Objective: To determine the changes in the clinical practice of infertility specialists in the Philippines, specifically, the proportion of specialists who stopped practice, length of break from clinics, the decrease in caseload, changes in consultation platform, screening frequency, number of clinicians that contracted COVI D 19 and safety protocols employed during the COVID - 19 pandemic.

Methods: A cross-sectional study using an online questionnaire given to all members of the Philippine Society for Reproductive Medicine (PSRM) last November 2020. Participants were requested to answer the questionnaire through google spread sheet, with informed consent. All data were collated, summarized and reported in terms of frequencies, and measures of central tendency.

Results: There were 110 active members of the PSRM who participated in the study. There was an overall decrease in the percentage of fertility consultations during the pandemic. There is also a substantial decrease in the caseload from different practices: 45.4% reported more than 50% decrease in !VF-related procedures, 54.5% noted more than 50% decrease in intrauterine insemination procedures, 52.8% reported more than 50% decrease in ovulation induction treatment, and 66.3% reported more than 50% decrease in endoscopic procedures. About 37% of the respondents deferred approximately 5-10 cases for fertility treatment, with 27.3% of the respondents reported deferring embryo transfer to less than 5 couples. More than half of the specialists (51.8%) stopped performing fertility procedures and 68.2% of the respondents completely stopped doing out patient consultations. However, some specialists resumed clinics by May 2020 (30.9%) and June 2020 (30.9%). Upon resumption of clinics, specialists used both face to face consultation and teleconsultation, with the largest proportion of respondents using both platforms. Safety measures employed during face-to-face consultations to prevent disease transmission included hand sanitizers in the clinics, restricted number of people in the waiting room and consultation room, use of personal protective equipment, symptom check prior to face to face consults, installation of air purifiers, and acrylic barriers, and use of health declaration forms. Majority of the specialists are aware of the international and local guidelines regarding infertility care during the pandemic (98.2%) and inform patients regarding the contents of the guidelines (90%).

Conclusion: There is a significant decline in the consultations and fertility procedures during the pandemic. Specialists are well informed of the international and local guidelines regarding fertility care during the pandemic.

Based on the macroanalysis of the unbalanced development of the "demand side" and the "supply side" of clinical medicine in China, this paper elucidates the stakeholders, resources, and ecosystem of the strategic scientific and technological capacity-building and calls for a larger coverage, smoother supply chain, and more sustainable ecosystem to ensure the development of clinical medicine. Furthermore, focusing on the establishment and development of clinical reproductive health in China, the authors introduce the strategic scientific and technological capacity-building of reproductive medicine in Peking University Third Hospital, with an attempt to inform similar efforts in other fields and even the whole clinical medicine in China.
Humans ; Ecosystem ; Universities ; China ; Clinical Medicine ; Reproductive Medicine ; Hospitals

BACKGROUND: Thin or damaged endometrium causes uterine factor-derived infertility resulting in a failure of embryonic implantation. Regeneration of endometrium is a major issue in gynecology and reproductive medicine. Various types of cells and scaffolds were studied to establish an effective therapeutic strategy. For this type of investigations, production of optimal animal models is indispensable. In this study, we tried to establish various murine uterine damage models and compared their features. METHODS: Three to ten-week-old C57BL/6 female mice were anesthetized using isoflurane. Chemical and mechanical methods using ethanol (EtOH) at 70 or 100% and copper scraper were compared to determine the most efficient condition. Damage of uterine tissue was induced either by vaginal or dorsal surgical approach. After 7-10 days, gross and microscopic morphology, safety and efficiency were compared among the groups. RESULTS: Both chemical and mechanical methods resulted in thinner endometrium and reduced number of glands. Gross morphology assessment revealed that the damaged regions of uteri showed various shapes including shrinkage or cystic dilatation of uterine horns. The duration of anesthesia significantly affected recovery after procedure. Uterine damage was most effectively induced by dorsal approach using 100% EtOH treatment compared to mechanical methods. CONCLUSION: Taken together, murine uterine damage models were most successfully established by chemical treatment. This production protocols could be applied further to larger animals such as non-human primate.
Anesthesia ; Animals ; Copper ; Dilatation ; Endometrium ; Ethanol ; Female ; Gynecology ; Horns ; Humans ; Infertility ; Isoflurane ; Mice ; Models, Animal ; Primates ; Regeneration ; Reproductive Medicine ; Uterus

