Natural Conception Research Articles

Resumption of ovulation in anovulatory women with PCOS and obesity is associated with reduction of 11β-hydroxyandrostenedione concentrations.

Is resumption of ovulation after a 6-month lifestyle intervention in women with PCOS and obesity associated with differential changes in endocrine and metabolic parameters (weight, insulin resistance, anti-Müllerian hormone (AMH), and androgens) compared to women with PCOS who remained anovulatory? Resumption of ovulation after a 6-month lifestyle intervention in women with PCOS and obesity is associated with changes in serum 11β-hydroxyandrostenedione (11OHA4) concentrations. Lifestyle interventions have been shown to reduce clinical and biochemical hyperandrogenism in women with PCOS. Weight loss of 5-10% may reverse anovulatory status, thereby increasing natural conception rates. However, the mechanisms underlying why some women with PCOS remain anovulatory and others resume ovulation after weight loss are unclear. Reproductive characteristics at baseline and a greater degree of change in endocrine and metabolic features with lifestyle intervention may be crucial for ovulatory response. We used data and samples originating from an earlier randomized controlled trial (RCT), which examined the efficacy of a 6-month lifestyle intervention prior to infertility treatment compared to prompt infertility treatment on live birth rate in women with obesity. A total of 577 women with obesity (BMI > 29 kg/m2) were randomized between 2009 and 2012. Anovulatory women with PCOS who were allocated to the intervention arm of the original RCT (n = 95) were included in the current analysis. We defined women as having resumed ovulation (RO+) based on the following criteria: spontaneous pregnancy; or assignment to expectant management; or IUI in natural cycles as the treatment strategy after lifestyle intervention. Steroid hormones were measured using liquid chromatography tandem mass spectrometry. Generalized estimating equations with adjustment for baseline measures and interaction between group and time was used to examine differences in changes of endocrine and metabolic parameters between RO+ (n = 34) and persistently anovulatory women (RO-, n = 61) at 3 and 6 months after intervention. At baseline, the mean ± SD age was 27.5 ± 3.6 years in the RO+ group and 27.9 ± 4.1 years in the RO- group (P = 0.65), and the mean ± SD weights were 101.2 ± 9.5 kg and 105.0 ± 14.6 kg, respectively (P = 0.13). Baseline AMH concentrations showed significant differences between RO+ and RO- women (median and interquartile range [IQR] 4.7 [3.2; 8.3] versus 7.2 [5.3; 10.8] ng/ml, respectively). Baseline androgen concentrations did not differ between the two groups. During and after lifestyle intervention, both groups showed weight loss; changes in 11OHA4 were significantly different between the RO+ and RO groups (P-value for interaction = 0.03). There was a similar trend for SHBG (interaction P-value = 0.07), and DHEA-S (interaction P-value = 0.06), with the most pronounced differences observed in the first 3 months. Other parameters, such as AMH and FAI, decreased over time but with no difference between the groups. No high-resolution transvaginal ultrasonography was used to confirm ovulatory status at the end of the lifestyle program. The small sample size may limit the robustness of the results. Reduction of androgen concentrations during and after lifestyle intervention is associated with recovery of ovulatory cycles. If our results are confirmed in other studies, androgen concentrations could be monitored during lifestyle intervention to provide individualized recommendations on the timing of resumption of ovulation in anovulatory women with PCOS and obesity. The study was supported by a grant from ZonMw, the Dutch Organization for Health Research and Development (50-50110-96-518). The Department of Obstetrics and Gynecology of the UMCG received an unrestricted educational grant from Ferring Pharmaceuticals BV, The Netherlands. A.H. reports consultancy for the development and implementation of a lifestyle App MyFertiCoach developed by Ferring Pharmaceutical Company. All other authors have no conflicts to declare. The LIFEstyle RCT was registered at the Dutch trial registry (NTR 1530).

