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P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility...
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P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility Care

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Reproductive Medicine & Andrology".

Deadline for manuscript submissions: closed (25 February 2024) | Viewed by 14060

Special Issue Editors

Dr. Amerigo Vitagliano

E-Mail Website
Guest Editor
Obstetrics and Gynecology Unit, IVF Center, DIM Department, University of Bari, Bari, Italy
Interests: infertility; assisted reproduction technologies; hysteroscopy; laparoscopy; reproductive biology; reproductive immunology; ovarian stimulation; endometrium; uterine pathologies; fertility preservation
Special Issues, Collections and Topics in MDPI journals
Dr. Andrea Garolla

E-Mail Website
Guest Editor
Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
Interests: andrology; reproductive endocrinology; male infertility; assisted reproduction; sexual medicine; sperm function; sexual infectious diseases
Special Issues, Collections and Topics in MDPI journals
Dr. Danilo Cimadomo

E-Mail Website
Guest Editor
Clinica Valle Giulia, GeneraLife IVF, Rome, Italy
Interests: embryo selection; preimplantation genetic testing; artificial intelligence applications in ART; implantation; IVF
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Infertility affects 10-15% of couples worldwide, with a growing burden in Western countries. Underlying this phenomenon, there are multiple factors, including advanced age in couples, sexually transmitted diseases, worsening of environmental conditions and increasing prevalence of oncological and autoimmune disorders.

Due to the development of new drugs, minimally invasive diagnostic and therapeutic tools for infertility, advanced technologies, and artificial intelligence in embryology laboratories, it is now possible to put precision medicine into practice, with individualized treatments based on the needs and characteristics of patients. At present, the primary objective of modern reproductive medicine (P4 reproductive medicine), that, in the past, was only to achieve a pregnancy at any cost, is to fulfil the expected cumulative live birth rate in each couple in the shortest time, with the least possible risks and stress for the patients.

The achievement of this goal implies the proper application of the existing technologies to elicit precise diagnoses of infertility through the synergistic contribution of a multidisciplinary team. When assisted reproduction technologies are required, one must plan therapeutic strategies to provide the highest chance of transferring healthy embryos into a receptive womb, supporting the patients throughout the journey.

In view of the advent of “P4 reproductive medicine”, the aim of this Special Issue is to look towards the future of this field, drawing lessons from the past from a multidisciplinary perspective. For this reason, the editors of this Special Issue include three of the main professional figures of a reproductive medicine team, namely the gynaecologist, the andrologist and the embryologist.

In this Special Issue, we would like to invite original clinical and basic research articles, meta-analyses and systematic reviews, aiming to improve the body of evidence on diagnostic and therapeutic strategies that embrace gynaecological, andrological and embryological interests.

We would be grateful to receive your submissions to move the field of reproductive medicine forward.

Dr. Amerigo Vitagliano
Dr. Andrea Garolla
Dr. Danilo Cimadomo
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • female infertility
  • male infertility
  • embryology
  • assisted reproduction technologies
  • IVF
  • minimally or non-invasive diagnosis
  • sperm function
  • semen infection
  • fertility treatments
  • embryo selection
  • artificial intelligence
  • reproductive genetics

Published Papers (5 papers)

