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1.
Iranian Journal of Medical Sciences ; 48(1 Supplement):70, 2023.
Article in English | EMBASE | ID: covidwho-2285036

ABSTRACT

Background: The coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spread all over the world. This study was designed to assess the possibility of SARS-CoV-2 presence in follicular fluid, which may have harmful effects on normal ovulation and fertility. Method(s): Five women who were candidates for Assisted Reproductive Technique (ART) and had a COVID-19 PCRpositive test on the day of oocyte retrieval participated in the study. SARS-CoV-2 tests were performed on the follicular fluid obtained from these women. Result(s): SARS-CoV-2 RNA was detected only in one follicular fluid sample, and other follicular fluid samples were negative. Conclusion(s): Because the COVID-19 effect on human reproduction is unknown, exact precautions should be taken during this pandemic, especially for women applying for ART.

2.
Journal of Family and Reproductive Health ; 17(1):21-28, 2023.
Article in English | EMBASE | ID: covidwho-2250694

ABSTRACT

Objective: This study aimed to compare the effects of clomiphene citrate (CC) combined with metformin or placebo on infertile patients with poly cystic ovary syndrome (PCOS) and insulin resistance (IR). Material(s) and Method(s): We included 151 infertile women with PCOS and IR in a university hospital from November 2015 to April 2022 in this prospective, double-blind, randomized, placebo-controlled trial. Patients were randomized into two groups;group A: received CC plus metformin (n = 76) and group B: received CC plus placebo (n = 75). The ovulation rate was the main outcome measure. Clinical pregnancy, ongoing pregnancy, live birth and abortion rates were secondary outcome measures. Result(s): There was no remarkable difference in ovulation rate in two groups. Moreover, no significant changes were observed in clinical pregnancy, ongoing pregnancy, live birth and abortion rates between two groups. A larger proportion of women in group A suffered from side effects of metformin (9.3% versus 1.4%;p=0.064), although this was not significant. Conclusion(s): In IR infertile women with PCOS, metformin pre-treatment did not increase the ovulation, clinical pregnancy and live birth rates in patients on clomiphene citrate.Copyright © 2023 Tehran University of Medical Sciences.

3.
International Journal of Women's Health and Reproduction Sciences ; 11(1):42-43, 2023.
Article in English | EMBASE | ID: covidwho-2246593

ABSTRACT

There is insufficient data on the impact of severe acute respiratory coronavirus-2 (SARS-CoV-2) on the reproductive tissues, its possible risk of cross-contamination, transmission and adverse effect on in vitro fertilization (IVF) outcome. Until today, there is no report associated with viral RNA in both follicular fluid and embryo culture medium from SARS-COV-2 positive women. In this case report, a 24-year-old woman with SARS-CoV-2 was presented. We investigated the SARS-COV-2 positivity in the follicular fluid and embryo culture medium of mildly symptomatic woman on oocyte pick up (OPU) day. We could not detect viral RNA in neither the follicular fluid nor the embryo culture medium. In addition, although the response of ovarian stimulation was normal, the number and maturity of the retrieved oocytes were low.

4.
Veterinary Ireland Journal ; 10(11):614-615, 2020.
Article in English | CAB Abstracts | ID: covidwho-2034344
5.
Drug Development and Delivery ; 22(4):18-23, 2022.
Article in English | Scopus | ID: covidwho-2012508
6.
Human Reproduction ; 37:i41, 2022.
Article in English | EMBASE | ID: covidwho-2008566

