Experiences and Perspectives of Women Undergoing Oocyte Cryopreservation in Riyadh, Saudi Arabia: A Mixed-Methods Study

Fatimah A Alzahrani,1 Dania Al-Jaroudi,2 Hamad Ali Alsufyan,3 Ali A Alzahrani,4 Saad Abdullah Alshehri,5 Sultana SK Jalwi,6 Elhadi Miskeen7 1Department of Obstetrics and Gynaecology, Al-Habib Medical Group, Riyadh, Saudi Arabia; 2Department of Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia; 3Department of Obstetrics and Gynaecology, Thuriah Medical Center, Riyadh, Saudi Arabia; 4Department of Public Health, King Faisal Medical City for Southern Regions, Abha, Saudi Arabia; 5Department of Medical Laboratory. Thuriah Medical Center, Riyadh, Saudi Arabia; 6Department of Obstetrics and Gynaecology (Medical Student), College of Medicine, University of Bisha, Bisha, Saudi Arabia; 7Department of Obstetrics and Gynaecology, College of Medicine, University of Bisha, Bisha, Saudi ArabiaCorrespondence: Fatimah A Alzahrani, Department of Obstetrics and Gynaecology, Al-Habib Medical Group, Riyadh, Saudi Arabia, Email [email protected]: Women increasingly desire fertility at later ages, yet fertility rates decline with age. Oocyte cryopreservation, offer support for women seeking pregnancy at advanced maternal ages. This mixed-methods study explored the experiences and perspectives of 100 women aged 18– 47 in Riyadh, Saudi Arabia who underwent oocyte cryopreservation for social and medical reasons. The research aims to understand the motivations, challenges, and satisfaction levels associated with oocyte cryopreservation within the context of Saudi Arabian society and culture.Methods: Using mixed methods, 100 subjects were enrolled in ten months. Self-administered questionnaires were dispersed to 100 women who underwent oocyte cryopreservation at a private clinic. Fifteen women willing to undergo recorded interviews were interviewed for 11—to 25-minute sessions. The interviews were transcribed entirely and subjected to thematic content analysis. Quantitative data was analyzed on STATA BE Version 18.Results: 77 women (77%) froze their oocytes for social reasons, and the women understood the medical/non-medical rationale for freezing. Interestingly, women’s reasons for oocyte cryopreservation were highly associated with satisfaction (p=0.050), with women stating social reasons being most satisfied. It can also be seen that factors such as the presence of complications during the oocyte cryopreservation process were tied to low satisfaction (p=0.040). Six thematic areas around oocyte cryopreservation are presented, including freezing concepts and aims, patient experience, challenges in service quality, communication and confidentiality, and -proposals.Conclusion: This research has highlighted how the medical and socio-cultural of women impacted the oocyte cryopreservation intersect. There is a need for improved culturally sensitive healthcare and educational services for better access and awareness. This is better to show that the public policy advocacy that contributes to the unique impacts of oocyte cryopreservation on a woman’s reproductive health and why is particularly concerning.Keywords: women, fertility preservation, reproduction, pregnancy, in-vitro fertilization, Saudi Arabi

Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

<p>Abstract</p> <p>Background</p> <p>Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.</p> <p>Methods</p> <p>A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO₂insufflation at the 10 cm of water. TIR was evaluated at the 24^th, 72^nd, 120^thand 168^thhour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.</p> <p>Results</p> <p>More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24^thand 72^nd; p < 0.01 - 120^thand p < 0.001 - 168^thhrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.</p> <p>Conclusions</p> <p>MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO₂insufflation however, led to moderate inflammation and less adhesion formation.</p

Transcriptome Analysis during Human Trophectoderm Specification Suggests New Roles of Metabolic and Epigenetic Genes

