225 results found
Murugesu S, Charalambides MM, Jones BP, et al., 2023, Social egg freezing: Motivations, treatment experiences and the impact of Covid-19 - a single-center experience., Acta Obstet Gynecol Scand, Vol: 102, Pages: 760-773
INTRODUCTION: This study aims to assess the motivations and treatment experiences of women undergoing social egg freezing and to understand the impact of the Covid-19 pandemic. MATERIAL AND METHODS: Between January 2011 to December 2021, 191 social egg freezing patients were recruited from the Lister Fertility Clinic, London UK. Participants completed a validated questionnaire investigating patients' perspectives of social egg freezing. A response rate of 46.6% was achieved. RESULTS: In all, 93.9% of women expressed concern regarding age-related fertility decline which influenced their decision to undergo social egg freezing. The majority (89.5%) of women were not in a relationship at the time of social egg freezing and considered this a motivating factor. Also, 39.0% of participants had side effects related to treatment which affected work and social life. Participants were significantly more likely to experience side effects if they underwent multiple egg freezing cycles (χ2 , p < 0.01) or if they cryopreserved oocytes during the COVID-19 pandemic (χ2 , p < 0.05). Of the women, 64.0% wished to have cryopreserved oocytes at a younger age, a view significantly more likely if older than 37 years at first social egg freezing cycle (χ2 , p < 0.001). Also, 82.3% of women reported their decision to undergo social egg freezing was not delayed due to concerns regarding COVID-19 exposure during treatment; 44.1% considered the pandemic made them more willing to undergo social egg freezing. CONCLUSIONS: Most participants did not regret their decision to undergo social egg freezing but the majority wished they had cryopreserved oocytes at a younger age. This highlights the importance of early education to optimize outcomes and patient choice. The egg freezing process can be stressful, women may have concerns around social egg freezing and unprecedented situations such as the COVID-19 pandemic may alter treat
Bayar E, 2023, Fertility preservation and realignment in transgender women, Human Fertility: an international, multidisciplinary journal dedicated to furthering research and promoting good practice, ISSN: 1464-7273
Medical care for transgender people is multi-faceted and attention to individual reproductiveaspirations and planning are an essential, yet often overlooked aspect of care. Given the impactof hormonal therapy and other gender affirmation procedures on reproductive function, extensivecounselling and consideration of fertility preservation is recommended prior to their commencement.This review article explores the reproductive aspirations of transgender women andconsiders the current disparity between stated desires regarding utilisation of fertility preservationservices. Current fertility preservation options and prospective treatments currently showingpromise in the research arena are explored.
Vali S, Jones BP, Saso S, et al., 2023, The impact of COVID-19 on the motivations of women seeking a uterus transplant., Future Sci OA, Vol: 9, ISSN: 2056-5623
AIM: The aim of this study was to investigate the change if any, in the motivations of women seeking a UTx and determine the impact of the COVID-19 pandemic. METHODS: A cross-sectional survey. RESULTS: 59% of women answered they were more motivated in achieving a pregnancy following the COVID-19 pandemic. 80% strongly agreed or agreed the pandemic had no impact on their motivation for a UTx, and 75% strongly agreed or agreed their desire for a baby strongly outweighs the risks of undergoing a UTx during a pandemic. CONCLUSION: Women continue to express a high level of motivation and desire for a UTx despite the risks imposed by the COVID-19 pandemic.