ABSTRACT

Study question: Is the number of cumulated oocytes with dual ovarian stimulation on the same cycle (duostim) higher compared to 2 consecutive antagonist cycles in poor responders? Summary answer: Considering the number of total and mature oocytes collected in poor ovarian responders, there is no benefit of duostim vs two consecutive antagonist cycles. What is known already: Several waves of follicular development exist on the same cycle. Recent studies have shown the ability to obtain oocytes with equivalent quality in the luteal phase, even after a previous ovarian stimulation in the follicular phase. During stimulation, smaller follicles are recruited and sensitized, which may increase the selection of follicles available on the second stimulation. In poor ovarian responders (POR) this potentialization may have a great interest, as 2 stimulations on the same cycle could give a higher number of oocytes compared to two conventional stimulations. However, these preliminary data need to be confirmed with a randomized controlled trial. Study design, size, duration: This is a multicenter, open-labeled randomized control trial (2018, september-2021, march). The primary objective was to demonstrate that two ovarian stimulations within the same cycle (first in the follicular phase, followed by a second in the luteal phase) lead to the retrevial of 1.5 more oocytes than the cumulative number of oocytes from two consecutive conventional stimulation, in POR women. According to this hypothesis, 44 patients were needed in each group. Participants/materials, setting, methods: 88 POR women, defined with Bologna criteria (AFC≤5 and/or AMH≤1.2ng/ml and ≤3 oocytes if previous IVF) were randomized, 44 in duostim group (D) and 44 in conventional group (C). Fertistart Kit®300IU/day with antagonist protocol was used except in luteal phase stimulation of group D. In group D, oocytes were pooled and inseminated after the second retrieval, with freeze all embryos. Fresh transfer was performed in group C. The analysis is presented in intention to treat. Main results and the role of chance: There was no difference between the groups regarding demographics, ovarian reserve markers (AFC, AMH) and stimulation parameters. The mean number of cumulated oocytes retrieved with 2 ovarian stimulation was not statistically different in group D and C, respectively 5.0+/-3.4 and 4.6+/-3.4 (p=0.56). The mean number of cumulated mature oocytes was not statistically different, 3.7+/-3.3 in group D vs 3.1+/-3.0 in group C (p=0.38). The mean number of embryos was significantly lower in the group D, 0.8+/-1.3 vs group C 1.6+/-1.3 (p<0.01). There was no statistical difference of the mean number of oocytes retrieved per cycle in cycle 1 vs cycle 2 in both group D and C. The delay, between the first and the second day 1 of stimulation was statistically different in group D 14.4 days (10-19) vs group C 90.6 (28-232). The ongoing pregnancy rate in group D 17.9% (7/39) was not statistically different with group C 29.3% (12/41), (p=0.23). And the mean time to ongoing pregnancy tends to be longer in group D (144 days) vs group C (115 days) but was not statistically different (p=0.21). Limitations, reasons for caution: The RCT was impacted by Covid pandemia and stop of IVF activities for 10 weeks. Delays were recalculated to exclude this period, however one women in group D cannot have the luteal stimulation. We also faced unexpected good ovarian responses and pregnancies after the first oocyte pick-up in group C. Wider implications of the findings: In routine practice, the benefit of duostim in patients with POR is not confirmed. Firstly, because there is no potentialization on the number of oocyte retrieved in luteal phase after follicular phase stimulation. Secondly, because the freeze all strategy avoids a pregnancy with fresh embryo transfer after the first cycle.

7.
Human Reproduction ; 37, 2022.
Article in English | EMBASE | ID: covidwho-2006768

ABSTRACT

The proceedings contain 1092 papers. The topics discussed include: semen impairment and occurrence of SARS-COV-2 virus in semen after recovery from COVID-19;the SELECTIMO study - clinical outcomes of uninterrupted embryo culture with or without time-lapse based embryo selection versus interrupted standard culture: a randomized controlled trial;the bias is out of the bag: IVF culture dish well number influences embryo selection decision-making and implantation outcome;reducing inter-observer and intra-observer variability of embryo quality assessment using deep learning;annotation-free embryo score calculated by Idascorecorrelated with live birth and has no correlation with neonatal outcomes after single vitrified-warmed blastocyst transfer;simplifying the complexity of time-lapse decisions with AI: CHLOE (fairtility) can automatically annotate morphokinetics and predict blastulation (at 30HPI), pregnancy and ongoing clinical pregnancy;and controlled ovarian stimulation (COS) protocols for assisted reproduction: a Cochrane systematic review and network meta-analysis.

