Fertility research and practice最新文献

Background: Polycystic ovary syndrome (PCOS) is characterized by hyperandrogenemia, oligo-anovulation, and numerous ovarian cysts. Hospital electronic medical records provide an avenue for investigating polycystic ovary morphology commonly seen in PCOS at a large scale. The purpose of this study was to develop and evaluate the performance of two machine learning text algorithms, for classification of polycystic ovary morphology (PCOM) in pelvic ultrasounds.

Methods: Pelvic ultrasound reports from patients at Boston Medical Center between October 1, 2003 and December 12, 2016 were included for analysis, which resulted in 39,093 ultrasound reports from 25,535 unique women. Following the 2003 Rotterdam Consensus Criteria for polycystic ovary syndrome, 2000 randomly selected ultrasounds were expert labeled for PCOM status as present, absent, or unidentifiable (not able to be determined from text alone). An ovary was marked as having PCOM if there was mention of numerous peripheral follicles or if the volume was greater than 10 ml in the absence of a dominant follicle or other confounding pathology. Half of the labeled data was used to develop and refine the algorithms, and the other half was used as a test set for evaluating its accuracy.

Results: On the evaluation set of 1000 random US reports, the accuracy of the classifiers were 97.6% (95% CI: 96.5, 98.5%) and 96.1% (94.7, 97.2%). Both models were more adept at identifying PCOM-absent ultrasounds than either PCOM-unidentifiable or PCOM-present ultrasounds. The two classifiers estimated prevalence of PCOM within the whole set of 39,093 ultrasounds to be 44% PCOM-absent, 32% PCOM-unidentifiable, and 24% PCOM-present.

Conclusions: Although accuracy measured on the test set and inter-rater agreement between the two classifiers (Cohen's Kappa = 0.988) was high, a major limitation of our approach is that it uses the ultrasound report text as a proxy and does not directly count follicles from the ultrasound images themselves.

Background: Infertility is a big health problem worldwide. Few data exist on infertility in Sudan.

Methods: A descriptive study was conducted to assess the pattern and the causes of infertility among couples (800) attending the University of Khartoum Fertility Centre, Saad Abualila Teaching Hospital in Khartoum, Sudan. The data on the socio-demographic characteristics of the patients, the type of infertility whether primary or secondary and the causes of infertility were extracted from the medical files retrospectively.

Results: The mean (SD) age of the females was 32.4 (7.4) years while that of the males was 37.5 (7.2) years. The mean (SD) duration of infertility was 4.9(3.9) years. Five hundred and fifty one (68.9%) couples had primary infertility, while the remainder 249(31.1%) had secondary infertility. Two hundred and eighty four (35.5%) couples had male infertility, 342(42.8%) couples had female infertility. One hundred and forty seven (18.4%) couples had combined male and female infertility and in 27 (3.4%) couples the cause of infertility was not identified. Factors identified in the female infertility (342) were; anovulation (178, 52.05%), tubal factor (142, 41.52%), uterine factor (7, 2.05%) and other/combined (7, 2.05%). Azoospermia (75, 26.41%), oligozoospermia (45, 15.85%), asthenozoospermia (51, 17.96%), teratospermia (15, 5.28%) and mixed pathology (101, 35.56%) were the causes of the male infertility (n = 284). Female factors of infertility were observed more frequently among couples with secondary infertility compared with primary infertility (143/551(57.4) vs. 199/249(36.1), P < 0.001.

Conclusion: The current study showed a high rate of primary infertility and female factor predominates compared with male factors. Future research direction should focus on the reasons why majority of clients seek this service very late.

Background: To assess knowledge and attitudes regarding elective oocyte cryopreservation among female undergraduate students (UG) and medical students (MS) in Eastern Virginia.

Methods: An anonymous cross-sectional study surveying female UG at a local university and MS at our academic medical center in May of 2017. The survey contained questions on demographic information, interest in fertility preservation, and knowledge about age related changes in fertility.

Results: There were 74 of 102 female UG and 95 of 117 female MS who responded, for a response rate of 73 and 81% respectively. UG were significantly younger than MS (21.4 vs 26.8, p < 0.001). Further, UG generally planned on conceiving at a younger age than MS (age 26-30 vs 31-35), and favored younger ages to consider oocyte cryopreservation (age 26-30 vs 31-35). Only a minority of both UG and MS were willing to undergo egg freezing at the current price of approximately $10,000 (15% vs 26% respectively, p = 0.044). Moreover, 73% of students overall responded that they would be more likely to freeze oocytes if their employer paid. Notably, both UG and MS underestimated age of fertility decline.

Conclusion: Both UG and MS revealed a need for education on age-related changes in fertility. Most UG and MS would not undergo elective oocyte cryopreservation at the present cost but would consider it at a lower cost.

Introduction: Ovarian transposition is a procedure that can help preserve fertility for female patients requiring radiation in the abdominopelvic region. However, the displacement of ovaries from its original anatomic location can make oocyte retrieval challenging.

Case presentation: A 24-year-old nulligravid patient recently diagnosed with colorectal carcinoma [CRC] underwent ovarian transposition prior to radiation. After radiation and chemotherapy, she began in vitro fertilization [IVF] by reproductive endocrinology and infertility physicians. Right ovary demonstrated nonviability due to failed transposition and radiation. Left ovarian oocytes were not able to be harvested due to risk of left kidney puncture via transvaginal ultrasound [TVUS]. Interventional Radiology [IR] was involved and performed a transabdominal ultrasound guided egg retrieval which led to successful IVF.

Conclusion: This case highlights the utility of IR-assisted transabdominal ultrasound approach for oocyte retrieval in patients with history of ovarian transposition.