Currie JLD, Saso S, Guerrero K, et al., 2022, Impact of covid-19 on subspecialty training in obstetrics and gynaecology, JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN: 0144-3615
Lebbos C, Barcroft J, Tan J, et al., 2022, Adnexal Mass Segmentation with Ultrasound Data Synthesis, p., Vol: 106
Ovarian cancer is the most lethal gynaecological malignancy. The disease ismost commonly asymptomatic at its early stages and its diagnosis relies onexpert evaluation of transvaginal ultrasound images. Ultrasound is thefirst-line imaging modality for characterising adnexal masses, it requiressignificant expertise and its analysis is subjective and labour-intensive,therefore open to error. Hence, automating processes to facilitate andstandardise the evaluation of scans is desired in clinical practice. Usingsupervised learning, we have demonstrated that segmentation of adnexal massesis possible, however, prevalence and label imbalance restricts the performanceon under-represented classes. To mitigate this we apply a novelpathology-specific data synthesiser. We create synthetic medical images withtheir corresponding ground truth segmentations by using Poisson image editingto integrate less common masses into other samples. Our approach achieves thebest performance across all classes, including an improvement of up to 8% whencompared with nnU-Net baseline approaches.
L'Heveder A, Chan M, Mitra A, et al., 2022, Sports Obstetrics: Implications of Pregnancy in Elite Sportswomen, a Narrative Review, JOURNAL OF CLINICAL MEDICINE, Vol: 11
Kasaven LS, Jones BP, Heath C, et al., 2022, Reproductive outcomes from ten years of elective oocyte cryopreservation, ARCHIVES OF GYNECOLOGY AND OBSTETRICS, Vol: 306, Pages: 1753-1760, ISSN: 0932-0067
Kasaven L, Jones B, L'Heveder A, et al., 2022, Implications of pregnancy in elite sportswomen, Journal of Clinical Medicine, ISSN: 2077-0383
Increasing numbers of females are participating in elite sport, with a record number having competed at the Tokyo Olympic Games. Importantly, the ages of peak performance and fertility are very likely to coincide, as such, it is inevitable that pregnancy will occur during training andcompetition. Whilst there is considerable evidence to promote regular exercise in pregnancy, withbenefits including a reduction in hypertensive disorders, gestational diabetes and reduced rates ofpost-natal depression, few studies have been conducted which include elite athletes. Indeed, thereare concerns that high-intensity exercise may lead to increased rates of miscarriage and pretermlabour amongst other pregnancy-related complications. There is minimal guidance on the obstetricmanagement of athletes and consequently healthcare professionals frequently adopt a very conservative approach to managing such people. This narrative review summarises the evidence onthe antenatal, intrapartum and postpartum outcomes in elite athletes and provides recommendations for healthcare providers demonstrating that generally, pregnant athletes can continue theirtraining, with a few notable exceptions. It also summarises the physiological changes that occur inpregnancy and reviews the literature base regarding how these changes may impact performance,with benefits arising from pregnancy-associated cardiovascular adaptations at earlier gestations,but later changes causing increased risk of injury and fatigue.
Murugesu S, Kasaven LS, Petrie A, et al., 2022, Does advanced paternal age affect outcomes following assisted reproductive technology? A systematic review and meta-analysis, REPRODUCTIVE BIOMEDICINE ONLINE, Vol: 45, Pages: 283-331, ISSN: 1472-6483
- Author Web Link
- Citations: 2
Kasaven L, Jones BP, Ghaem-Maghami S, et al., 2022, Study protocol for a randomised controlled trial on the use of intra-operative Ultrasound Guided Laparoscopic Ovarian Cystectomy (UGLOC) as a method of fertility preservation in the management of benign ovarian cysts, BMJ Open, Vol: 12, ISSN: 2044-6055