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Research

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14 pages, 308 KiB  
Article
Elevated Sperm DNA Damage in IVF–ICSI Treatments Is Not Related to Pregnancy Complications and Adverse Neonatal Outcomes
by Irene Hervás, Rocio Rivera-Egea, Alberto Pacheco, Maria Gil Julia, Ana Navarro-Gomezlechon, Laura Mossetti and Nicolás Garrido
J. Clin. Med. 2023, 12(21), 6802; https://doi.org/10.3390/jcm12216802 - 27 Oct 2023
Viewed by 892
Abstract
This multicenter retrospective cohort study assesses the effect of high paternal DNA fragmentation on the well-being of the woman during pregnancy and the health of the newborn delivered. It was performed with clinical data from 488 couples who had a delivery of at [...] Read more.
This multicenter retrospective cohort study assesses the effect of high paternal DNA fragmentation on the well-being of the woman during pregnancy and the health of the newborn delivered. It was performed with clinical data from 488 couples who had a delivery of at least one newborn between January 2000 and March 2019 (243 used autologous oocytes and 245 utilized donated oocytes). Couples were categorized according to sperm DNA fragmentation (SDF) level as ≤15% or >15%, measured by TUNEL assay. Pregnancy, delivery, and neonatal outcomes were assessed. In singleton pregnancies from autologous cycles, a higher but non-significant incidence of pre-eclampsia, threatened preterm labor, and premature rupture of membranes was found in pregnant women from the >15%SDF group. Additionally, a higher proportion of children were born with low birth weight, although the difference was not statistically significant. After adjusting for potential confounders, these couples had lower odds of having a female neonate (AOR = 0.35 (0.1–0.9), p = 0.04). Regarding couples using donor’s oocytes, pregnancy and neonatal outcomes were comparable between groups, although the incidence of induced vaginal labor was significantly higher in the >15% SDF group (OR = 7.4 (1.2–46.7), p = 0.02). Adjusted analysis revealed no significant association of elevated SDF with adverse events. In multiple deliveries from cycles using both types of oocytes, the obstetric and neonatal outcomes were found to be similar between groups. In conclusion, the presence of an elevated SDF does not contribute to the occurrence of clinically relevant adverse maternal events during pregnancies, nor does it increase the risk of worse neonatal outcomes in newborns. Nevertheless, a higher SDF seems to be related to a higher ratio of male livebirths. Full article
(This article belongs to the Special Issue P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility Care)
13 pages, 1260 KiB  
Article
Intrauterine Infusion of Leukocyte-Poor Platelet-Rich Plasma Is an Effective Therapeutic Protocol for Patients with Recurrent Implantation Failure: A Retrospective Cohort Study
by Yanna Ban, Xiaoliang Yang, Yan Xing, Wenjun Que, Zebo Yu, Wenwu Gui, Ying Chen and Xiru Liu
J. Clin. Med. 2023, 12(8), 2823; https://doi.org/10.3390/jcm12082823 - 12 Apr 2023
Cited by 6 | Viewed by 1627
Abstract
Background: The clinical application of autologous leukocyte-poor platelet-rich plasma (LP-PRP) in patients with recurrent implantation failure (RIF) is rare. This retrospective observational cohort study aimed to evaluate the efficacy of LP-PRP intrauterine infusion in patients with RIF. Methods: Patients with RIF undergoing frozen [...] Read more.
Background: The clinical application of autologous leukocyte-poor platelet-rich plasma (LP-PRP) in patients with recurrent implantation failure (RIF) is rare. This retrospective observational cohort study aimed to evaluate the efficacy of LP-PRP intrauterine infusion in patients with RIF. Methods: Patients with RIF undergoing frozen embryo transfer (FET) from January 2019 to December 2021 (n = 118) were enrolled, with those undergoing LP-PRP intrauterine infusion as the PRP group (n = 64), and those receiving no LP-PRP treatment as the control group (n = 54). The beta-human chorionic gonadotropin (β-hCG)-positive rate, clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR) per ET cycle were compared. Results: The β-hCG-positive rate (57.8% vs. 38.9%, p = 0.041), CPR (45.3% vs. 24.5%, p = 0.022), and LBR per ET cycle (42.2% vs. 18.5%, p = 0.009) were higher in the PRP group than in the control group, and the three variables (62.5% vs. 41.2%, p = 0.040, 47.5% vs. 23.5%, p = 0.033, and 47.5% vs. 20.6%, p = 0.027) in the PRP group transferred with the blastocyst-stage embryos were also higher than those in the control group. The MR was similar in all groups. Conclusions: The LP-PRP treatment could improve the β-hCG-positive rate, CPR, and LBR in RIF patients undergoing FET cycles. Full article
(This article belongs to the Special Issue P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility Care)
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18 pages, 2663 KiB  
Article
Towards Automation in IVF: Pre-Clinical Validation of a Deep Learning-Based Embryo Grading System during PGT-A Cycles
by Danilo Cimadomo, Viviana Chiappetta, Federica Innocenti, Gaia Saturno, Marilena Taggi, Anabella Marconetto, Valentina Casciani, Laura Albricci, Roberta Maggiulli, Giovanni Coticchio, Aisling Ahlström, Jørgen Berntsen, Mark Larman, Andrea Borini, Alberto Vaiarelli, Filippo Maria Ubaldi and Laura Rienzi
J. Clin. Med. 2023, 12(5), 1806; https://doi.org/10.3390/jcm12051806 - 23 Feb 2023
Cited by 11 | Viewed by 2974
Abstract
Preimplantation genetic testing for aneuploidies (PGT-A) is arguably the most effective embryo selection strategy. Nevertheless, it requires greater workload, costs, and expertise. Therefore, a quest towards user-friendly, non-invasive strategies is ongoing. Although insufficient to replace PGT-A, embryo morphological evaluation is significantly associated with [...] Read more.
Preimplantation genetic testing for aneuploidies (PGT-A) is arguably the most effective embryo selection strategy. Nevertheless, it requires greater workload, costs, and expertise. Therefore, a quest towards user-friendly, non-invasive strategies is ongoing. Although insufficient to replace PGT-A, embryo morphological evaluation is significantly associated with embryonic competence, but scarcely reproducible. Recently, artificial intelligence-powered analyses have been proposed to objectify and automate image evaluations. iDAScore v1.0 is a deep-learning model based on a 3D convolutional neural network trained on time-lapse videos from implanted and non-implanted blastocysts. It is a decision support system for ranking blastocysts without manual input. This retrospective, pre-clinical, external validation included 3604 blastocysts and 808 euploid transfers from 1232 cycles. All blastocysts were retrospectively assessed through the iDAScore v1.0; therefore, it did not influence embryologists’ decision-making process. iDAScore v1.0 was significantly associated with embryo morphology and competence, although AUCs for euploidy and live-birth prediction were 0.60 and 0.66, respectively, which is rather comparable to embryologists’ performance. Nevertheless, iDAScore v1.0 is objective and reproducible, while embryologists’ evaluations are not. In a retrospective simulation, iDAScore v1.0 would have ranked euploid blastocysts as top quality in 63% of cases with one or more euploid and aneuploid blastocysts, and it would have questioned embryologists’ ranking in 48% of cases with two or more euploid blastocysts and one or more live birth. Therefore, iDAScore v1.0 may objectify embryologists’ evaluations, but randomized controlled trials are required to assess its clinical value. Full article
(This article belongs to the Special Issue P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility Care)
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11 pages, 250 KiB  
Article
The Effect of Short-Term Aspirin Administration during Programmed Frozen-Thawed Embryo Transfer on Pregnancy Outcomes and Complications
by Hongcheng He, Dan Qi, Mei Fang, Yizheng Tian, Lei Yan, Jinlong Ma and Yanbo Du
J. Clin. Med. 2023, 12(3), 1064; https://doi.org/10.3390/jcm12031064 - 30 Jan 2023
Viewed by 6513
Abstract
Low-dose aspirin is widely used during frozen-embryo transfer (FET) cycles. Its anti-platelet property makes it a potentially useful drug for the prevention of hypertension disorders of pregnancy (HDP). However, the existing evidence about the effect of short-term aspirin administration on pregnancy outcomes is [...] Read more.
Low-dose aspirin is widely used during frozen-embryo transfer (FET) cycles. Its anti-platelet property makes it a potentially useful drug for the prevention of hypertension disorders of pregnancy (HDP). However, the existing evidence about the effect of short-term aspirin administration on pregnancy outcomes is not clear. In our study, we retrospectively investigated women who had their first or second FET cycles at the Reproductive Hospital Affiliated with Shandong University from April 2017 to December 2020. A total of 4454 programmed FET cycles were recruited. According to whether aspirin was administrated in the protocols, the patients were divided into two groups: The Control group (n = 2793, 85 of them using donor sperm) and the Aspirin group (n = 1661, 35 of them using donor sperm). We analyzed the pregnancy outcomes and pregnancy complications of these cycles and observed similar live birth rates. We found that the short-term use of aspirin at a dosage of 50 mg per day for women undergoing programmed FET did not elevate the live birth rate or decrease the incidence of a series of pregnancy complications, including HDP. Based on our experience, short-term administration of low-dose aspirin may not improve the outcomes of young women undergoing frozen-thawed embryo transfer cycles. Full article
(This article belongs to the Special Issue P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility Care)