8.
J Womens Health (Larchmt) ; 31(8): 1097-1102, 2022 08.
Article in English | MEDLINE | ID: covidwho-1992076

ABSTRACT

Background: Some studies have suggested minor changes in the menstrual cycle after COVID-19 vaccination, but more detailed analyses of the menstrual cycle are needed to evaluate more specific changes in the menstrual cycle that are not affected by survey-based recall bias. Materials and Methods: Using a pretest-post-test quasi-experimental evaluation of menstrual cycle parameters before and after COVID-19 vaccination, we conducted an anonymous online survey of two groups of North American women who prospectively monitor their menstrual cycle parameters daily including bleeding patterns, urinary hormone levels using the ClearBlue Fertility Monitor, or cervical mucus observations. The primary outcome measures were cycle length, length of menses, menstrual volume, estimated day of ovulation (EDO), luteal phase length, and signs of ovulation. Perceived (subjective) menstrual cycle changes and stressors were also evaluated in this study as secondary outcome measures. Results: Of the 279 women who initiated the survey, 76 met the inclusion criteria and provided 588 cycles for analysis (227 pre-vaccine cycles, 145 vaccine cycles, 216 post-vaccine cycles). Although 22% of women subjectively identified changes in their menstrual cycle, there were no significant differences in menstrual cycle parameters (cycle length, length of menses, EOD, and luteal phase length) between the pre-vaccine, vaccine, and post-vaccine cycles. Conclusions: COVID-19 vaccines were not associated with significant changes in menstrual cycle parameters. Perceived changes by an individual woman must be compared with statistical changes to avoid confirmation bias.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , Female , Humans , Luteal Phase/urine , Menstrual Cycle , Progesterone , Vaccination
9.
Sleep Medicine ; 100:S306, 2022.
Article in English | EMBASE | ID: covidwho-1967133

ABSTRACT

Introduction: Women are twice as likely to develop insomnia across their lifetime compared with men. This may be explained, in part, by changes in hormones and menstrual cycle phase in reproductive-aged women. Intra- and inter-variability of menstrual cycle timing can make it difficult to accurately measure sleep quality and quantity in sleep research studies. This study aimed to examine the role of menstrual cycle phase in daily self-report and actigraphy-assessed sleep across two consecutive menstrual cycles. Materials and Methods: Fifty-one women (43% Caucasian) between the ages of 18 and 35 (m age = 23.67, SD = 4.68) completed continuous sleep monitoring via actigraphy and daily sleep diaries over two menstrual cycles (m days = 51.29). Cycles were identified via first date of menstrual bleeding and midcycle urinary ovulation testing and were coded into four phases: perimenstrual, mid-follicular, periovulatory, and mid-luteal. The perimenstrual phase was defined as the 3 days prior to and the first 3 days of menstrual bleeding. Within- and between-person relationships between menstrual phase and sleep parameters were estimated using multistep hierarchical linear modeling. Subjective and objective measures yielded the following sleep variables: Total Wake Time (TWTsub and TWTobj), Sleep Efficiency (SEsub and SEobj), and subjective sleepiness. Pandemic-related stress and daily US and region-specific COVID-19 case counts were included as covariates in adjusted models. Results: The sample had a mean a cycle length of 28.61 days (SD = 2.69). Regarding actigraphy data, menstrual phase predicted TWTobj and SEobj. Women spent 4-7 fewer minutes awake during the mid-follicular (m = 61.54, SE = 3.37) and mid-luteal phases (m = 63.11, SE = 3.29), compared to the perimenstrual phase (m = 67.54, SE = 3.37;p <.001). Sleep efficiency was higher in the mid-luteal phase (m = 82.50, SE = 0.79) compared to the perimenstrual phase (m = 80.71, SE = 0.82, p =.006). Subjective ratings indicated that during the perimenstrual phase women spent 8-16 minutes longer awake (m = 52.23, SE = 5.01, p <.001) and experienced reduced sleep efficiency of between 1-3 percentage points (m = 89.70, SE = 0.10, p <.001) compared to all other phases. Women also reported increased morning sleepiness in the perimenstrual (m = 4.71, SE = 0.21) compared to the periovulatory phase (m = 4.34, SE = 0.22, p =.02). Random coefficients models for objective and subjective sleep variables were nonsignificant, indicating that these relationships did not vary significantly between participants. Conclusions: To our knowledge, this is one of the first studies to examine subjective and objective sleep prospectively across two consecutive menstrual cycles. Disturbed sleep was highest in the perimenstrual phase. Future studies should measure menstrual cycle phase when investigating sleep in reproductive age women.