Introduction: The lifetime risk of women undergoing surgery for the presence of benign ovarian pathology in the united kingdom (UK) is 5-10%. Despite minimally invasive surgical techniques, evidence suggests a number of healthy ovarian follicles and tissues are resected intraoperatively, resulting in subsequent decline of ovarian reserve. As such, there is an increasing demand for the implementation of fertility preservation surgery (FPS). This study will evaluate the effect on ovarian reserve following two different surgical interventions for the management of benign ovarian cysts. Methods and analysis: We will conduct a two-armed randomised controlled trial comparing laparoscopic ovarian cystectomy, considered gold standard treatment as per the Royal College of Obstetricians and Gynaecologists (RCOG) Green Top guidelines for the management of benign ovarian cysts, with ultrasound guided laparoscopic ovarian cystectomy (UGLOC), a novel method of FPS. The study commencement date was October 2021 and completion date October 2024. The primary outcome will be the difference in anti-Mullerian hormone (pmol/L) (AMH) and antral follicle count (AFC) measured 3 and 6 months post operatively from the pre-operative baseline. Secondary outcomes include assessment of various surgical and histopathological outcomes including: duration of hospital stay (days), duration of surgery (mins), presence of intra-operative cyst rupture (yes/no), presence of ovarian tissue within the specimen (yes/no) and the grade of follicles excised with specimen (grade 0-4). We aim to randomise 94 patients over 3 years to achieve power of 80% at an alpha level of 0.05.Ethics and dissemination: Findings will be published in peer reviewed journals and presented at national and international conferences and scientific meetings. The Chelsea NHS Research and Ethics Committee have awarded ethical approval of the study (21/LO/036).Trial registration number: NCT05032846
Lutaaya N, Dhonnabhain BN, Elfaki N, et al., 2022, A systematic review and meta-analysis of ovarian stimulation outcomes in cancer patients opting for oocyte cryopreservation prior to treatment compared to social egg-freezers, Publisher: OXFORD UNIV PRESS, Pages: I411-I411, ISSN: 0268-1161
Kasaven LS, Saso S, Getreu N, et al., 2022, Age-related fertility decline: is there a role for elective ovarian tissue cryopreservation?, HUMAN REPRODUCTION, Vol: 37, Pages: 1970-1979, ISSN: 0268-1161
Dhonnabhain BN, Elfaki N, Fraser K, et al., 2022, A comparison of fertility preservation outcomes in patients who froze oocytes, embryos, or ovarian tissue for medically indicated circumstances: a systematic review and meta-analysis, FERTILITY AND STERILITY, Vol: 117, Pages: 1266-1276, ISSN: 0015-0282
- Author Web Link
- Citations: 3
Kasaven L, Chawla M, Jones B, et al., 2022, Fertility sparing surgery and borderline ovarian tumours, Cancers, Vol: 14, ISSN: 2072-6694
o determine the oncological outcomes following fertility-sparing surgery (FSS) for the management of Borderline Ovarian Tumours (BOTs). A retrospective analysis of participants diagnosed with BOTs between January 2004 and December 2020 at the West London Gynaecological Oncology Centre was conducted. A total of 172 women were diagnosed; 52.3% (90/172) underwent FSS and 47.7% (82/172) non-FSS. The overall recurrence rate of disease was 16.9% (29/172), of which 79.3% (23/29) presented as the recurrence of serous or sero-mucinous BOTs and 20.7% (6/29) as low-grade serous carcinoma (LGSC). In the FSS group, the recurrence rate of BOTs was 25.6% (23/90) presenting a median 44.0 (interquartile range (IQR) 41.5) months, of which there were no episodes of recurrence presenting as LGSC reported. In the non-FSS group, all recurrences of disease presented as LGSC, with a rate of 7.7% (6/78), following a median of 47.5 months (IQR 47.8). A significant difference between the type of surgery performed (FSS v Non-FSS) and the association with recurrence of BOT was observed (Pearson Chi-Square: p = 0.000; x = 20.613). Twelve women underwent ultrasound-guided ovarian wedge resection (UGOWR) as a novel method of FSS. Recurrence of BOT was not significantly associated with the type of FSS performed (Pearson Chi- Square: x = 3.166, p = 0.379). Non-FSS is associated with negative oncological outcomes compared to FSS, as evidenced by the higher rate of recurrence of LGSC. This may be attributed to the indefinite long-term follow up with ultrasound surveillance all FSS women undergo, enabling earlier detection and treatment of recurrences.