A comprehensive study of pre-eclampsia in IVF and natural conceptions: clinical phenotypes, perinatal outcomes and neonatal echocardiography

Research question: What differences exist in the preeclampsia phenotypes, perinatal outcomes, and neonatal echocardiography between pregnancies conceived naturally and through in vitro fertilization? DesignFrom January 2002 to December 2022, a total of 610 women diagnosed with preeclampsia were included. This research was conducted within the IVF and Maternal-Fetal Medicine Department of Kaohsiung Chang Gung Memorial Hospital. Participants were divided into two groups, one achieved pregnancy through IVF and another, spontaneously. This study reviewed preeclampsia phenotypes, perinatal outcomes, and screening of newborn echocardiography. Results: After conducting propensity score matching, the natural conception group had a higher prevalence of early-onset preeclampsia (53.9% vs. 37.7%, p = 0.04) and exhibited more severe features (89.1% vs. 69.8%, p = 0.01), when compared to the IVF group. Regarding perinatal outcomes, neonates in the IVF group had higher placental weights than those in the natural conception group (580 vs. 480 g, p = 0.031). There were no differences in the prevalence of abnormal newborn echocardiography. Multivariate analysis showed that greater gestational age at delivery reduced the likelihood of abnormal cardiac echo (RR 0.950, p=0.001), while pregestational diabetes increased it (RR 1.451, p=0.044). Septal defects were the most common, occurring in 15.5% of infants. Conclusion: Our study revealed that the impact of IVF conception on the preeclampsia severity is not as expected. Through neonatal echocardiography, a higher occurrence of abnormalities was observed compared to the general population. Furthermore, these issues were not linked to conception method, suggesting undisclosed factors that could influence the clinical features and perinatal outcomes of preeclampsia.

The Concept of Nature Underlying Early Childhood Education and Care from Pre-Modern to Contemporary Japan, via Sozo Kurahashi and Kitaro Nishida

ABSTRACT This article examines the Japanese historical concept of nature in early childhood education and care (ECEC). Through modernisation, Japan was infused with Anglo-European philosophy. However, Japan’s pre-modern concept of nature differed from that of the West or modern Japan and latently affected the Japanese modern educational system. The concept of nature comprised two modes: mizukara, meaning “voluntarily” or indicating the mode of the voluntary self or “I,” and onozukara, referring to what is “spontaneously or naturally so” or indicating modes of transcendence beyond the self that permeate Japanese pre-modern reading education and apprenticeship as well as contemporary Japanese society. This study investigates Japanese modern texts by representative educator Sozo Kurahashi and philosopher Kitaro Nishida on education and philosophy to describe the latent and underlying connection between the concept of nature and Japanese ECEC as well as to depict the configuration of educational discourse focused on nature.

Fetal growth in IVF/ICSI pregnancies from fresh/thawed embryo transfer and natural conception.

Linked article: This is a mini commentary on Ageheim et al., pp. 1229–1237 in this issue. To view this article visit https://doi.org/10.1111/1471‐0528.17786.

Ovulation induction and subfertile untreated conception groups offer improved options for interpreting risks associated with ART

PurposeTo identify and characterise appropriate comparison groups for population studies of health outcomes in ART-conceived births: ovulation induction (OI), subfertile untreated and fertile natural conceptions. Our secondary objective was to examine whether known risks of pregnancy complications and adverse birth outcomes in ART births are elevated in comparison with subfertile (untreated and OI) conception groups.MethodsWe linked State and Commonwealth datasets to identify all live and stillbirths (≥ 20 weeks) in Western Australia from 2003 to 2014 by method of conception. Demographic characteristics, maternal pre-existing conditions, adverse obstetric history and pregnancy complications were compared across conception groups. Generalised estimating equations were used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CI) for pregnancy complications and birth outcomes in singletons.ResultsWe identified 9456 ART, 3870 OI, 11,484 subfertile untreated and 303,921 fertile naturally conceived deliveries. OI and subfertile untreated groups more closely resembled the ART group than the fertile group; however, some differences remained across parity, maternal age, pre-existing conditions and obstetric history. In multivariate analyses, ART singletons had greater risks of placental problems (e.g. placenta praevia aRR 2.42 (95% CI 1.82–3.20)) and adverse birth outcomes (e.g. preterm birth aRR 1.38 (95% CI 1.25–1.52)) than the subfertile untreated group, while OI singletons were more similar to the subfertile group with higher risk of preeclampsia and gestational diabetes.ConclusionOI and subfertile untreated conception groups offer improved options for interpreting health outcomes in ART births. Pregnancy complications (particularly placental disorders) and adverse outcomes at delivery are more common following ART.