OBJECTIVE: The primary objective of this study was to compare clinical pregnancy rates in intrauterine insemination (IUI) treatment cycles with transabdominal ultrasound guidance during intrauterine catheter insemination (US-IUI) versus the “blind method” IUI without ultrasound guidance (BM-IUI). The secondary objective was to compare whether US-IUI had better patient tolerability and whether US-IUI made the insemination procedure easier for the clinician to perform compared to BM-IUI. METHODS: This was a randomized controlled trial done at the Reproductive Medicine Unit of General Hospital Kuala Lumpur, Malaysia. We included women aged between 25 and 40 years who underwent an IUI treatment cycle with follicle-stimulating hormone injections for controlled ovarian stimulation. RESULTS: A total of 130 patients were recruited for our study. The US-IUI group had 70 patients and the BM-IUI group had 60 patients. The clinical pregnancy rate was 10% in both groups (p> 0.995) and there were no significant difference between the groups for patient tolerability assessed by scores on a pain visual analog scale (p= 0.175) or level of difficulty for the clinician (p> 0.995). The multivariate analysis further showed no significant increase in the clinical pregnancy rate (adjusted odds ratio, 1.07; 95% confidence interval, 0.85–1.34; p= 0.558) in the US-IUI group compared to the BM-IUI group even after adjusting for potential covariates. CONCLUSION: The conventional blind method for intrauterine catheter insemination is recommended for patients undergoing IUI treatment. The use of ultrasound during the insemination procedure increased the need for trained personnel to perform ultrasonography and increased the cost, but added no extra benefits for patients or clinicians.
Catheters ; Female ; Follicle Stimulating Hormone ; Hospitals, General ; Humans ; Insemination ; Insemination, Artificial ; Malaysia ; Methods ; Multivariate Analysis ; Odds Ratio ; Ovulation Induction ; Pain Measurement ; Pregnancy Rate ; Reproductive Medicine ; Ultrasonography ; Visual Analog Scale

Based on the current understanding of a preventive effect of bilateral salpingectomy on ovarian/fallopian/peritoneal cancers, the Korean Society of Obstetrics and Gynecology, Korean Society of Gynecologic Endocrinology, Korean Society of Gynecologic Oncology, Korean Society of Maternal Fetal Medicine, and Korean Society for Reproductive Medicine support the following recommendations:• Women scheduled for hysterectomy for benign gynecologic disease should be informed that bilateral salpingectomy reduces the risk of ovarian/fallopian/peritoneal cancer, and they should be counseled regarding this procedure at the time of hysterectomy.• Although salpingectomy is generally considered as a safe procedure in terms of preserving ovarian reserve, there is a lack of evidences representing its long-term outcomes. Therefore, patients should be informed about the minimal potential of this procedure for decreasing ovarian reserve.• Prophylactic salpingectomy during vaginal hysterectomy is favorable in terms of prevention of ovarian/fallopian/peritoneal cancer, although operation-related complications minimally increase with this procedure, compared to the complications associated with vaginal hysterectomy alone. Conversion to open or laparoscopic approach from vaginal approach to perform prophylactic salpingectomy is not recommended.• Women who desire permanent sterilization at the time of cesarean delivery could be counseled for prophylactic salpingectomy before surgery on an individual basis.
Endocrinology ; Fallopian Tubes ; Female ; Genital Diseases, Female ; Gynecology* ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Obstetrics* ; Ovarian Neoplasms ; Ovarian Reserve ; Prophylactic Surgical Procedures ; Reproductive Medicine ; Salpingectomy* ; Sterilization

