Mapping research in assisted reproduction worldwide.

In medicine, safety and efficacy are the two pillars on which the implementation of novel treatments rest. To protect the patient from unnecessary or unsafe treatments, usually, a stringent path of (pre) clinical testing is followed before a treatment is introduced into routine patient care. However, in reproductive medicine several techniques have been clinically introduced without elaborate preclinical studies. Moreover, novel reproductive techniques may harbor safety risks not only for the patients undergoing treatment, but also for the offspring conceived through these techniques. If preclinical (animal) studies were performed, efficacy and functionality the upper hand. When a new medically assisted reproduction (MAR) treatment was proven effective (i.e. if it resulted in live birth) the treatment was often rapidly implemented in the clinic. For IVF, the first study on the long-term health of IVF children was published a decade after its clinical implementation. In more recent years, prospective follow-up studies have been conducted that provided the opportunity to study the health of large groups of children derived from different reproductive techniques. Although such studies have indicated differences between children conceived through MAR and children conceived naturally, results are often difficult to interpret due to the observational nature of these studies (and the associated risk of confounding factors, e.g. subfertility of the parents), differences in definitions of clinical outcome measures, lack of uniformity in assessment protocols and heterogeneity of the underlying reasons for fertility treatment. With more novel MARs waiting at the horizon, there is a need for a framework on how to assess safety of novel reproductive techniques in a preclinical (animal) setting before they are clinically implemented. In this article, we provide a blueprint for preclinical testing of safety and health of offspring generated by novel MARs using a mouse model involving an array of tests that comprise the entire lifespan. We urge scientists to perform the proposed extensive preclinical tests for novel reproductive techniques with the goal to acquire knowledge on efficacy and the possible health effects of to-be implemented reproductive techniques to safeguard quality of novel MARs.

Moving from awareness to action on preventing patient exposure to toxic environmental chemicals

Science linking environmental contaminant exposures with fertility and reproductive health impacts in the adult male

Reproductive health needs to be front and centre in development

Phthalates and other endocrine-disrupting chemicals: the 21st century's plague for reproductive health

<h3>Background</h3> Men who have sex with men (MSM) bear a disproportionate burden of sexually transmitted infections (STIs) including HIV. While routine STI surveillance data indicate MSM regularly access genitourinary medicine (GUM) services for their sexual health care, the extent to which MSM attend non-specialist Level 2 sexual health services is unclear. We investigated access of Level 2 services by MSM in England. <h3>Methods</h3> We used provisional data from the GUM Clinic Activity Dataset (GUMCADv2) to compare the characteristics, service usage and outcomes between MSM accessing GUM and Level 2 services who reported data in 2013. <h3>Results</h3> Of all male attendances where sexual orientation was recorded, 12.3% (6,957/57,048) of Level 2 attendances were among MSM compared to 26.3% (299,456/1,139,424) of GUM attendances (p &lt; 0.001). MSM attending Level 2 compared to GUM services, were younger (mean age: 30.5 yrs vs 38.5 yrs; p &lt; 0.001), and more likely to be of black ethnicity (6.8% vs 4.1%; p &lt; 0.001) and reside in London (49.9% vs 46.0%; p &lt; 0.001). MSM attending non-GUM services were more likely to have a full sexual health screen (41.4% vs 27.0%; p &lt; 0.001), HIV test (8.9% vs 7.1%; p &lt; 0.001), and be diagnosed with chlamydia (6.2% vs 3.0%; p &lt; 0.001), gonorrhoea (5.6% vs 4.6%: p &lt; 0.001) and first-episode genital warts (1.5% vs 1.0%: p &lt; 0.001). There was no significant difference in the proportion newly diagnosed with HIV (0.57% vs 0.69%; p = 0.268) or first-episode genital herpes (0.47% vs 0.46%; p = 0.830). <h3>Conclusion</h3> Level 2 sexual health services play an important role in the sexual health care of MSM, especially those of younger age.