Multimodal learning system integrating electronic medical records and hysteroscopic images for reproductive outcome prediction and risk stratification of endometrial injury: a multicenter diagnostic study.

To develop a multimodal learning application system that integrates electronic medical records (EMR) and hysteroscopic images for reproductive outcome prediction and risk stratification of patients with intrauterine adhesions (IUAs) resulting from endometrial injuries. EMR and 5014 revisited hysteroscopic images of 753 post hysteroscopic adhesiolysis patients from the multicenter IUA database we established were randomly allocated to training, validation, and test datasets. The respective datasets were used for model development, tuning, and testing of the multimodal learning application. MobilenetV3 was employed for image feature extraction, and XGBoost for EMR and image feature ensemble learning. The performance of the application was compared against the single-modal approaches (EMR or hysteroscopic images), DeepSurv and ElasticNet models, along with the clinical scoring systems. The primary outcome was the 1-year conception prediction accuracy, and the secondary outcome was the assisted reproductive technology (ART) benefit ratio after risk stratification. The multimodal learning system exhibited superior performance in predicting conception within 1-year, achieving areas under the curves of 0.967 (95% CI: 0.950-0.985), 0.936 (95% CI: 0.883-0.989), and 0.965 (95% CI: 0.935-0.994) in the training, validation, and test datasets, respectively, surpassing single-modal approaches, other models and clinical scoring systems (all P<0.05). The application of the model operated seamlessly on the hysteroscopic platform, with an average analysis time of 3.7±0.8s per patient. By employing the application's conception probability-based risk stratification, mid-high-risk patients demonstrated a significant ART benefit (odds ratio=6, 95% CI: 1.27-27.8, P=0.02), while low-risk patients exhibited good natural conception potential, with no significant increase in conception rates from ART treatment (P=1). The multimodal learning system using hysteroscopic images and EMR demonstrates promise in accurately predicting the natural conception of patients with IUAs and providing effective postoperative stratification, potentially contributing to ART triage after IUA procedures.

An Ecocritical Exploration of Bakhtin's Major Concepts in Solar Storms

Mikhail Bakhtin is a Russian scholar who has been studied internationally in fields of literature and the humanities. Basing his theory on the principle of communication, Bakhtin formed a significant path in literary and cultural studies. Some scholars like Michael Gardiner (1993), Michael M. Bell (1994), Michael J. McDowell (1996), Timo Müller (2010) and Patrick D. Murphy (2013) propose that Bakhtin’s concepts can be appropriated to ecocriticism to make more powerful analyses of literary texts since both Bakhtinian literary criticism and ecocriticism highlight diversity, heterogeneity, agency, and interaction. In this way, Bakhtinian ecocritical theory suggests a new definition of the human subject in its relation to the physical environment and nonhuman beings. Revealing the viability of Bakhtinian critical theory with ecological concerns, this article aims to study the novel Solar Storms by Linda Hogan, a Native American female writer, through an “eco-Bakhtinian” approach to explore how nature is represented in Native American context, how the relationship between human and nonhuman worlds is depicted, how both worlds function in one another, how and why the perception of nature differs in cultural aspects, and how the concept of nature has changed over time. In doing so, this article attempts to show the interaction between culture-nature, human-nonhuman, earth-body, body-mind, traditional-modern, native-non-native, fact-fiction, story-history, self-other, individual-society, and text-reader.

Observation on efficacy and underlying mechanism of cheek acupuncture on ovulation induction for infertile women with PCOS: Case series.