OBJECTIVE: Placental oxidative stress is known to be a factor that contributes to pregnancy failure. The aim of this study was to determine whether selenium could induce antioxidant gene expression and regulate invasive activity and mitochondrial activity in trophoblasts, which are a major cell type of the placenta. METHODS: To understand the effects of selenium on trophoblast cells exposed to hypoxia, the viability and invasive activity of trophoblasts were analyzed. The expression of antioxidant enzymes was assessed by reverse-transcription polymerase chain reaction. In addition, the effects of selenium treatment on mitochondrial activity were evaluated in terms of adenosine triphosphate production, mitochondrial membrane potential, and reactive oxygen species levels. RESULTS: Selenium showed positive effects on the viability and migration activity of trophoblast cells when exposed to hypoxia. Interestingly, the increased heme oxygenase 1 expression under hypoxic conditions was decreased by selenium treatment, whereas superoxide dismutase expression was increased in trophoblast cells by selenium treatment for 72 hours, regardless of hypoxia. Selenium-treated trophoblast cells showed increased mitochondrial membrane potential and decreased reactive oxygen species levels under hypoxic conditions for 72 hours. CONCLUSION: These results will be used as basic data for understanding the mechanism of how trophoblast cells respond to oxidative stress and how selenium promotes the upregulation of related genes and improves the survival rate and invasive ability of trophoblasts through regulating mitochondrial activity. These results suggest that selenium may be used in reproductive medicine for purposes including infertility treatment.
Adenosine Triphosphate ; Anoxia ; Antioxidants ; Gene Expression ; Heme Oxygenase-1 ; Infertility ; Membrane Potential, Mitochondrial ; Mitochondria ; Oxidative Stress ; Placenta ; Polymerase Chain Reaction ; Pregnancy ; Reactive Oxygen Species ; Reproductive Medicine ; Selenium* ; Superoxide Dismutase ; Survival Rate ; Trophoblasts* ; Up-Regulation

Adolescent and young adult (AYA) patients are generally defined as being from 15 to 39 years old. For preservation of fertility in AYA cancer patients, the best-known guideline in this field was released by the American Society of Clinical Oncology (ASCO) in 2006. However, the ASCO guideline is not necessarily applicable to Japanese cancer patients. The Japan Society for Fertility Preservation (JSFP) was formed in 2012, and a system and guideline for fertility preservation in Japanese AYA cancer patients plus children was released in July 2017. According to this guideline, patients should receive psychological and social support from health care providers such as doctors, nurses, psychologists, pharmacists, and social workers. In 2013, the American Society for Reproductive Medicine stated that freezing oocytes is a method that has passed beyond the research stage. However, freezing ovarian tissue is still a research procedure. While slow freezing of ovarian tissue is generally performed, rapid freezing (vitrification) is more popular in Japan. We have developed a new closed technique for ovarian tissue cryopreservation. It has been suggested that optical coherence tomography might be applied clinically to measure the true ovarian reserve and localize follicles in patients undergoing ovarian tissue transplantation. Combining gonadotropin-releasing hormone agonist therapy with anticancer agents might be useful for ovarian protection and it is expected that discussion of such combined treatment will continue in the future. This article outlines practical methods of fertility preservation using assisted reproductive techniques for AYA cancer patients in Japan.
Adolescent* ; Antineoplastic Agents ; Asian Continental Ancestry Group ; Child ; Cryopreservation ; Fertility Preservation* ; Fertility* ; Freezing ; Gonadotropin-Releasing Hormone ; Health Personnel ; Humans ; Japan* ; Medical Oncology ; Methods ; Oocytes ; Ovarian Reserve ; Pharmacists ; Psychology ; Reproductive Medicine ; Reproductive Techniques, Assisted ; Social Work ; Social Workers ; Tissue Transplantation ; Tomography, Optical Coherence ; Transplants ; Vitrification ; Young Adult*