In Uganda, only 19% of adolescents utilize adolescents’ reproductive health services yet complications of pregnancy, abortions, and childbirth are the leading cause of disability and death among the same age group. The purpose of this study was to assess factors that were contributing to the low utilization of adolescents’ reproductive health services. A quantitative cross-sectional study employed simple random sampling among 85 adolescents that were attending Kampala international university outpatient clinic. Results found out that majority 46(53.4) of adolescents were aged from 15-16 years, 46(53.4%) were male, 28(32.5%) were Catholics most 81(94.1%) were single. 18(36%) had got the information from their friends, 28(56%) of adolescents said that the information about adolescents' reproductive health services was not freely shared in their communities and 33(66%) said that their communities did not accept adolescents sexual reproductive health services where 7(50%) gave a reason they expected to be young to have sexual intercourse. 43(86%) of adolescents were from within 1-5km, 28(73.8%) mentioned lack of privacy at the facility, and 30(79%) said that health workers segregated adolescents that needed similar reproductive health services. In conclusion, factors that were contributing to the low hindering utilization of adolescents’ reproductive health services were both demographic, socio-economic, and facility related. Keywords: Adolescents, Reproductive, Health Services, Uganda.

The increase in migrant populations in western Europe has led to specific problems and dilemmas in the area of sexual and reproductive health and service provision. In general, these problems and dilemmas can be divided into four categories: (1) epidemiology of diseases and risk factors; (2) psychosocial and cultural aspects; (3) communication; and (4) moral and ethical dilemmas.Regarding epidemiology, there is an increased prevalence in migrant groups of unwanted pregnancy and abortion, HIV/STDs, and sexual violence. Effective contraceptive use is hampered by knowledge deficits, uncertain living conditions, ambivalence regarding the use of contraceptives, and problems accessing (information on) contraception. Psychosocial and cultural aspects relate to the norms and attitudes individuals and groups have regarding the family, social relationships, sexuality, and gender. These norms and attitudes have an impact on the sexual and reproductive choices people make and the possibilities and restrictions they feel in this respect. Problems in communication concern not only language but also communication styles, the way patients present their problems, and the expectations they have from the service provider. Communication problems inevitably lead to a lower quality of care. Moral and ethical dilemmas arise where cultures collide, for example regarding sexuality education and virginity problems. Two examples of practical situations in which migrant patients ask for help with sexual or reproductive health problems will be described.

Women’s health—what’s new worldwide

BackgroundGlobally, women face many barriers in the attainment of sexual and reproductive health and rights (SRHR). Since 2002, the legalisation of abortion in Nepal has seen significant progress in the expansion of safe abortion and family planning services.MethodsThis qualitative, exploratory study was conducted in 2014 and uses nine in-depth, open-ended interviews with a cross-section of SRHR professionals, to explore their perspectives on abortion in Nepal. The study was underpinned by the Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology and used the health information pyramid conceptual framework.ResultsThematic content analysis revealed emerging themes relating to barriers to access and uptake of skilled safe abortion services and post-abortion family planning. Findings also emphasised current practical and legal components relating to the provision of medical abortion through pharmacies and highlighted issues of sex-selective abortion within the predominantly patriarchal society.ConclusionEffective and ongoing sector-wide monitoring and evaluation of safe abortion services and their staff is essential for women in Nepal to have adequate access to effective and efficient safe abortion services, access to contraception and sexual and reproductive health (SRH) information post-abortion and to ensure adherence to current Safe Abortion Policy. It is critical that the unsafe (less and least safe) provision of medical abortion through pharmacies and sex-selective abortion continues to be investigated and that innovative strategies are formulated to ensure the cultural, reproductive and sexual health and rights of Nepali women are realised.

P94 The 13th national genitourinary medicine (GUM) taster day

Despite recent advances in reproductive medicine, there are still no effective treatments for severe infertility caused by congenital absence of germ cells or gonadotoxic treatments during prepubertal childhood. However, the development of technologies for germ cell formation from stem cells in vitro, induction of pluripotency from somatic cells, and production of patient-specific pluripotent stem cells may provide new solutions for treating these severe fertility problems. It may be possible to produce germ cells in vitro from our own somatic cells that can be used to restore fertility. In addition, these technologies may also bring about novel therapies by helping to elucidate the mechanisms of human germ cell development. In this review, we describe the current approaches for obtaining germ cells from pluripotent stem cells, and provide basic information about induction of pluripotency and germ cell development.

Certain anogenital conditions require surgical intervention and although the specialty training curriculum for genitourinary (GU) medicine mentions skin biopsy as the only surgical skill required for training, most practitioners could usefully provide a more extensive surgical or 'minor ops' service. The purpose of this paper is to provide guidance for practitioners considering starting a minor surgery service, outlines the equipment required and describes commonly used techniques such as skin biopsy, cryotherapy, excision, electrosurgery and laser ablation.