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder among women of childbearing age and is the primary cause of anovulatory infertility, accounting for 70% to 80% of cases. Ovulation induction is the main treatment approach for infertile patients with PCOS. Commonly utilized medications for this purpose are clomiphene citrate (CC) and letrozole (LE). Clomiphene citrate administration results in an ovulation rate ranging from 60% to 85%, while the pregnancy rate is limited to 35% to 40%, and a further reduction is observed in live birth rates. Letrozole demonstrates a slightly higher pregnancy rate and live birth rate compared to clomiphene citrate, although challenges persist in terms of longer stimulation cycles, multiple pregnancies, and the risk of ovarian hyperstimulation syndrome (OHSS). Clinical reports indicate that acupuncture therapy shows promising efficacy in treating patients with PCOS-related infertility, despite a partially unclear understanding of its underlying mechanisms. In this study, one patient did not achieve pregnancy despite more than a year of ovulation induction using clomiphene citrate and letrozole. However, after 3 months of receiving cheek acupuncture therapy, she successfully conceived and gave birth to a liveborn baby. Another patient achieved natural conception and live birth after 2 months of exclusive cheek acupuncture therapy. PCOS. Cheek acupuncture therapy. Both of them successfully conceived and gave birth to a liveborn baby. These findings suggest that cheek acupuncture therapy can effectively stimulate follicle development and ovulation, potentially improving endometrial receptivity. According to holographic theory, there is a biologically holographic model within the cheek region that shares a homology with the human body structure. This model provides an explanation for the regulatory effects of cheek acupuncture point stimulation on the Hypothalamic-Pituitary-Ovarian axis (HPO), which subsequently influences follicle development and ovulation in patients. Consequently, when cheek acupuncture therapy is applied alone or in combination with ovulation induction medication, patients have the ability to achieve successful pregnancy and experience a smooth delivery.

The problem of pain and its assessment in children with epidermolysis bullosa

Goal. Currently, there is an increasing interest in the treatment and improvement of the quality of life of patients with rare chronic diseases, and one of the urgent issues remains the problem of pain syndrome assessment and prevention. The purpose of the review article was to study the problem of pain and its assessment in children with epidermolysis bullosa. Theoretical justification. In the article, the problem of pain is considered as a complex biopsychosocial phenomenon, according to the results of a theoretical review, the main provisions of the concept of the multifactorial nature of pain are presented, which must be taken into account when selecting tools for assessing pain when working with gene dermatoses (epidermolysis bullosa) in childhood. Based on the analysis of Russian and foreign studies, a number of the most problematic areas in the assessment of pain in children are identified. Results and their discussion. According to the results of the analysis of a number of studies, the description of the main manifestations of epidermolysis bullosa and possible causes of pain is given. The biopsychosocial multifactorial nature of pain is considered, its neurobiological, psychological and functional consequences are presented, and on the basis of the research presented, conclusions are drawn for the first time about the principles of selecting the most effective tools for assessing pain and its impact on the vital activity of children with a chronic incurable disease. Pain assessment should include children’s previous experiences and expectations, coping strategies and pain relief resources, and communication features with caring adults. All forms of epidermolysis bullosa are characterized by pain and discomfort, and their elimination plays a key role in terms of the patient’s well-being and quality of life.

Navigating fertility dilemmas across the lifespan in girls with Turner syndrome-a scoping review.