In humans, successful pregnancy depends on a cascade of dynamic events during early embryonic development. Unfortunately, molecular data on these critical events is scarce. To improve our understanding of the molecular mechanisms that govern the specification/development of the trophoblast cell lineage, the transcriptome of human trophectoderm (TE) cells from day 5 blastocysts was compared to that of single day 3 embryos from our in vitro fertilization program by using Human Genome U133 Plus 2.0 microarrays. Some of the microarray data were validated by quantitative RT-PCR. The TE molecular signature included 2,196 transcripts, among which were genes already known to be TE-specific (GATA2, GATA3 and GCM1) but also genes involved in trophoblast invasion (MUC15), chromatin remodeling (specifically the DNA methyltransferase DNMT3L) and steroid metabolism (HSD3B1, HSD17B1 and FDX1). In day 3 human embryos 1,714 transcripts were specifically up-regulated. Besides stemness genes such as NANOG and DPPA2, this signature included genes belonging to the NLR family (NALP4, 5, 9, 11 and 13), Ret finger protein-like family (RFPL1, 2 and 3), Melanoma Antigen family (MAGEA1, 2, 3, 5, 6 and 12) and previously unreported transcripts, such as MBD3L2 and ZSCAN4. This study provides a comprehensive outlook of the genes that are expressed during the initial embryo-trophectoderm transition in humans. Further understanding of the biological functions of the key genes involved in steroidogenesis and epigenetic regulation of transcription that are up-regulated in TE cells may clarify their contribution to TE specification and might also provide new biomarkers for the selection of viable and competent blastocysts

A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part® Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group

<p>Abstract</p> <p>Background</p> <p>Postoperative adhesions occur when fibrous strands of internal scar tissue bind anatomical structures to one another. The most common cause of intra-abdominal adhesions is previous intra-abdominal surgical intervention. Up to 74% of intestinal obstructions are caused by post surgical adhesions. Although a variety of methods and agents have been investigated to prevent post surgical adhesions, the problem of peritoneal adhesions remains largely unsolved. Materials serving as an adhesion barrier are much needed.</p> <p>Methods/Design</p> <p>This is a prospective, randomised, controlled, patient blinded and observer blinded, single centre phase I-II trial, which evaluates the safety of A-Part^®Gel as an adhesion prophylaxis after major abdominal wall surgery, in comparison to an untreated control group. 60 patients undergoing an elective median laparotomy without prior abdominal surgery are randomly allocated into two groups of a 1:1- ratio. Safety parameter and primary endpoint of the study is the occurrence of wound healing impairment or peritonitis within 28 (+10) days after surgery. The frequency of anastomotic leakage within 28 days after operation, occurrence of adverse and serious adverse events during hospital stay up to 3 months and the rate of adhesions along the scar within 3 months are defined as secondary endpoints. After hospital discharge the investigator will examine the enrolled patients at 28 (+10) days and 3 months (±14 days) after surgery.</p> <p>Discussion</p> <p>This trial aims to assess, whether the intra-peritoneal application of A-Part^®Gel is safe and efficacious in the prevention of post-surgical adhesions after median laparotomy, in comparison to untreated controls.</p> <p>Trial registration</p> <p>NCT00646412</p

Deletion of Genes Implicated in Protecting the Integrity of Male Germ Cells Has Differential Effects on the Incidence of DNA Breaks and Germ Cell Loss

Infertility affects approximately 20% of couples in Europe and in 50% of cases the problem lies with the male partner. The impact of damaged DNA originating in the male germ line on infertility is poorly understood but may increase miscarriage. Mouse models allow us to investigate how deficiencies in DNA repair/damage response pathways impact on formation and function of male germ cells. We have investigated mice with deletions of ERCC1 (excision repair cross-complementing gene 1), MSH2 (MutS homolog 2, involved in mismatch repair pathway), and p53 (tumour suppressor gene implicated in elimination of germ cells with DNA damage).We demonstrate for the first time that depletion of ERCC1 or p53 from germ cells results in an increased incidence of unrepaired DNA breaks in pachytene spermatocytes and increased numbers of caspase-3 positive (apoptotic) germ cells. Sertoli cell-only tubules were detected in testes from mice lacking expression of ERCC1 or MSH2 but not p53. The number of sperm recovered from epididymes was significantly reduced in mice lacking testicular ERCC1 and 40% of sperm contained DNA breaks whereas the numbers of sperm were not different to controls in adult Msh2 -/- or p53 -/- mice nor did they have significantly compromised DNA.These data have demonstrated that deletion of Ercc1, Msh2 and p53 can have differential but overlapping affects on germ cell function and sperm production. These findings increase our understanding of the ways in which gene mutations can have an impact on male fertility