Jones BP, Kasaven LS, Chan M, et al., 2022, Uterine Transplantation in 2021: Recent Developments and the Future, CLINICAL OBSTETRICS AND GYNECOLOGY, Vol: 65, Pages: 4-14, ISSN: 0009-9201
- Author Web Link
- Citations: 3
Vali S, Jones BP, Saso S, et al., 2022, Uterus Transplantation: A 50-Year Journey, CLINICAL OBSTETRICS AND GYNECOLOGY, Vol: 65, Pages: 92-100, ISSN: 0009-9201
- Author Web Link
- Citations: 1
Vali S, Jones BP, Saso S, et al., 2022, Uterine transplantation: Legal and regulatory implications in England, BJOG: an International Journal of Obstetrics and Gynaecology, Vol: 129, Pages: 590-596, ISSN: 1470-0328
Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications on fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein.
Kasaven LS, Saso S, Ben Nagi J, et al., 2022, TOGadvisor: the role of online feedback in obstetrics and gynaecology, OBSTETRICIAN & GYNAECOLOGIST, Vol: 24, Pages: 7-11, ISSN: 1467-2561
Salvo G, Ramirez PT, Leitao MM, et al., 2022, Open vs minimally invasive radical trachelectomy in early-stage cervical cancer: International Radical Trachelectomy Assessment Study, AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol: 226, ISSN: 0002-9378
- Author Web Link
- Citations: 10
Lebbos C, Barcroft J, Tan J, et al., 2022, Adnexal Mass Segmentation with Ultrasound Data Synthesis, Editors: Aylward, Noble, Hu, Lee, Baum, Min, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 106-116, ISBN: 978-3-031-16901-4
Bayar E, Galazis N, Jones B, et al., 2021, Impact of polyunsaturated fatty acid supplementation on assisted reproductive technology outcomes: a systematic review, HUMAN FERTILITY, ISSN: 1464-7273
McLean KA, Kamarajah SK, Chaudhry D, et al., 2021, Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 1448-1464, ISSN: 0007-1323
- Author Web Link
- Citations: 7
Vaulet T, Al-Memar M, Fourie H, et al., 2021, Gradient boosted trees with individual explanations: An alternative to logistic regression for viability prediction in the first trimester of pregnancy, COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE, Vol: 213, ISSN: 0169-2607
Glasbey J, Ademuyiwa A, Adisa A, et al., 2021, Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study, The Lancet Oncology, Vol: 22, Pages: 1507-1517, ISSN: 1470-2045
BackgroundSurgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.MethodsThis international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.FindingsOf eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notif
Ahmed-Salim Y, Saso S, Meehan H, et al., 2021, A novel application of calcium electroporation to cutaneous manifestations of gynaecological cancer, European Journal of Gynecological Oncology, Vol: 42, Pages: 662-672, ISSN: 0392-2936
Introduction: Calcium electroporation (CaEP) is a new technique whereby intracellular concentrations of calcium are elevated by transient permeabilisation of the cell membrane using high-voltage electrical pulses. Tumour necrosis is induced with little damage to healthy tissue. Within gynaecological cancer, vulval cancer and vulval intraepithelial neoplasia (VIN) pose challenges for treatment, given the high recurrence rate, persistent symptoms and repeated resections required. In certain cases, CaEP may provide a suitable alternative.Methods: We present a case series of six patients with recurrent vulval squamous cell carcinoma(n=2), VIN III (n=2) and metastatic ovarian cancer (n=2), five of whom were treated with CaEP. This is the first known application of CaEP to gynaecological cancers .Results: The median follow-up time was 14 months (range 2-18 months). Within the cohort of patients, CaEP was applied a total of 10 times, achieving a complete response five times and partial response four times. Symptoms improved within six weeks for eight episodes following CaEP application. Beyond six weeks, symptoms eventually recurred in all patients and four patients required more than one CaEP procedure. CaEP was useful for palliation of distressing symptoms in one case of metastatic ovarian cancer. No intra-operative or post-operative complications have been reported to date. Conclusion: CaEP may be a promising short-term treatment in selected patients with recurrent VIN and vulval cancer, where other treatments had failed. If validated, it could provide an acceptable alternative where surgery is unacceptable. Long term follow-up is required to evaluate effects on recurrence.