Girls with Turner syndrome (TS) lack a partial or complete sex chromosome, which causes an accelerated decline of their ovarian reserve. Girls have to deal with several dilemmas related to their fertility, while only a limited number of them are referred to a fertility specialist and counselled about options of family planning on time. This scoping review provides an update of the literature on fertility in girls with TS throughout their lifespan and aims to propose a clinical practice guideline on fertility in TS. Databases of PubMed, Embase, and Web of science were searched using the following key terms: Turner syndrome, fertility, puberty, pregnancy, sex-hormones, karyotype, fertility preservation, assisted reproductive techniques, and counselling, alongside relevant subject headings and synonymous terms. English language articles published since 2007 were critically reviewed. Pregnancies after using donated oocytes and data about girls with TS with Y-chromosomal content were excluded. This search identified 1269 studies of which 120 were extracted for the review. The prevalence of natural conception ranged from 15% to 48% in women with 45,X/46,XX, 1% to 3% in women with 45,X, and 4% to 9% in women with other TS karyotypes. When assessing a girl's fertility potential, it was crucial to determine the karyotype in two cell lines, because hidden mosaicism may exist. In addition to karyotype, assessment of anti-Müllerian hormone (AMH) played a significant role in estimating ovarian function. Girls with AMH above the detection limit were most likely to experience spontaneous thelarche, menarche, and ongoing ovarian function during the reproductive lifespan. Fertility preservation became more routine practice: vitrification of oocytes was reported in 58 girls with TS and a median of five oocytes were preserved per stimulation. Ovarian tissue cryopreservation has demonstrated the presence of follicles in approximately 30% of girls with TS, mostly in girls with mosaic-TS, spontaneous puberty, and AMH above the detection limit. Although girls and their parents appreciated receiving counselling on fertility in TS, only one in ten girls with TS received specialized counselling. Unfamiliarity with fertility preservation techniques or uncertainties regarding the eligibility of a girl for fertility preservation constituted barriers for healthcare professionals when discussing fertility with girls with TS. There currently is a high demand for fertility preservation techniques in girls with TS. A reliable prognostic model to determine which girls with TS might benefit from fertility preservation is lacking. Only a minority of these girls received comprehensive fertility counselling on the full spectrum of fertility, including uncertainties of fertility preservation, pregnancy risks, and alternatives, such as adoption. Fertility preservation could be a viable option for girls with TS. However, the question remains whether enough oocytes can be obtained for a realistic prospect of a live birth. It is important that girls and parents are empowered with the necessary information to make a well-informed decision.

Blood pressure and lipid profiles in children born after ART with frozen embryo transfer.

Are blood pressure (BP) and lipid profiles different between children conceived after ART with frozen embryo transfer (FET), fresh embryo transfer (fresh-ET), and natural conception (NC)? Girls conceived after FET had significantly higher systolic BP and heart rate compared with girls born after fresh-ET; boys conceived after FET had a slightly more favourable lipid profile compared with boys born after fresh-ET and NC. Children conceived after ART with FET are more often born large for gestational age (LGA). LGA in general increases the risk of obesity, diabetes, and cardiovascular disease later in life. Studies on mice and humans on the whole ART population have raised concerns about premature vascular ageing and higher BP. The cardiovascular health of children born after FET is scarcely explored and the results are diverging. This study was part of the cohort study 'Health in Childhood following Assisted Reproductive Technology' (HiCART), which included 606 singletons (292 boys) born between December 2009 and December 2013: 200 children were conceived after FET; 203 children were conceived after fresh-ET; and 203 children were conceived naturally and matched for birth year and sex. The study period lasted from January 2019 to September 2021. The included children were 7-10 years of age at examination and underwent a clinical examination with anthropometric measurements, pubertal staging, and BP measurement. Additionally, a fasting blood sample was collected and analysed for cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), and triglycerides. Systolic and diastolic BP were converted to standard deviation scores (SDS) using an appropriate reference and accounting for height (SDS) of the child. The three study groups were compared pairwise using a univariate linear regression model. Mean differences were adjusted for confounders using multiple linear regression analyses. Girls and boys conceived after FET had significantly higher birthweight (SDS) compared with naturally conceived peers (mean difference: girls: 0.35, 95% CI (0.06-0.64), boys: 0.35, 95% CI (0.03-0.68)). Girls conceived after FET had significantly higher systolic BP (SDS) and heart rate compared with girls conceived after fresh-ET (adjusted mean difference: systolic BP (SDS): 0.25 SDS, 95% CI (0.03-0.47), heart rate: 4.53, 95% CI (0.94-8.13)). Regarding lipid profile, no significant differences were found between the three groups of girls. For the boys, no significant differences were found for BP and heart rate. Lipid profiles were more favourable in boys born after FET compared with both boys conceived after fresh-ET and NC. All outcomes were adjusted for parity, maternal BMI at early pregnancy, smoking during pregnancy, educational level, birthweight, breastfeeding, child age at examination, and onset of puberty. The participation rate varied from 18 to 42% in the three groups, and therefore selection bias cannot be excluded. However, extensive non-participant analyses were performed that showed almost no differences in background characteristics between participants and non-participants in the three groups, making selection bias less likely. The higher birthweight in children conceived after FET was associated with increased systolic BP (SDS) and heart rate in girls conceived after FET compared with fresh-ET. This may be an early indicator of compromised long-term cardiovascular health in this group. The study was not powered to investigate these outcomes and further studies are therefore warranted to confirm the findings. The study was funded by the Novo Nordisk Foundation (grant number: NNF18OC0034092, NFF19OC0054340) and Rigshospitalets Forskningsfond. The authors have no conflicts of interest to declare. ClinicalTrials.gov identifier: NCT03719703.