John Michael Bedford ( Figure 1) studied at Sidney Sussex College, Cambridge University (1952–1958), and gained his BA (1955) and MA (1958) in Natural Sciences, with postgraduate training in Veterinary Medicine and Surgery (Vet MB 1958). He had academic appointments as a Fellow at Bristol University (1958–1959), a scientist with MC Chang at the Worcester Foundation in Shrewsbury, MA, USA (1959–1961), and studied for a PhD in Physiology with Professor Amoroso at the University of London (1961–1965). During this time, he was also a lecturer at the Royal Veterinary College (1961–1966) and a teacher at the University of London (1965). He then returned to Worcester (1966–1967) and thereafter was an Assistant Professor of Anatomy at Columba University, New York (1967–1970), Associate Professor (1970–1972), and from 1972 to 2000, both Professor of Reproductive Biology and Professor of Cell Biology and Anatomy at Cornell University Medical College (now Weill Cornell Medical College). He became the Percy and Harold Uris Professor of Reproductive Biology (1981–2000) and Professor Emeritus of Reproductive Biology in Obstetrics and Gynecology (2000) at Cornell University. From 1986 to 1990, he was the Director of the in vitro fertilization laboratories at Cornell.
History, 20th Century ; History, 21st Century ; Humans ; Male ; Reproductive Medicine/history* ; Spermatozoa/physiology* ; United Kingdom

Polycystic ovary syndrome (PCOS) is the most common metabolic and endocrine disorder in women, leading to infertility. However, there is no general agreement concerning how to diagnose and treat PCOS. The Rotterdam consensus statement from the European Society of Human Reproduction and Embryology/American Society for Reproductive Medicine, the Chinese diagnostic criteria and consensus statement, and the clinical practice guideline from the Endocrine Society in the USA are widely recognized. Guidance has been provided for clinical practice based on a comparative analysis of the above three practice guidelines or consensus statements (Wang et al., 2018a). High body mass index (BMI) has no negative effect on the outcome of in vitro fertilization (IVF) in Chinese patients with PCOS; however, the conclusion may be limited by the retrospective design and potential bias (Pan et al., 2018). Neonatal birth weight is positively affected by both maternal pre-pregnancy body mass index (pre-BMI) and gestational weight gain (Du et al., 2017). Normal body weight is very important for conception. Women with PCOS are almost 3 times more likely to be obese than those without PCOS; however, no specific interventions are available to induce weight loss, and drugs are used to treat other symptoms of the syndrome or obesity in the general population. A network meta-analysis found that the amount of weight loss differed significantly according to the choice of drugs (in descending order): liraglutide, orlistat, and metformin. Liraglutide alone, liraglutide/metformin, and metformin alone significantly reduced waist circumference, but no change was found with orlistat, indicating liraglutide appears superior to the other drugs in reducing weight and waist circumference (Wang et al., 2018b). IVF, as a choice for more than 1 000 000 infertile couples each year, gives rise to the birth of over 3 000 000 babies worldwide.
Acupuncture Therapy ; Adolescent ; Adult ; Body Mass Index ; Body Weight ; China ; Clinical Trials as Topic ; Female ; Fertilization in Vitro ; Humans ; Infertility, Female/therapy* ; Interdisciplinary Communication ; Medicine, Chinese Traditional ; Polycystic Ovary Syndrome/therapy* ; Reproductive Medicine/methods* ; Research Design ; Young Adult

The development of biomarkers of reproductive medicine is still in its infancy because many black boxes are still present in reproductive medicine. Novel approaches to human infertility diagnostics and treatment must be developed because reproductive medicine has lagged behind in the implementation of biomarkers in clinical medicine. Despite the dearth of the available literature, the current rapid pace of publications suggests that this gap will soon be filled therefore; this review is a précis of the research that has been done so far and will provide a basis for the development of biomarkers in reproductive medicine.
Biomarkers* ; Clinical Medicine ; Humans ; Infertility ; Reproduction ; Reproductive Medicine