications during pregnancy. 12 Additionally, low socioeconomic status, lack of social support, and bearing children during adolescence have been associated with a greater risk of developing perinatal depression after delivery.…”

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confidence: 99%

“…12 Additionally, low socioeconomic status, lack of social support, and bearing children during adolescence have been associated with a greater risk of developing perinatal depression after delivery. 5,6,8,13 Numerous interventions have been proposed to prevent perinatal depression; however, there is no commonly agreed-on method of prevention. Thus, there is likely substantial variation in clinical practice.…”

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Interventions to Prevent Perinatal Depression

O’Connor

Senger

Henninger

et al. 2019

JAMA

221

150

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IMPORTANCE Depression during pregnancy and the postpartum period is relatively common and can have adverse effects on both mother and child. OBJECTIVE To systematically review benefits and harms of primary care-relevant interventions to prevent perinatal depression, a major or minor depressive episode during pregnancy or up to 1 year after childbirth, to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; surveillance through December 5, 2018. STUDY SELECTION Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies of interventions (eg, behavior-based, antidepressants, dietary supplements) to prevent perinatal depression in general populations of pregnant and postpartum individuals or in those at increased risk of perinatal depression. Large cohort studies were considered for harms of antidepressant use only. DATA EXTRACTION AND SYNTHESIS Two investigators independently reviewed abstracts and full-text articles and quality rated included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions. MAIN OUTCOMES AND MEASURES Depression status; depression symptoms; maternal, infant, and child health outcomes. RESULTS Fifty studies (N = 22 385) that met inclusion criteria were identified. Counseling interventions were the most widely studied interventions. Compared with controls, counseling interventions were associated with a lower likelihood of onset of perinatal depression (pooled risk ratio [RR], 0.61 [95% CI, 0.47-0.78]; 17 RCTs [n = 3094]; I 2 = 39.0%).The absolute difference in the risk of perinatal depression ranged from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Health system interventions showed a benefit in 3 studies (n = 5321) and had a pooled effect size similar to that of the counseling interventions, but the pooled effect was not statistically significant using a method appropriate for pooling a small number of studies (restricted maximum likelihood RR, 0.58 [95% CI, 0.22-1.53]; n = 4738; I 2 = 66.3%; absolute risk reduction range, −3.1% to −13.1%). None of the behavior-based interventions reported on harms directly. A smaller percentage of participants prescribed sertraline had a depression recurrence compared with those prescribed placebo (7% vs 50%, P = .04) at 20 weeks postpartum in 1 very small RCT (n = 22 analyzed) but with an increased risk of adverse effects to the mother. CONCLUSIONS AND RELEVANCE Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research.

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confidence: 99%

mentioning

confidence: 99%

Interventions to Prevent Perinatal Depression

O’Connor

Senger

Henninger

et al. 2019

JAMA

221

150

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Pharmacoeconomic analysis of the application of follitropin alfa in combination with assisted reproductive technologies

et al. 2022

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Objective: to evaluate clinical-economic feasibility and impact of follitropin alfa on the state healthcare budget of the Russian Federation in the population of women with diagnosed infertility and poor ovarian response, who undergo treatment with assisted reproductive technologies (ART).Material and methods. A cost minimization analysis to evaluate clinical-economic feasibility of follitropin alfa in women with infertility and poor ovarian response who underwent ART was performed. The model of the budget impact analysis included the costs required for the ovarian stimulation of patients distributed by various variants of their management. The current practice involved the application only of fixed dose combinations (FDC) of follitropin alfa + lutropin alfa. The expected practice suggested a change in the approach by shifting 25% of patients with poor ovarian response from FDC of follitropin alfa + lutropin alfa to follitropin alfa. A time horizon of modeling was 1 year.Results. The cost minimization analysis demonstrated that the application of drug with international nonproprietary name follitropin alfa is characterized by the cost cut of 12,020 rubles (–21.56%) per patient compared with FDС of follitropin alpha + lutropin alpha. The results of budget impact analysis showed that a shift of 25% of population from FDC of follitropin alfa + lutropin alfa to follitropin alfa could cut direct medical costs by 7.96 million rubles per year (–5.39%).Conclusion. Evaluation of clinical-economic feasibility and budget impact analysis showed that the application of follitropin alfa during ovarian stimulation in women with infertility and poor ovarian response leads to a decrease in budget expenses.

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Luteal phase deficiency: pathophysiology and role in reproductive disorders

Ivanov

2021

Medicinskij sovet

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It is well known that corpus luteum normal functioning is crucial for the luteal phase, which determines the embryo implantation and the progression of pregnancy. Luteal phase deficiency (LPD), associated with impaired progesterone secretion by the corpus luteum, is considered as a significant factor of infertility and early pregnancy loss, both in the natural cycle and in assisted reproductive technology (ART) programs. The LPD formation is associated with hypothalamic-pituitary-ovarian axis dysregulation, which leads to abnormal secretion of FSH, LH, ovulation and luteinization disorders, premature luteolysis. The most significant problem in the study of LPD is the lack of reliable and reproducible methods of its verification. This review summarizes the available data on the methods and issues of LPD diagnosing, including the duration of the luteal phase, the level of progesterone secretion, and endometrial biopsy. LPD is an important factor in reproductive failures during IVF, which is caused by suppression of the physiological FSH, LH secretion and requires mandatory progesterone support in the luteal phase of the cycle. It’s hard to define the contribution of LPD to miscarriage, however, empirical progestogen therapy may increase the live births rate in women with recurrent pregnancy loss. Currently, there is no evidence of the LPD role and progesterone support effectiveness in infertility management, so the diagnosis and therapy of LPD among these patients should not be considered.

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Management of Infertility

Cited by 3 publications

References 0 publications

Interventions to Prevent Perinatal Depression

Interventions to Prevent Perinatal Depression

Pharmacoeconomic analysis of the application of follitropin alfa in combination with assisted reproductive technologies

Luteal phase deficiency: pathophysiology and role in reproductive disorders

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