Role of DNase Activity in Human Sperm DNA Fragmentation.

In this clinical era of intracytoplasmic sperm injection (ICSI), where a single spermatozoon is chosen for fertilization, the diagnostic functionality of the classical parameters typically associated with fertilization, such as sperm concentration, sperm motility, acrosome integrity, and mitochondria, is perhaps becoming less critical. In contrast, the contribution of sperm DNA quality to our understanding of the impact of male fertility within the context of ICSI is gaining increasing interest and importance. Even with respect to natural conception, high levels of sperm DNA fragmentation (SDF) in the ejaculate can adversely affect reproductive outcomes. However, the precise origin of SDF pathology in sperm cells is often ambiguous and most likely to be multifactorial. Hence, the genetic makeup of an individual, unbalanced REDOX processes, enzymatic activity, environmental and lifestyle factors, and even damage during sperm handling in the laboratory all operate in a unique and often synergistic manner to produce or induce sperm DNA damage. Surprisingly, the contribution of active enzymes as potential agents of SDF has received much less attention and, therefore, is likely to be underrated. This review highlights the roles of different enzymes related to the degradation of sperm DNA as possible effectors of DNA molecules in spermatozoa.

Aneuploidy in Oocytes From Women of Advanced Maternal Age: Analysis of the Causal Meiotic Errors and Impact on Embryo Development

ABSTRACT Many chromosome abnormalities are commonly observed and can lead to early pregnancy loss, miscarriage, or the birth of children with chromosomal defects. Such abnormalities are considered a major factor in the low pregnancy rate after assisted reproductive technology and natural conception. Preimplantation genetic testing for aneuploidy (PGT-A) aims to minimize the transfer of aneuploid embryos. Embryonic aneuploidies arising from errors in meiosis have an incidence of approximately 25% in embryos from women younger than 35 years, to more than half in embryos from women aged older than 35 years. Although these embryos are able to develop to the blastocyst stage, they tend to be of lower morphological quality. A recent multicenter randomized clinical trial (ESTEEM) analyzed polar bodies (PBs) from women after intracytoplasmic sperm injection aged between 36 and 40 years using microarrays in 205 cycles and found that the transfer of embryos from euploid oocytes did not lead to a higher live birth rate but was associated with a reduction in the number of embryo transfers and miscarriages. This study aimed to evaluate all PB results from this RCT and characterize the types of chromosomal abnormalities and the chromosomes most frequently affected. The ESTEEM trial obtained biopsy of first (PB1) and second (PB2) PB in the cohort receiving PGT-A and analyzed them using array comparative genomic hybridization (aCGH). A total of 693 PB pairs had full results available, including 676 confirmed fertilized oocytes. Chromosome segregations, including likely underlying mechanisms, from these pairs are reported here. To estimate the reliability of the aCGH procedure, 72 PB pairs from a single center were reanalyzed using next-generation sequencing (NGS). Embryos were classified into 4 categories based on morphology: good, fair, poor, and degenerated. A comparative analysis was performed to assess the association between chromosome status and embryo quality as well as study group (PGT-A vs control) and embryo quality. A total of 213/676 oocytes were euploid and 413/676 were aneuploid, whereas in the remaining 50 oocytes, an abnormality observed in PB1 was compensated by an abnormality in PB2. A total of 693 PB pairs reported chromatic numbers with results for 15,939 chromosomes. An abnormal segregation, in PB1 and/or PB2, was observed in 1162 chromosomes (7.3%) in 461 PB pairs. Chromosomes 22 (16.7%), 16 (16.6%), 19 (14.4%), 21 (13.7%), and 15 (12.4%) had the highest frequencies for abnormal segregations. The abnormal segregations were compatible with precocious separation of sister chromatids in meiosis 1 (M1) (n = 568; 48.9%), nondisjunction of chromatics in meiosis 2 (M2) or reverse segregation (n = 417; 35.9%), and nondisjunction in M1 (n = 65; 5.6%). However, 112 chromosomes had segregation patterns that could not be categorized into 1 of the 9 known mechanisms causing aneuploidy in oocytes. Concordance between aCGH and NGS was obtained for both PBs for 1650 of 1656 analyzed chromosomes (99.6%). Embryos predicted to be aneuploid had significantly worse quality scores on day 3 (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.43–0.90), day 4 (aOR, 0.15; 95% CI, 0.06–0.39), and day 5 (aOR, 0.28; 95% CI, 0.14–0.58). This study represents one of the largest analyses of chromosomal copy number in both PBs to date and highlights the frequent unexplained chromosome copy numbers underscoring the gap of knowledge into the mechanisms causing aneuploidy in oocytes.