10.
Front Glob Womens Health ; 3: 866104, 2022.
Article in English | MEDLINE | ID: covidwho-1952311

ABSTRACT

Stress is known to be associated with adverse health outcomes. The COVID-19 pandemic and its associated lockdowns are examples of chronic stressors. Lockdown measures inadvertently caused significant psychological distress and became a powerful source of anxiety/stress, sleep disturbances, nutritional changes and weight gain. Stress is known to impact women's health specifically, through hypothalamic-pituitary-gonadal (HPG) axis dysfunction and resultant ovulatory dysfunction. Such dysfunction may manifest in menstrual irregularities and/or infertility due to hypothalamic hypogonadism. Here, we review the key physiological mediators of stress and associated ovulatory dysfunction. The kisspeptinergic system is comprised of sets of neurons located in the hypothalamus, the rostral periventricular region of the third ventricle (RP3V) and the arcuate nucleus (ARC). This system links nutrition, reproductive signals and stress. It plays a key role in the function of the HPG axis. During chronic stress, the kisspeptinergic system affects the HPG axis, GnRH pulsatility, and, therefore, ovulation. Leptin, insulin and corticotrophin-releasing hormone (CRH) are thought to be additional key modulators in the behavioral responses to chronic stress and may contribute to stress-related ovulatory dysfunction. This mini-review also summarizes and appraises the available evidence on the negative impact of chronic stress as a result of the COVID-19 pandemic lockdowns. It proposes physiological mechanisms to explain the observed effects on women's reproductive health and well-being. The review suggests areas for future research.

11.
American Journal of Reproductive Immunology ; 87(SUPPL 1):84, 2022.
Article in English | EMBASE | ID: covidwho-1927550

ABSTRACT

Problem: A37 y.o, P1+1 presented with a 1.5 year Hx of secondary infertility. Initial ovulation induction with clomifene citrate was unsuccessful, followed by a single IUI attempt with gonadotropin stimulation. The couple progressed to IVF treatment with 3 failed embryo transfers. There were no endocrinological abnormalities, endometrial/ uterine anatomy was normal on transvaginal USS and saline infusion sonograpy, so an Endometrial Immune Profile(EIP) and Receptivity Array(ERA) were performed prior to further treatment. ERA was in the receptive range, and EIP demonstrated an overactive profile with high IL15:Fn14, suggestive of NK overactivation. In the absence of other pathology this was hypothesised as a potential cause for implantation failure. Immunotherapy options were discussed, including IVIG and adalumimab. Risks of these during the Covid pandemic resulted in the decision to try oral hydroxychloroquine, with cost benefits and potentially less adverse side effects. Unfortunately there is a paucity of published data and outcomes, but proposed benefits of this treatment were based on demonstration of improvemed serum TH1:TH2 cytokine ratios (reduction in TNFa and increase in IL:10), and demonstration of a reduction in miscarriage rate. Method of Treatment: Hydroxycholoroquine 200mgPOBD was commenced 6 weeks prior to commencing treatment, followed by a frozen transfer of a single blastocyst (5AA). Unfortunately this transfer after 8/52 treatment was unsuccessful. A repeat cycle was scheduled after a further 8 weeks, continuing the hydroxychloroquine for >3 months. Initial hCG 13 days post transfer was 2934, but the patient presented with sudden PV bleeding after 6 days, follow up hCG was only 3650. Transvaginal USS demonstrated a collapsed intrauterine gestation sac in keeping with a non-viable pregnancy. Onward referral to an Early Pregnancy unit for follow up confirmed a miscarriage. PGS was not incorporated into the cycles to assess for embryo aneuploidy. Results: Overall the implantation rate had increased from 0 (0/3) to 50% (1/2), but due to sample size this was not statistically significant (p = 0.81). Pregnancy rate per embryo transfer also increased form 0/3 to 1/2, but again was not significant because of low numbers. Due to the failure to achieve an ongoing pregnancy, a repeat biopsy was performed while using hydroxychloroquine to assess its effects on the endometrial immunological environment. This showed a normalisation of the IL15:Fn14 ratio (5.680 to 0.831), but with a slight elevation in the IL18:Tweak ratio (0.088 to 0.114).CD56 remained in the normal range (0.993 to 1.344). Conclusion: Although prescribed for inconsistent indications, there is little published data on hydroxychloroquine use for adverse reproductive outcome. This case report demonstrates the effect of oral hydroxychloroquine therapy on an overactive endometrial profile, leading to a major reduction in IL15:Fn4 ratio, suggesting a potential role in reducing uNK cytotoxicity. Anecdotally a 3 month course is recommended prior to transfer, which would be supported by these events. Unfortunately there is limited ability to make treatment recommendations based on a single sample, however, the findings suggest that a larger study to explore if this pattern is reproducible would have important clinical value.

