Unique Patient Issues: Early Interventions and Management
Unique Patient Issues: Early Interventions and Management
This review presented several instances of repeated issues in sperm or oocytes, ranging from cases that remain unexplained to explained, even with some experimental treatment strategies available. From these cases should emerge the recommendation to act on complete failure cases and unusual gametes. The financial, emotional, physical health, and time costs of repeated failures are too high not to warrant early attention from both clinicians and the ART laboratory. Based on a candidate gene approach, the genetic or microarray analyses of patients will help identify genes and pathways involved in complete failures. The overall incidences of these unique cases are likely underestimated, and we must strive for systematic, rather than sporadic, reporting. Documenting new cases and intervention strategies will inform professionals adequately and enrich our future diagnostic, management, and therapeutic efforts. A chance for early interventions may be missed without a careful assessment strategy. Ideally, every laboratory should have a management plan for any such unique cases; Fig. 2 outlines one strategy. If diagnostic tests cannot be performed in house, collaborations with basic scientists studying gamete biology will prove necessary. Establishing an interface between basic researchers and the clinic will undoubtedly fuel future advances. Also instrumental is a commitment to adopt evidence-guided strategies promptly, to avoid pursuing multiple cycle attempts in vain. Patients could then be guided promptly and convincingly toward gamete donation or adoption.
(Enlarge Image)
Figure 2.
Flowchart of a potential evidence-based course of action for patients with unexplained recurring total failures. Given the complexity and uniqueness of each case, a personalized approach must be adopted; shown are mere guidelines for interventions and management based on lessons learned from several cases to date. Further details and rationalization for each guideline is presented in the text. AOA, artificial oocyte activation; FF, failed fertilization; ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilization; IVM, in vitro maturation; MOAT, mouse oocyte activation test; TFF, total failed fertilization.
Concluding Remarks and Future Perspectives
This review presented several instances of repeated issues in sperm or oocytes, ranging from cases that remain unexplained to explained, even with some experimental treatment strategies available. From these cases should emerge the recommendation to act on complete failure cases and unusual gametes. The financial, emotional, physical health, and time costs of repeated failures are too high not to warrant early attention from both clinicians and the ART laboratory. Based on a candidate gene approach, the genetic or microarray analyses of patients will help identify genes and pathways involved in complete failures. The overall incidences of these unique cases are likely underestimated, and we must strive for systematic, rather than sporadic, reporting. Documenting new cases and intervention strategies will inform professionals adequately and enrich our future diagnostic, management, and therapeutic efforts. A chance for early interventions may be missed without a careful assessment strategy. Ideally, every laboratory should have a management plan for any such unique cases; Fig. 2 outlines one strategy. If diagnostic tests cannot be performed in house, collaborations with basic scientists studying gamete biology will prove necessary. Establishing an interface between basic researchers and the clinic will undoubtedly fuel future advances. Also instrumental is a commitment to adopt evidence-guided strategies promptly, to avoid pursuing multiple cycle attempts in vain. Patients could then be guided promptly and convincingly toward gamete donation or adoption.
(Enlarge Image)
Figure 2.
Flowchart of a potential evidence-based course of action for patients with unexplained recurring total failures. Given the complexity and uniqueness of each case, a personalized approach must be adopted; shown are mere guidelines for interventions and management based on lessons learned from several cases to date. Further details and rationalization for each guideline is presented in the text. AOA, artificial oocyte activation; FF, failed fertilization; ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilization; IVM, in vitro maturation; MOAT, mouse oocyte activation test; TFF, total failed fertilization.
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