Anti-Mullerian Hormone Assessment in Assisted Reproductive Technique Outcome and Natural Conception.

In recent years, the prevalence of infertility has increased, and appears to affect approximately one in six couples. Some of them must perform assisted reproductive techniques (ART) in order to achieve pregnancy. As a result, growing interest has arisen about predictive factors of pregnancy and live birth with and without ART. Anti-Mullerian hormone (AMH) is a glycoprotein discovered in the 1950s in male embryonic sexual differentiation. Later, in 1984, its role in folliculogenesis was reported: secreted by granulosa cells, this hormone is involved in the regulation of the recruitment of primordial follicles and in follicular growth. AMH assays were developed for women in 1990s, and the serum AMH level has rapidly become a crucial element in managing women's fertility. Based mainly on its ability to be a quantitative but indirect marker of ovarian reserve, the serum AMH assay is widely used in reproductive medicine and ART. This review summarizes current knowledge of the AMH assessment in the field of reproductive medicine. We focus on the role of AMH level to predict spontaneous pregnancy occurrence, ART outcomes, and fertility preservation outcomes.

Poesis, God, and the Connectedness of All Beings

Abstract The article examines the significance of J. G. Herder's analogical thinking in the history of comparative practices. It shows how Herder's comparative method, of positing one phenomenon as another in its own singular and inimitable manner, emerges from his concept of God and nature as informed by Baruch Spinoza, as well as his study of scientific and cultural phenomena, including the active mechanisms of poesis as sensory perception. While Herder's concept of comparison and his analogical practices influenced prominent thinkers contemporary to him such as J.W. Goethe, the specificity of his comparative method has been overlooked by scholars past and present, such as Michel Foucault, as Herder's approach resists assimilation in histories of comparativism centered on nineteenth-century projects of comparison. Yet his outlook on the tension between difference and identity offers fresh insight into relations between distinct cultures and entities without effacing their particularity or placing them in static hierarchies. Herder's comparative method provides new perspectives on contemporary debates on the benefits of and dangers of historical analogies.

Challenging the Concept of Naturalism between the Sixteenth and Seventeenth Centuries: Annibale Carracci and El Greco as Readers of Vasari’s Vite

Challenging the Concept of Naturalism between the Sixteenth and Seventeenth Centuries: Annibale Carracci and El Greco as Readers of Vasari’s <i>Vite</i>

The impact of metabolic surgery on natural conception rates in women with infertility, obesity and polycystic ovary syndrome: a retrospective study.