Jones BP, Kasaven L, Vali S, et al., 2021, Uterine Transplantation: Review of Livebirths and Reproductive Implications, TRANSPLANTATION, Vol: 105, Pages: 1695-1707, ISSN: 0041-1337
Bracewell-Milnes T, Holland JC, Jones BP, et al., 2021, Exploring the knowledge and attitudes of women of reproductive age from the general public towards egg donation and egg sharing: a UK-based study., Human Reproduction, Vol: 36, Pages: 2189-2201, ISSN: 0268-1161
STUDY QUESTION: What are the knowledge and views of UK-based women towards egg donation (ED) and egg sharing (ES)? SUMMARY ANSWER: Lacking knowledge of the practices of ED and ES could be an influential factor in donor egg shortages, rather than negative perceptions or lack of donor anonymity and financial incentives. WHAT IS KNOWN ALREADY: The increasing age of women trying to conceive has led to donor egg shortages, with ED and ES failing to meet demand. Indeed, in recent years in the UK, ES numbers have fallen. This results in long waiting lists, forcing patients abroad for fertility treatment to take up cross border reproductive care. Previous research suggests a lack of knowledge of ED among members of the general public; however, no study has yet assessed knowledge or views of ES in the general public. STUDY DESIGN, SIZE, DURATION: Six hundred and thirty-five UK-based women over 18 years were voluntarily recruited from social media community groups by convenience sampling. The recruitment period was from February to April 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants completed a previously validated questionnaire regarding female fertility, ED and ES, including knowledge, perceptions and approval of the practices and relevant legislation. This included ranking key benefits and issues regarding egg sharing. The questionnaire was completed using the online Qualtrics survey software. Statistical analysis was conducted using SPSS. MAIN RESULTS AND THE ROLE OF CHANCE: Regarding knowledge of ED and ES, 56.3% and 79.8%, respectively had little or no prior knowledge. Upon explanation, most approved of ED (85.8%) and ES (70.4%). A greater proportion of respondents would donate to a family member/friend (49.75%) than to an anonymous recipient (35.80%). Overall, ES was viewed less favourably than ED, with ethical and practical concerns highlighted. Women aged 18-30 years were significantly more likely to approve of egg donation practice compa
COVIDSurg Collaborative Co-authors, 2021, Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score, British Journal of Surgery, Vol: 108, Pages: 1274-1292, ISSN: 0007-1323
Since the beginning of the COVID-19 pandemic tens of millions of operations have been cancelled1 as a result of excessive postoperative pulmonary complications (51.2 per cent) and mortality rates (23.8 per cent) in patients with perioperative SARS-CoV-2 infection2. There is an urgent need to restart surgery safely in order to minimize the impact of untreated non-communicable disease.As rates of SARS-CoV-2 infection in elective surgery patients range from 1–9 per cent3–8, vaccination is expected to take years to implement globally9 and preoperative screening is likely to lead to increasing numbers of SARS-CoV-2-positive patients, perioperative SARS-CoV-2 infection will remain a challenge for the foreseeable future.To inform consent and shared decision-making, a robust, globally applicable score is needed to predict individualized mortality risk for patients with perioperative SARS-CoV-2 infection. The authors aimed to develop and validate a machine learning-based risk score to predict postoperative mortality risk in patients with perioperative SARS-CoV-2 infection.
Keefe D, 2021, Fertility Treatment and Cancers-The Eternal Conundrum: A Systematic Review and Meta-analysis, OBSTETRICAL & GYNECOLOGICAL SURVEY, Vol: 76, Pages: 343-344, ISSN: 0029-7828
Elfaki N, Lutaaya N, Hardiman PJ, et al., 2021, Oocyte cryopreservation for social reasons versus fertility preservation; a systematic review, Publisher: WILEY, Pages: 238-238, ISSN: 1470-0328
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