RESUMEN
Space travel has different effects on the reproductive capacity of women compared to men. The radiation exposure intrinsic to deep space travel causes destruction of some of a woman's primordial follicles. Data suggests that a typical Mars mission may reduce a women's ovarian reserve by about 50%. This has consequences to a woman's reproductive capacity and, more significantly, decreases the time interval to her menopause. A reduced time interval to menopause is associated with earlier mortality. Estrogen replacement therapy and cryopreservation of a female astronaut's oocytes may be used to address these issues. However, cortical tissue freezing provides advantages to more directly compensate for these workplace complications. Cortical tissue freezing especially provides advantages if there are plans to reproduce in an extraterrestrial location.
Asunto(s)
Reserva Ovárica , Vuelo Espacial , Astronautas , Criopreservación , Femenino , Humanos , Menopausia , Folículo OváricoRESUMEN
Letrozole is a targeted aromatase inhibitor which has primarily been used in post-menopausal women with breast cancer. Recently, it has been utilized in infertile pre-menopausal women because of its ability to enhance FSH production for ovulation induction. However, the ovarian follicle's response to FSH is only a part of the endocrine events occurring in a developing follicle. The health of the small antral follicles is driven primarily by androgens, which contribute to granulosa cell mitosis, sensitivity to FSH, and resistance to atresia. In contrast, elevated androgens in the late antral to pre-ovulatory follicle have a negative impact on follicle health and lead to atresia and cystic follicle formation. This ovarian physiologic data suggests that current applications of letrozole to infertility may be squandering some of the primary benefits available in using letrozole to promote follicle development. Four applications of letrozole to infertility that have appeared in the medical literature are reviewed. Androgen-related benefits are reviewed and various questions put forward about how letrozole could be more effectively used to help patients in these settings.
Asunto(s)
Inhibidores de la Aromatasa/uso terapéutico , Neoplasias de la Mama/genética , Infertilidad Femenina/tratamiento farmacológico , Letrozol/uso terapéutico , Andrógenos/genética , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Estradiol/genética , Femenino , Hormona Folículo Estimulante/genética , Hormona Folículo Estimulante/uso terapéutico , Humanos , Infertilidad Femenina/patología , Folículo Ovárico/efectos de los fármacos , Folículo Ovárico/crecimiento & desarrolloRESUMEN
Fragile X and fragile X-associated tremor-ataxia syndrome (FXTAS) are caused by mutations of the FMR1 gene. The mutations causing FXTAS can expand in a generation to a "full mutation" causing fragile X syndrome. The mutations causing FXTAS and the phenotype, fragile X-associated premature ovarian insufficiency (FXPOI), are referred to as the FMR1 premutation (PM). The objective of this paper was to formulate a theory to explain the Mechanism for FXPOI.Recent research on fragile X syndrome and FXTAS has led to sophisticated theories about the mechanisms underlying these diseases. It has been proposed that similar mechanisms underlie FXPOI. Utilizing recent research on FXTAS, but a more detailed application of ovarian physiology, we present a more ovarian specific theory as to the primary mechanism explaining the development of FXPOI.The FXPOI phenotype may best be viewed as derivative of the observation that fragile X PM carriers experience menopause an average of 5 years earlier than non-carriers. Women carrying the PM experience an earlier menopause because of an accelerated activation of their primordial follicle pool. This acceleration of primordial follicle activation occurs, in part, because of diminished AMH production. AMH production is diminished because of accelerated atresia of early antral follicles. This accelerated atresia likely occurs because the fragile X PM leads to a slowing of the rate of granulosa cell mitosis in some follicles.
Asunto(s)
Proteína de la Discapacidad Intelectual del Síndrome del Cromosoma X Frágil/genética , Folículo Ovárico/metabolismo , Ovario/metabolismo , Insuficiencia Ovárica Primaria/genética , Ataxia/genética , Ataxia/patología , Femenino , Síndrome del Cromosoma X Frágil/genética , Síndrome del Cromosoma X Frágil/patología , Células de la Granulosa/metabolismo , Células de la Granulosa/patología , Heterocigoto , Humanos , Mitosis/genética , Mutación/genética , Folículo Ovárico/crecimiento & desarrollo , Folículo Ovárico/patología , Ovario/crecimiento & desarrollo , Ovario/patología , Fenotipo , Insuficiencia Ovárica Primaria/patología , Temblor/genética , Temblor/patologíaRESUMEN
The world's first babies with CRISPR-Cas9 (Clustered Regularly Interspaced Short Palindromic Repeats)-edited genes were born on November 25, 2018. Dr. Jiankui He of Southern University of Science and Technology in Shenzhen performed this gene editing. Dr. He's objectives and an assessment of how well they were achieved are discussed in the context of existing research in this area.
Asunto(s)
Sistemas CRISPR-Cas , Obstetricia , Femenino , Humanos , Recién Nacido , EmbarazoRESUMEN
OBJECTIVE: To compare in vitromaturation (IVM) to conventional in vitro fertilization (IVF) with a focus on what is required of patients in order to complete cycles, the differences in work required from the clinic providing the service, and the difference in the cost of cycles. STUDY DESIGN: This was a retrospective cohort-control study. RESULTS: With IVM as compared to IVF: office visits were reduced by an average of 3.2, the number of venipunctures was decreased by an average of 4.5, transvaginal ultrasound examinations were decreased by an average of 2.3, the number of injections given by the patient to herself was decreased by an average of 48.7, the interval from starting gonadotropins to receiving hCG was decreased by an average of 4.6 days, the number of endocrine tests was reduced by an average of 11.4, the number of minutes required for oocyte retrieval was increased by an average of 20.1 minutes, and the number of intracytoplasmic sperm injection procedures increased by an average of 1.7, medication costs were decreased by an average of 91%, and the total cost of a cycle was reduced by an average of 45.9%. CONCLUSION: Patient friendliness and cycle costs are clear advantages of IVM over conventional IVF.
Asunto(s)
Fertilización In Vitro/economía , Fertilización In Vitro/métodos , Adulto , Estudios de Cohortes , Femenino , Humanos , Recuperación del Oocito , Inducción de la Ovulación , Estudios Retrospectivos , Inyecciones de Esperma IntracitoplasmáticasRESUMEN
OBJECTIVE(S): To measure levels of lipid peroxidation (LPO) and total antioxidant capacity (TAC) in the follicular fluid from patients undergoing IVF and to examine the association among LPO and TAC and oocyte maturity, embryo quality, fertilization, cleavage, and pregnancy rates. DESIGN: Prospective study. SETTING: Tertiary care medical center. PATIENT(S): Forty-one patients undergoing IVF. INTERVENTION(S): Clear follicular fluid specimens were collected at oocyte retrieval. MAIN OUTCOME MEASURE(S): Follicular fluid LPO and TAC levels measured by the thiobarbituric acid and the chemiluminescence method, respectively. RESULT(S): The mean LPO level was 0.95 micromol malonaldehyde/L, and the mean TAC level was 819.16 Trolox equivalents. No correlation was seen among LPO or TAC levels and oocyte maturity, fertilization, cleavage, and embryo quality. The pregnancy rate was 31.7%. Pregnant patients were significantly younger than the patients who did not become pregnant (30.53 +/- 3.5 years vs. 34.32 +/- 3.98 years). After adjusting for age, a positive correlation was seen between pregnancy rate and LPO and between pregnancy rate and TAC. CONCLUSION(S): Both LPO and TAC levels were positively correlated with the pregnancy rate. Lipid peroxidation may be a good marker of metabolic activity within the follicle, and some amounts may be necessary to establish a pregnancy.