Women with obesity and polycystic ovary syndrome (OPOS) are at high risk for infertility. However, the reproductive effects of metabolic surgery on women with infertility and OPOS have not been fully elucidated. We investigated the natural conception rates after metabolic surgery, and the variables associated with infertility in women with OPOS. Shanghai Sixth People's Hospital, Shanghai, China. This study included 72 women with infertility and OPOS who underwent metabolic surgery and were followed up for 4 years after surgery. Finally, 54 patients completed the study. Reproductive outcomes were assessed, along with changes in anthropometric parameters and metabolic indices before and 1year after surgery (prepregnancy). Logistic regression analysis was used to identify variables influencing natural conception and delivery outcomes. After metabolic surgery, 35 patients (64.8%) became pregnant naturally, while 16 were still unable to conceive naturally. Preoperative body mass index (BMI) tended to be lower in the natural conception group than in the no natural conception group (38.9 ± 6.9 versus 43.6 ± 11.0 kg/m2, P = .070) and there were no significant differences in weight loss between the 2 groups after surgery. Logistic regression analysis showed that the BMI 1year after surgery (prepregnancy) was an independent predictor of natural conception, and receiver operating characteristic analysis showed that a BMI of 27.0 kg/m2 was the optimal cutoff for predicting successful natural conception after surgery. Metabolic surgery can improve fertility in women with OPOS. Patients with a BMI < 27.0 kg/m2 1year after surgery (prepregnancy) are more likely to become pregnant naturally and give birth.

Surgery for Hydrosalpinx—History, Classification, Incidence, Results, and Recommendation for Management

Terminal tubal obstruction with formation hydrosalpinx results in cellular deciliation, hormone receptor depletion and intraluminal scarring. Fluid secretion, blood flow, and muscular contractility are similarly progressively affected to varying degrees. Intraluminal epithelial damage is best assessed by salpingoscopy or microsalpingoscopy and extratubal pathology by laparoscopy. Hydrosalpinges with severe intratubal pathology require excision and IVF management for fertility. Restorative salpingostomy can be considered at a single endoscopic procedure when salpingoscopy severity scale indicates mild or no significant change. The role of reproductive surgery should be considered complementary to IVF allowing infertile couples the possibility of recurring natural conception.

Semantic Flowers for Good-for-Games and Deterministic Automata

We present an innovative approach for capturing the complexity of ω-regular languages using the concept of flowers. This semantic tool combines two syntax-based definitions, namely the Mostowski hierarchy of word languages and syntactic flowers. The former is based on deterministic parity automata with a limited number of priorities, while the latter simplifies deterministic parity automata by reducing the number of priorities used, without altering their structure. Synthesising these two approaches yields a semantic concept of flowers, which offers a more effective way of dealing with the complexity of ω-regular languages. This letter provides a comprehensive definition of semantic flowers and shows that it captures the complexity of ω-regular languages. We also show that this natural concept yields simple proofs of the expressive power of good-for-games automata.

Business Development Strategy Towards “Natural Concept” Restaurant (Study of Botanica Dining Restaurant, Jakarta)

Purpose: The population density in Jakarta has resulted in a reduction of the green open environment in the capital city of Indonesia. In addition, the capital is the center of government and state business, making this city occupied by the majority of workers. The availability of entertainment and tourist spots in the capital city of Jakarta is quite diverse, especially restaurants. Relaxing to unwind from work activities is a moment that workers always await. The demand for unique elements in restaurants is very challenging for business owners. There are many elements that a restaurant can highlight to make its business more attractive. Based on these problems, this study aims to determine the strategy for developing a restaurant business with a natural concept (the study of Botanica Dining Jakarta). Research method: This research is a qualitative approach involving the phenomenon of the surrounding environment for a sample and the interview method with business owners. Results and discussion: The research shows that several strategies are needed in this business to develop the Botanica Dining Jakarta restaurant business. Implication: It was found that the strategy that the management of the Botanica Dining Jakarta Restaurant can carry out is to expand market penetration followed by developing product attractiveness to expand market targets and maintain consumer loyalty. The benefits of the results of this study are expected so that the selection of market penetration strategies can be implemented to the fullest extent possible to benefit the company. Keywords: Business development, restaurant, nature concept, workers.