The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
C.f. Fleming - One of the best experts on this subject based on the ideXlab platform.
-
Tubal surgery versus assisted reproduction: assessing their role in Infertility Therapy.
Current opinion in obstetrics & gynecology, 1995Co-Authors: Michael G.r. Hull, C.f. FlemingAbstract:The majority of women with tubal/pelvic infective damage have a poor prognosis for natural conception, and in-vitro fertilization and embryo transfer would be a better primary choice. Other determining factors are sperm disorder or the woman's age, and personal issues may be of overriding importance. The most important requirement in the first place, however, is well defined, comparable statistical information on time-specific cumulative pregnancy rates related to specific diagnostic features. The main aims of this review are to analyze the most useful comparable data available and present them in graphical form for easy reference and clear understanding (by the patients too), and to try to derive a practically simple and prognostically valuable diagnostic classification.
Eli Y. Adashi - One of the best experts on this subject based on the ideXlab platform.
-
Yes, Elective Single-Embryo Transfer Should Be the Standard of Care
Biennial Review of Infertility, 2015Co-Authors: Dmitry M. Kissin, Sheree L. Boulet, Eli Y. AdashiAbstract:Despite early warnings of assisted reproductive technology (ART) pioneers about the risks of multiple births, the desire to improve effectiveness of ART procedures led to the widespread practice of multiple-embryo transfer. Adverse consequences for both the pregnant mothers and their children followed suit. Recognizing the risk of multiple births, the field is gradually moving toward elective single-embryo transfer (eSET) as the standard of care in good-prognosis patients. Overwhelming evidence from observational studies and randomized control trials supports the view that reliance on eSET versus on double-embryo transfer in appropriate groups of patients reduces perinatal morbidity and mortality, improves the likelihood of a healthy singleton infant, and reduces healthcare costs. Effective strategies for overcoming the barriers toward widespread implementation of eSET include the provision of expanded insurance coverage for Infertility Therapy coupled with limits on the number of embryos to transfer, as well as ongoing patient education on the benefits of eSET and risks associated with multiple births. From clinical, economical, and public health perspectives, transferring one embryo at a time in the context of good-prognosis Infertility patients will lead to the most desirable outcome of ART – a healthy singleton infant.
-
ovarian stimulation and intrauterine insemination at the quarter centennial implications for the multiple births epidemic
Fertility and Sterility, 2012Co-Authors: Howard D Mcclamrock, Howard W Jones, Eli Y. AdashiAbstract:Ovarian stimulation and intrauterine insemination (OS/IUI), a mainstay of current Infertility Therapy and a common antecedent to IVF, is a significant driver of the multiple births epidemic. Redress of this challenge, now marking its quarter centennial, will require a rethinking of current practice patterns. Herein we explore prospects for prevention, mitigation, and eventual resolution. We conclude that the multiple births attributable to OS/IUI may not be entirely preventable but that the outlook for their mitigation is promising, if in need of solidification. Specifically, we observe that low-dose (≤75 IU) gondotropin, clomiphene, and especially off-label letrozole regimens outperform high-dose (≥150 IU) gonadotropin counterparts in the gestational plurality category while maintaining comparable per-cycle pregnancy rates. Accordingly we recommend that, subject to appropriate exceptions, high-dose gonadotropin regimens be used sparingly and that whenever possible they be replaced with emerging alternatives. Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.
-
Infertility Therapy-associated multiple pregnancies (births): an ongoing epidemic
Reproductive biomedicine online, 2003Co-Authors: Eli Y. Adashi, John A Collins, Pedro N. Barri, Richard L. Berkowitz, Peter Braude, Elizabeth Bryan, Judith Carr, Jean Cohen, Paul Devroey, René FrydmanAbstract:Multiple gestation is now recognized as a major problem associated with both assisted reproductive technologies (ART) and also with ovulation induction therapies. Although some countries are beginning to adopt measures to address this issue, either through legislation or the development of clinical guidelines, there is a clear need to ensure recognition and a consistent approach to this problem worldwide. In particular, there is a need to educate both healthcare professionals and the lay population that multiple gestations are not a desirable outcome for the infertile couple.
P H Wise - One of the best experts on this subject based on the ideXlab platform.
-
Fertility Therapy and the risk of very low birth weight.
Obstetrics and gynecology, 1997Co-Authors: T F Mcelrath, P H WiseAbstract:To test the hypothesis of an association between maternal Infertility Therapy and the risk of very low birth weight (VLBW), defined as birth weight less than 1500 g, independent of the risk of multiple births, and to estimate the contribution of Infertility Therapy to the national incidence of VLBW. The National Maternal and Infant Health Survey conducted in 1988 was used to develop statistics describing outcomes among this birth cohort and to construct logistic regression models evaluating fertility Therapy as an independent risk factor for VLBW. An estimated 10.1% of live births and 18.2% of VLBW births nationally were associated with either maternal subfertility or Infertility Therapy (6.8% and 11.4%, respectively). The risk of VLBW among women concerned with subfertility (i.e., receiving diagnostic testing or advice on timing intercourse) was 1.4 (95% confidence interval [CI] 1.1, 1.9), whereas that for women undergoing therapeutic interventions (ie, ovarian stimulation, surgery, in vitro fertilization, or artificial insemination) was 2.6 (95% CI 2.1, 3.2). Accounting for effects of multiple gestation, maternal age, and a history of miscarriage, the odds ratios for the concerned and Therapy groups were 1.5 (95% CI 1.1, 1.9) and 2.0 (95% CI 1.5, 2.5), respectively. Black women were less likely to use fertility Therapy but more likely to experience a Therapy-related VLBW. Fertility Therapy is associated with an important portion of all VLBW and with an elevated risk of VLBW, related only in part to an increased risk of multiple gestations. Women expressing concern about subfertility but not receiving Therapy are also at increased risk of VLBW, suggesting that a history of Infertility may mediate part of the risk associated with fertility Therapy.