Review

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13 pages, 308 KiB  
Review
Before Is Better: Innovative Multidisciplinary Preconception Care in Different Clinical Contexts
by Martina Cristodoro, Marinella Dell’Avanzo, Matilda Ghio, Faustina Lalatta, Walter Vena, Andrea Lania, Laura Sacchi, Maria Bravo, Alessandro Bulfoni, Nicoletta Di Simone and Annalisa Inversetti
J. Clin. Med. 2023, 12(19), 6352; https://doi.org/10.3390/jcm12196352 - 03 Oct 2023
Cited by 1 | Viewed by 1004
Abstract
Context: Implementation of pre-conception care units is still very limited in Italy. Nowadays, the population’s awareness of the reproductive risks that can be reduced or prevented is very low. Purpose and main findings: We presented a new personalized multidisciplinary model of preconception care [...] Read more.
Context: Implementation of pre-conception care units is still very limited in Italy. Nowadays, the population’s awareness of the reproductive risks that can be reduced or prevented is very low. Purpose and main findings: We presented a new personalized multidisciplinary model of preconception care aimed at identifying and possibly reducing adverse reproductive events. We analyzed three cohorts of population: couples from the general population, infertile or subfertile couples, and couples with a previous history of adverse reproductive events. The proposal involves a deep investigation regarding family history, the personal histories of both partners, and reproductive history. Principal conclusions: Preconception care is still neglected in Italy and under-evaluated by clinicians involved in natural or in vitro reproduction. Adequate preconception counseling will improve maternal and fetal obstetrical outcomes. Full article
(This article belongs to the Special Issue P4 Reproductive Medicine: Prediction, Prevention, Personalization, and Participation in Infertility Care)
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