12.
Sleep ; 45(SUPPL 1):A142-A143, 2022.
Article in English | EMBASE | ID: covidwho-1927402

ABSTRACT

Introduction: Women experience increased risk for sleep and affective disorders compared to men, attributed in part to monthly oscillations in sex hormones. Emotional functioning worsens during the perimenstrual phase. There is increasing evidence that sleep continuity also decreases during this phase. Thus, this study examined the interactive effects of sleep and menstrual phase on emotion across two menstrual cycles in healthy women. Methods: Participants (N=51, 43% Caucasian) aged 18-35 (m=23.67) completed actigraphy and daily sleep/emotion diaries over two menstrual cycles (m days=51.29). Cycles were identified via date of menses and urinary ovulation detection, and coded into four phases: perimenstrual, mid-follicular, periovulatory, and mid-luteal. The perimenstrual phase was defined the 3 days prior to and the 3 days following menses onset. Variables included diary and actigraphic total wake time (TWT), daily ratings of positive (happy, calm, enthusiastic) and negative (angry, afraid, sad) affect using a 9-point scale. Relationships between phase, sleep, and emotion were estimated using multistep hierarchical linear modeling. Pandemic-related stress and daily US and region-specific COVID-19 case counts were included as covariates in adjusted models. Results: Mean menstrual cycle length was 28.61±2.69 days. Menstrual phase was first entered into models as predictors for sleep and emotion variables independently. The perimenstrual phase positively predicted anger (p<.001) but no other emotions. Additionally, the perimenstrual phase predicted higher rates of TWT, such that diary-reported TWT was 8-16 minutes longer during the perimenstrual (m=67.54, SE=3.37) compared to other phases (p<.001). Actigraphic TWT was also increased by 4-7 minutes (m=61.54, SE=3.37) in the perimenstrual phase (p<.001). A second model included the interaction term, TWT∗phase to the original model. Positive emotions were .05- .10 points lower (ps=.006-.02) when TWT was greater in the perimenstrual phase. Conclusion: Menstruating women experienced greater rates of anger and sleep disruption during the perimenstrual phase compared to other phases. When poor sleep occurred during the perimenstrual phase, however, women reported reduced positive emotions. Sleep disruptions, particularly occurring during the perimenstrual phase, may be an important intervention target for women at risk for affective disorders. Future studies should be mindful to assess menstrual phases when assessing sleep and circadian rhythm.

13.
Obstetrics and Gynecology ; 139(SUPPL 1):35S, 2022.
Article in English | EMBASE | ID: covidwho-1925333

ABSTRACT

INTRODUCTION: Prior research has demonstrated how immune functioning and physiological signals fluctuate across the menstrual cycle, with eumenorrheic womenmore likely to become ill during the luteal phase. Examining such changes during the current pandemic, we explored how the relationship betweenmenstrual cycle phase and physiological signals impacts a wearable medical device's ability to detect COVID-19. METHODS: The largest institutional review board-approved wearable device study monitoring SARS-CoV-2's effects on biophysiology to date, COVID-RED aims to develop a machine learning algorithm predicting an infection up to 3 days prior to symptom onset. Wearing the device nightly, participants (N=17,824) sync it with a mobile application and log SARS-CoV-2 diagnostic tests, symptoms, and menses in the app's Daily Diary. The algorithm ingests physiological and selfreported features to provide each user with a real-time update about their likelihood of infection. RESULTS: Daily infection likelihood and predictions of ovulation using proprietary algorithms were generated during a 9-month period for 1,574 eumenorrheic women (n=3,281 menstrual cycles) not currently on hormonal birth control. The negative/positive ratio of predicted COVID-19 cases during the 5-day period preceding ovulation was 2.94 compared to 4.83 in the 5 days post-ovulation (chi-square (1, N=33,920)5343.34, P<.0001). Participants reported 22 SARS-CoV-2 positive test results, with five times as many confirmed infections occurring in the postovulatory period (n510) compared to the preceding 10-day window (n=2). CONCLUSION: Demonstrating that machine-learning algorithms ingesting wearable data should consider menstrual cycle impact, our findings suggest that women may be more susceptible to SARS-CoV-2 during their luteal phase, with further studies needed to disentangle underlying mechanisms.