Nurses continue to play a crucial role in helping to deliver the Department of Health's 10-year National Strategy for Sexual Health and HIV (DH, 2001) and the Government's White Paper, Choosing Health (DH, 2004). Both policies aim to reduce the transmission of sexually transmitted infections (STIs) and the prevalence of undiagnosed cases. However, over the past 10-years the rate of newly diagnosed STIs among men who have sex with men (MSM) has increased by 77% (Health Protection Agency, 2007). Genitourinary medicine (GUM) clinics have long been popular with MSM owing to their provision of non-judgemental services, and are increasingly becoming nurse-led. However, the relative underfunding of GUM clinics and the pressures placed on nursing staff to reach waiting time targets has called in to question the quality of service provided. Concurrently, potential contributors to poor sexual health among MSM, including the deep-rooted effects of homophobia and low self-esteem, continue to be overlooked in the fight against rising STIs. Despite the Government's pledge to transform sexual health services with 300 million pounds of extra funding, there has been little significant improvement in the sexual health of MSM. Poor stewardship of resources and poor management of service targets arising from current policy contribute to a negative impact on the sexual health of MSM and the quality and effectiveness of nursing care.

Study question Evaluate the population attending Assisted reproductive techniques (ART) who have suffered the interruption of fertilization paths because of the SARS-CoV–2 italian national lockdown declared under goverment provision. Summary answer The research show that some infertile couples candidate to ART paths obtained a spontaneous pregnancy during the lockdown due to SARS-CoV–2 pandemic. What is known already The real impact of psychological stress on couple infertility in terms of pregnancies obtained is largely under-investigated in the literature and the potential low frequency of sexual activity is usually poorly considered in the management of couple infertility and its role on pregnancies failure is unclear, but probably underestimated. Moreover, the worldwide spread of the SARS-CoV–2 infection has profoundly affected all aspects of human life, with tangible consequences in several contexts, including reproduction. This allowed to highlight the interrelation between psychological distress and reproductive medicine are still conflicting. Study design, size, duration This is a study conducted at the Fertility Centre of the Department of Obstetrics and Gynaecology of Reggio Emilia (Italy), that evaluated the conception ability of couples who suffered the postponement of ART cycles during the SARS-CoV–2 pandemic. In particular, we collected anamnestic, anthropometrical and demographic data of those women attending ART straddling the lockdown period, from March 2020 to April 2020. Participants/materials, setting, methods The study evaluated couples attending ART, who had an interruption of the fertilization paths due to the SARS-CoV–2 pandemic. The variables as women age, BMI, duration of infertility, number of sexual intercourses per week and infertility aetiology were considered in a multivariate logistic analysis. The statistical analysis was performed setting pregnancy (categorical data) as the dependent variable, and all other available data as either covariates or cofactors. Main results and the role of chance Among the 431 couples recalled to reschedule ART cycles 34 couples (7.9%) obtained a spontaneous pregnancy during the COVID–19 lockdown. The statistical analysis for the 431 couples recalled showed that average duration of couple infertility was 3.5 ± 2.8 years, while an exclusively female causal factor was observed in the 23.7% of cases (102 couples), an exclusively male one in the 32.7% (141 couples), a coexistence of male/female factor in the 18.6% (80 couples), and an idiopathic form in the 25.1% (108 couples). The 34 couples obtained a spontaneous pregnancy presented a female infertility factor in the 26.5% of cases (9 couples), a male factor in the 29.4% (10 couples), a male/female factor in the 11.8% (4 couples), and idiopathic infertility in the 32.4% (11 couples). The male factor of infertility was not evaluated in all couples, thus this definition came from the anamnestic evaluation of the couple. In a multivariate logistic analysis we highlighted that the infertility history duration and the sexual intercourses frequency were significantly related to pregnancy (F = 4.8, degrees of freedom=1, p = 0.030 and F = 81.6, degrees of freedom=1, p &amp;lt; 0.001, respectively). Limitations, reasons for caution Despite the short observation period (two months of italian national lockdown declared under goverment provision), the large sample size of women evaluated attending to a single ART centre constitutes a point of strength of our study. However, the absence of a control group represents the most important limit. Wider implications of the findings: In conclusion, the lockdown allowed to increase the knowledge about under-explored causes of idiopathic infertility: the frequency of sexual intercourses. This aspect in reproductive medicine could help to identify those couples able to conceive spontaneously, avoiding unnecessary over-treatment, and to correctly apply ART to those couples who really need it. Trial registration number none