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Open access

Francesco Saverio Ludovichetti, Anna Giulia Signoriello, Edoardo Alvise Gobbato, Anna Artuso, Edoardo Stellini, and Sergio Mazzoleni

Today periodontal health is considered as an integral part of systemic health itself and no longer as a single factor. The literature recognizes that the presence of periodontal disease can represent a risk factor for numerous systemic conditions such as heart disease and diabetes. In recent years, we have witnessed a progressive interest regarding the influence exerted by this condition on reproduction, as well as the possible repercussions on conception possibilities. Upon analyzing a limited number of studies available for the correlation between periodontal disease and female infertility, it could be inferred that this condition can be equated to the presence of a real outbreak of infection and therefore exert its influence, not only through bacterial translocation in the bloodstream, causing the systemic dissemination of pathogens, but also through the production of cytokines and immunoglobulins by inflammatory mediators. This situation limits bacterial growth, but it could cause damage to the fetus, to the reproductive system, and could hinder conception attempts. Although further research is needed to better clarify the mechanism underlying the possible correlation between periodontal disease and female infertility, the present article aims to review all the available literature on this topic.

Lay summary

In recent years, interest regarding the influence of gum disease on conception has increased. Since serious gum disease (periodontitis) can be compared to an outbreak of infection, studies suggest that the bacteria that mediate inflammation do not remain confined only to the gum tissue, but can enter the bloodstream and spread, thus spreading the infection and having a whole-body effect. This situation could cause damage to the developing baby, to the reproductive system and could hinder conception attempts. Constant maintenance of oral health is definitely necessary. It is important for the professionals involved (gynecologists, obstetricians, dentists, etc.) to communicate and collaborate on these issues. Dentists could advise on the correct hygienic maintenance not only to pregnant women, but also to those who are planning a pregnancy in order to avoid the occurrence of unfavorable conditions.

Open access

Briet D Bjarkadottir, Charlotte A Walker, Muhammad Fatum, Sheila Lane, and Suzannah Alice Williams

In vitro follicle growth is a potential fertility preservation method for patients for whom current methods are contraindicated. Currently this method has only been successful using fresh ovarian tissue. Since many patients who may benefit from this treatment currently have cryopreserved ovarian tissue in storage, optimising in vitro follicle growth (IVG) for cryopreserved-thawed tissue is critical. This study sought to improve the first step of IVG by comparing different short-term culture systems for cryopreserved-thawed human ovarian tissue, in order to yield a higher number of healthy multilayer follicles. We compared two commonly used culture media (αMEM and McCoy’s 5A), and three plate conditions (300 µL, 1 mL on a polycarbonate membrane and 1 mL in a gas-permeable plate) on the health and development of follicles after six days of culture. A total of 5,797 follicles from three post-pubertal patients (aged 21.3 ± 2.3 years) were analysed across six different culture conditions and non-cultured control. All culture systems supported follicle development and there was no difference in developmental progression between the different conditions tested. Differences in follicle morphology were evident with follicles cultured in low volume conditions having significantly greater odds of being graded as morphologically normal compared to other conditions. Furthermore, culture in a low volume of αMEM resulted in the highest proportion of morphologically normal primary and multilayer follicles (23.8% compared to 6.3-19.9% depending on condition). We therefore recommend culture of cryopreserved human ovarian tissue in a low volume of αMEM to support follicle health and development.

Open access

Elis Torrezan-Nitao, Hector Guidobaldi, Laura Giojalas, Christopher Barratt, and Stephen Publicover

Repetitive [Ca2+]i transients (oscillations), observed in progesterone (P4)-stimulated immobilised human sperm, reversibly modifiy flagellar beating. Here we report that such oscillations also occur in P4-stimulated free-swimming sperm and regulate (or contribute to) behavioural switching.