14.
JBRA Assisted Reproduction ; 26(2):315-320, 2022.
Article in English | ProQuest Central | ID: covidwho-1870818

ABSTRACT

ObjectiveTo compare the number of oocytes obtained in the follicular puncture of high- responder oocyte donors, submitted to ovarian stimulation for in vitro fertilization (IVF) in two different protocols: Friendly and Conventional.MethodsThere were one hundred-and-eight infertile egg-donor women, aged between 21 and 35 years, undergoing IVF in this retrospective cohort study. The women were divided into two groups: 1) Friendly protocol: controlled ovarian stimulation (COS) with corifollitropin alpha, clomiphene citrate and dydrogesterone without daily rFSH (n=52) and 2) In the Conventional protocol, we had COS with menotropin daily and ganirelix (n=66). We assessed age, body mass index, time and cause of infertility, antral follicle count (AFC) by three-dimensional ultrasound, number of visits to the clinic, COS duration, number of follicles ≥14mm on the trigger day, early ovulation frequency, number of mature oocytes, number of cryopreserved embryos, clinical pregnancy rate, frequency of OHSS.ResultsThe ovulatory factor was higher in women in the Conventional protocol (p=0.03), and the tubal factor (p=0.02) was higher in the Friendly protocol group. The number of visits to the clinic was lower among women in the Friendly protocol (p=0.04). The number of mature eggs, the clinical pregnancy rate and the frequency of OHSS were similar between the groups. The number of frozen embryos was higher in the Friendly group (p=0.02). The regression model demonstrated that the ovulatory factor, the tubal factor and the number of visits to the clinic were not predictors of the number of mature oocytes. Only AFC was an independent predictor of the number of meiosis II oocytes (p<0.01).ConclusionsThe Friendly protocol seems to be as safe and effective as the Conventional protocol for infertile high-responder oocyte donors, resulting in a similar number of mature oocytes and OHSS incidence.

15.
American Journal of Reproductive Immunology ; 87(S1):84-84, 2022.
Article in English | Academic Search Complete | ID: covidwho-1861183

ABSTRACT

There were no endocrinological abnormalities, endometrial/uterine anatomy was normal on transvaginal USS and saline infusion sonograpy, so an Endometrial Immune Profile(EIP) and Receptivity Array(ERA) were performed prior to further treatment. Due to the failure to achieve an ongoing pregnancy, a repeat biopsy was performed while using hydroxychloroquine to assess its effects on the endometrial immunological environment. This case report demonstrates the effect of oral hydroxychloroquine therapy on an overactive endometrial profile, leading to a major reduction in IL15:Fn4 ratio, suggesting a potential role in reducing uNK cytotoxicity. [Extracted from the article] Copyright of American Journal of Reproductive Immunology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

16.
Journal of Clinical and Diagnostic Research ; 16(3):QD01-QD04, 2022.
Article in English | EMBASE | ID: covidwho-1744635

ABSTRACT

Derangements in coagulation profile due to on-going anticoagulant medication can complicate the most primitive physiology in a woman, ovulation. Unmonitored anticoagulant therapy can lead to an array of complications, one of which is intraperitoneal haemorrhage secondary to numerous medical and surgical conditions. The resultant haemoperitoneum can cause sudden hypovolemic shock, especially in a patient with compromised cardiovascular status. This report narrates the case of a 30 years old nulliparous female patient on anticoagulant therapy, operated for multiple cardiac defects and developed massive haemoperitoneum as a consequence of ovulation. The patient presented in shock to the Emergency Department with unstable haemodynamic status. A multi-disciplinary approach to the case converged on ruptured functional ovarian cyst as a working diagnosis. Conservative management of haemoperitoneum was decided upon, whereby correcting shock and providing pro-coagulant therapy along with blood products was the main line of management. All efforts failed soon after when the cyst wall ruptured catastrophically, leading to collapse of the general condition of the patient. Surgical approach was undertaken and a ruptured ovarian cyst wall was identified to be the cause. The cyst wall was subsequently repaired electrosurgically and the patient recovered well with an uneventful postoperative period. However, the characteristic feature of this case is the lack of follow-up due to lockdown restrictions of this continuum, the Coronavirus Disease-2019 (COVID-19) pandemic. The management of such cases must be carefully titrated, keeping in mind the risks and benefits of both pro-coagulant and anti-coagulant therapy wherein one can jeopardise the effects of the other.