-
Fertility Therapy and the risk of very low birth weight.
Obstetrics & Gynecology, 1997Co-Authors: T F Mcelrath, P H WiseAbstract:Objective To test the hypothesis of an association between maternal Infertility Therapy and the risk of very low birth weight (VLBW), defined as birth weight less than 1500 g, independent of the risk of multiple births, and to estimate the contribution of Infertility Therapy to the national incidence of VLBW. Methods The National Maternal and Infant Health Survey conducted in 1988 was used to develop statistics describing outcomes among this birth cohort and to construct logistic regression models evaluating fertility Therapy as an independent risk factor for VLBW. Results An estimated 10.1% of live births and 18.2% of VLBW births nationally were associated with either maternal subfertility or Infertility Therapy (6.8% and 11.4%, respectively) The risk of VLBW among women concerned with subfertility (ie, receiving diagnostic testing or advice on timing intercourse) was 1.4 (95% confidence interval [CI] 1.1, 1.9), whereas that for women undergoing therapeutic interventions (ie, ovarian stimulation, surgery, in vitro fertilization or artificial insemination) was 2.6 (95% CI 2.1, 3.2). Accounting for effects of multiple gestation, maternal age, and a history of miscarriage, the odds ratios for the concerned and Therapy groups were 1.5 (95% CI 1.1,1.9) and 2.0 (95% CI 1.5, 2.5), respectively. Black women were less likely to use fertility Therapy but more likely to experience a Therapy-related VLBW. Conclusion Fertility Therapy is associated with an important portion of all VLBW and with an elevated risk of VLBW, related only in part to an increased risk of multiple gestations. Women expressing concern about subfertility but not receiving Therapy are also at increased risk of VLBW, suggesting that a history of Infertility may mediate part of the risk associated with fertility Therapy.
Linda C. Giudice - One of the best experts on this subject based on the ideXlab platform.
-
The dynamics of the vaginal microbiome during Infertility Therapy with in vitro fertilization-embryo transfer
Journal of Assisted Reproduction and Genetics, 2012Co-Authors: Richard W. Hyman, Christopher N. Herndon, Curtis Palm, Marilyn Fukushima, Denise Bernstein, Kim Chi Vo, Zara Zelenko, Hui Jiang, Ronald W. Davis, Linda C. GiudiceAbstract:Purpose To determine the vaginal microbiome in women undergoing IVF-ET and investigate correlations with clinical outcomes. Methods Thirty patients had blood drawn for estradiol (E_2) and progesterone (P_4) at four time points during the IVF-ET cycle and at 4–6 weeks of gestation, if pregnant. Vaginal swabs were obtained in different hormonal milieu, and the vaginal microbiome determined by deep sequencing of the 16S ribosomal RNA gene. Results The vaginal microbiome underwent a transition during Therapy in some but not all patients. Novel bacteria were found in 33% of women tested during the treatment cycle, but not at 6–8 weeks of gestation. Diversity of species varied across different hormonal milieu, and on the day of embryo transfer correlated with outcome (live birth/no live birth). The species diversity index distinguished women who had a live birth from those who did not. Conclusions This metagenomics approach has enabled discovery of novel, previously unidentified bacterial species in the human vagina in different hormonal milieu and supports a shift in the vaginal microbiome during IVF-ET Therapy using standard protocols. Furthermore, the data suggest that the vaginal microbiome on the day of embryo transfer affects pregnancy outcome.
-
the dynamics of the vaginal microbiome during Infertility Therapy with in vitro fertilization embryo transfer
Journal of Assisted Reproduction and Genetics, 2012Co-Authors: Richard W. Hyman, Christopher N. Herndon, Curtis Palm, Marilyn Fukushima, Denise Bernstein, Zara Zelenko, Hui Jiang, Ronald W. Davis, Linda C. GiudiceAbstract:Purpose To determine the vaginal microbiome in women undergoing IVF-ET and investigate correlations with clinical outcomes.
Michael G.r. Hull - One of the best experts on this subject based on the ideXlab platform.
-
Tubal surgery versus assisted reproduction: assessing their role in Infertility Therapy.
Current opinion in obstetrics & gynecology, 1995Co-Authors: Michael G.r. Hull, C.f. FlemingAbstract:The majority of women with tubal/pelvic infective damage have a poor prognosis for natural conception, and in-vitro fertilization and embryo transfer would be a better primary choice. Other determining factors are sperm disorder or the woman's age, and personal issues may be of overriding importance. The most important requirement in the first place, however, is well defined, comparable statistical information on time-specific cumulative pregnancy rates related to specific diagnostic features. The main aims of this review are to analyze the most useful comparable data available and present them in graphical form for easy reference and clear understanding (by the patients too), and to try to derive a practically simple and prognostically valuable diagnostic classification.