Open access

Megan Brown, Mick Rae, and Nick Wheelhouse

N/A

Open access

Babu Karavadra, Andrea Stockl, Adam H Balen, and Edward Patrick Morris

Recently, fertility services have started the process of resumption since COVID 19 was declared a pandemic, but there remains significant uncertainty in the way this care will be delivered in the United Kingdom (UK). The objective of our study was to explore the impact of COVID-19 on individuals using fertility services in the UK. The study was conducted in two phases between May 2020 to July 2020: an online questionnaire involving 1212 participants and subsequent individual semi-structured telephone interviews with 15 participants. Through thematic analysis, we learned from the questionnaire findings that 74% of individuals identified as White British, 21% as Black And Minority Ethnic (BAME) and 2.6% as male. 96% of individuals from the questionnaire explained that COVID-19 had a ‘negative impact’ on their fertility treatment, namely ‘delay in care’. 82% of participants discussed concerns about the 'uncertainty' they felt about fertility services; these included the ‘unknown impact of COVID-19 on pregnancy outcomes’, the ‘unknown impact on general gynaecology services’ and the ‘unknown impact of COVID-19 on fertility success'. Through semi-structured telephone interviews with fifteen participants, we learned about the ‘cultural pressures’ individuals from BAME backgrounds faced in relation to care. Participants were mindful about the ‘pressures on the service’ when re-opening, and therefore ‘advancing maternal age’, ‘socio-economic background’ and ‘previous unsuccessful fertility treatment’ were the main factors individuals considered important when ‘prioritising’ fertility care. Our findings can be used by fertility service providers to appreciate the patient perspective when considering the re-opening of fertility services nationally and internationally.

Open access

Michelle Engelsman, Leisa-Maree L. Toms, Xianyu Wang, Andrew P. Banks, and Debbie Blake

Not included as not required for a Research Letter.

Open access

Jennifer B Nagashima, Andrea M. Hill, and Nucharin Songsasen

Isolation of ovarian follicles is a key step in culture systems for large mammalian species, to promote continued growth of follicles beyond the preantral stage in fertility preservation efforts. Still, mechanical isolation methods are user-skill dependent and time consuming, whereas enzymatic strategies carry increased risk of damaging theca cell layers and the basement membranes. Here, we sought to determine the optimal method to rescue domestic cat (Felis catus) early antral and antral stage follicles from ovarian tissue and evaluate the influence of isolation strategy on follicle development, survival, and gene expression during 14 day in vitro culture in alginate hydrogel. Mechanical isolation was compared with 90 min digestion in 0.7 and 1.4 Wünsch units/ml Liberase blendzyme (0.7L and 1.4L, respectively). Mechanical isolation resulted in improved follicle growth and survival, and better antral cavity and theca cell maintenance in vitro, compared with 1.4L (P<0.05), but displayed higher levels of apoptosis after incubation compared with enzymatically isolated follicles. However, differences in follicle growth and survival were not apparent until 7+ days in vitro. Expression of CYP19A1, GDF9, LHR, or VEGF were similar among isolation-strategies. Cultured follicles from all isolation methods displayed reduced StAR expression compared with freshly-isolated follicles obtained mechanically or via 0.7L, suggesting that prolonged culture resulted in loss of theca cell presence and/or function. In sum, early antral and antral stage follicle development in vitro is significantly influenced by isolation strategy, but not necessarily observable in the absence of extended culture. These results indicate additional care must be taken in follicle isolation optimizations for genome rescue and fertility preservation efforts.

Open access

W. Colin Duncan

The corpus luteum is the source of progesterone in the luteal phase of the cycle and the initial two-thirds of the first trimester of pregnancy. Normal luteal function is required for fertility and the maintenance of pregnancy. Progesterone administration is increasingly used during fertility treatments and in early pregnancy to mitigate potentially inadequate corpus luteum function. This commentary considers the concept of the inadequate corpus luteum and the role and effects of exogenous progesterone. Progesterone supplementation does have important beneficial effects but we should be wary of therapeutic administration beyond or outside the evidence base.

Open access

Dimitra Apostolia Androni, Sophie Dodds, Mathew Tomlinson, and Walid E Maalouf

Human sperm cryopreservation is characterised to this day by sub-optimal success rates. Interestingly, a traditional approach to improving post-thaw outcome has been to integrate standard sperm preparation techniques into freezing protocols as a means of selecting sperm with the highest fertilisation potential prior to insemination. However, no consensus has been reached yet regarding the optimal timing (before or after freezing) of this selection step. Following analysis of a total of 20 human semen samples, which were divided into two aliquots prepared by density gradient centrifugation either before or after freezing, this study demonstrated higher post-thaw total (p<0.0001), progressively motile (p=0.005) and vital (p<0.0001) sperm counts for frozen prepared semen samples. The present study suggests that direct insemination with frozen-prepared sperm with minimal intervening post-thaw processing might be a more advantageous approach to current clinical practices, particularly for donor and patient intrauterine insemination programmes. Further research into the cryopreservation-induced coiled sperm tail morphology is also warranted.

Open access

Bhorika Aggarwal, Amanda L Evans, Howard Ryan, and Sarah Martins da Silva

Not required for research letter submission