17.
Cryobiology ; 103:204, 2021.
Article in English | EMBASE | ID: covidwho-1587990

ABSTRACT

During the pandemic, most infertility and IVF Units decided to keep fertility preservation active as an urgent procedure. It is well established that chemotherapy is gonadotoxic and impact negatively on quality of life. The American Society of Reproductive Medicine (ASRM) and European Society of Human Reproduction and Embryology (ESHRE) recommend to offer fertility preservation before cancer treatment. Oocyte cryopreservation and sperm cryopreservation are the best treatments of the choices to preserve fertility in cancer patients. This is a prospective study performed at Infertility and IVF Unit, Sant’Orsola University Hospital, University of Bologna, Italy, from February 2020 to January 2021. 149 cancer patients underwent gamete cryopreservation to preserve their fertility. All patients tested for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2 48 hours before cryopreservation. The viral RNA detection was provided only in case of positive swab and no treatment was interrupted. 59 women underwent ovarian stimulation with gonadotropins followed by oocyte retrieval. Women’s basal characteristics were: Age (m±sd) 31.0 ± 7.0 years, FSH (m±sd) 14 ±9IU/l, AMH (m±sd) 2.4 ± 1.3 ng±ml, AFC (m±sd) 9 ±5. 90 men underwent spermatozoa rapid cryopreservation. Men’s basal characteristics were: Age (m±sd) 34±7 years;Total Sperm count x 106 (m±sd) 52.3±49.6, Sperm x 106/ml 28.1±25.5, Total motility (m±sd) 48.0±26.7 %, Progressive motility (m±sd) 22.2±20.5 %, normal morphology (m±sd) 22.3±11.1 %. 296 oocyte were cryopreserved: 5.5±4.3 (mean±sd per patient). Vitrification with closed devices (High-Security Vitrification™ - HSV) was used for oocyte cryopreservation to minimize the risk of viral contamination. 403 Sperm samples were frozen with slow freezing: 5.7±2.1 (m±sd) per patient. All patients tested negative for realtime (RTPCR) analysis of throat swab specimens for Sars-Cov-2. The oncofertility activity must be maintained even in pandemic periods by implementing adequate safety measures to protect the health of patients and healthcare professionals. Funding: Supported by Italian Ministry of Health "Fertility Preservation in gonadotoxic treatments” project code RF-2011-02348826 Conflict of Interest: None to disclose

18.
Fertil Steril ; 116(6): 1631-1640, 2021 12.
Article in English | MEDLINE | ID: covidwho-1427933

ABSTRACT

OBJECTIVE: To determine the temporal expression of angiotensin-converting enzyme 2 (ACE2), a receptor for SARS-CoV-2, in dominant follicles throughout the periovulatory period in women and the regulatory mechanisms underlying ACE2 expression in human granulosa/lutein cells (hGLC). DESIGN: Experimental prospective clinical study and laboratory-based investigation. SETTING: University Medical Center and private in vitro fertilization center. PATIENT(S): Thirty premenopausal women undergoing surgery for tubal ligation and 16 premenopausal women undergoing in vitro fertilization. INTERVENTION(S): Administration of human chorionic gonadotropin (hCG) and harvesting of preovulatory/ovulatory follicles by timed laparoscopy, and collection of granulosa/lutein cells and cumulus cells at the time of oocyte retrieval. MAIN OUTCOME MEASURE(S): Expression and localization of ACE2 in granulosa cells and dominant follicles collected throughout the periovulatory period of the menstrual cycle and in hGLC using quantitative polymerase chain reaction, immunoblotting, and immunohistochemistry. RESULT(S): ACE2 expression (mRNA and protein) is up-regulated in human ovulatory follicles after administration of hCG. ACE2 expression was higher in cumulus cells than in granulosa cells. hCG increased the expression of ACE2 in primary hGLC cultures; the increase was inhibited by RU486 (an antagonist for progesterone receptor and glucocorticoid receptor) and CORT125281 (a selective glucocorticoid receptor antagonist), but not by AG1478 (an EGF receptor tyrosine kinase inhibitor) or by dexamethasone. CONCLUSION(S): The hormone-regulated expression of ACE2 in granulosa cells suggests a potential role of ACE2 in the ovulatory process. These data also imply the possible impact of COVID-19 on a vital cyclic event of ovarian function and thus on women's overall reproductive health. However, SAR-CoV-2 infection in ovarian cells in vivo or in vitro has yet to be determined.


Subject(s)
Angiotensin-Converting Enzyme 2/biosynthesis , Ovarian Follicle/metabolism , Ovulation/metabolism , SARS-CoV-2/metabolism , Up-Regulation/physiology , Adult , Angiotensin-Converting Enzyme 2/genetics , Cells, Cultured , Female , Humans , Ovary/cytology , Ovary/metabolism , Ovulation/genetics , SARS-CoV-2/genetics
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