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Introduction
Current institution
Publications
Publications (379)
Background
Polycystic ovary syndrome (PCOS) is a common endocrinopathy with significant reproductive, metabolic, and psychological complications. Consensus on PCOS clinical research priorities across end-users is fundamental and necessitates a robust co-development of a clinical research roadmap to guide international research efforts.
Methods
A m...
The need for fertility education arises from changing patterns of family formation in recent times. Young people feel unprepared for how best to plan their career and family and have little idea of the various factors that may influence their fertility later in their life. Research shows young people would like to know more and need the information...
BACKGROUND
The World Health Organization (WHO) system for the classification of disorders of ovulation was produced 50 years ago and, by international consensus, has been updated by the International Federation of Gynecology and Obstetrics (FIGO).
OBJECTIVE AND RATIONALE
This review outlines in detail each component of the FIGO HyPO-P (hypothalami...
Background
In the last 15 years, the care provided for individuals born with differences of sex development (DSD) has evolved, with a strong emphasis on interdisciplinary approaches. However, these developments have not convinced some stakeholders to embrace the current model of care. This care model has also paid insufficient attention to socio-cu...
Study question:
What is the recommended assessment and management of those with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference?
Summary answer:
International evidence-based guidelines address prioritized questions and outcomes and include 254 recommendations and practice points...
Objectives
In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. Howe...
Study question
Can differences in the live birth rate (LBR) between clinics with similar standard operating procedures (SOPs) be explained by variations in socioeconomic deprivation?
Summary answer
Socioeconomic deprivation does not appear to explain differences in LBR between clinics with similar SOPs in this cohort
What is known already
IVF suc...
Background
IVF add-ons are techniques, medicines or procedures used in addition to standard IVF with the aim of improving the chance of success. The United Kingdom’s IVF regulator, ( the Human Fertilisation Embryology Authority (HFEA) developed a traffic light system to categorise add-ons as either green, amber, or red, based on results of randomis...
Paediatric and Adolescent Gynaecology (PAG) is a subspecialty that encompasses a broad spectrum of conditions affecting girls from birth up to adulthood. For younger children, vulval dermatological conditions are frequently seen, whilst the adolescent population will often present with menstrual dysfunction or pelvic pain, with a range of aetiologi...
Study question:
What are the associations between baseline BMI (Study 1) and change in body weight (Study 2) with the likelihood of pregnancy in women with polycystic ovary syndrome (PCOS).
Summary answer:
In women with PCOS, higher baseline BMI was associated with a lower chance of pregnancy; however, weight loss was associated with an increase...
Multiple pregnancies are associated with higher risks for both mother and babies. Women with multiple pregnancies have an increased risk of miscarriage, anemia, hypertensive disorders, haemorrhage, and postnatal illness. These pregnancies are more likely to need an operative delivery, and maternal mortality is generally 2.5 times that of singleton...
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epid...
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemi...
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding, and infertility, and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical, and epid...
Objective
To assess risks of assisted reproduction in patients with cardiac disease.
Study Design
Retrospective case note review of patients with cardiac disease undergoing ART over a 10 year period in the obstetric cardiac services of three UK tertiary centres. Assessment of maternal, obstetric and fetal complications during ART and resultant preg...
Study question
Why do patients, clinicians and embryologists opt to use IVF add-ons in fertility treatment?
Summary answer
Add-ons offer options, hope and control in a desperate situation. The perceived drivers differ between patients and professionals; however, both feel add-ons offer bespoke care.
What is known already
Evidence that add-ons off...
Polycystic ovary syndrome (PCOS) is one of the most common reproductive health problems of women, causing irregular periods and potential infertility amongst other challenging symptoms. Effective treatment remains a significant challenge and is largely achieved through hormonal medication and lifestyle changes. This third edition covers the aetiolo...
PCOS is the commonest cause of anovulatory infertility. Many potential therapies are available and the mainstay of treatment centers around enhancing general health to achieve the best reproductive outcome for mother and baby. We describe the pathophysiology of anovulation in brief before an outline of pragmatic evidence-based algorithm for ovulati...
The third edition of the Oxford Textbook of Endocrinology and Diabetes is an up-to-date, objective and comprehensive text that covers the full scope of endocrinology and diabetes. It contains wide ranging and pragmatic advice on diagnosis and clear guidelines for recommended management, while also covering the scientific principles that underlie th...
Introduction
Risks of pregnancy in women with cardiac disease are well described, but data regarding the risks of assisted conception in this cohort is limited. As increasing numbers of older women seek fertility treatment, more women with congenital heart disease desire to have children of their own, and pre-implantation genetic testing (PGT) beco...
This chapter includes clinical cases, background, evidence-based practical management options, preventive measures, key-point summaries of polycystic ovaries and answers to questions patients ask. Women with anovulatory infertility secondary to polycystic ovary syndrome (PCOS) should first be treated by ovulation induction and only then proceed to...
Infertility is common. Female age remains the single most important factor determining the ability to conceive. General investigations address all aspects of fertility including tubal assessment, ovarian reserve, and semen analysis. Assisted conception techniques with gamete preparation enhances fertility by either bypassing absolute obstruction or...
Introduction
For couples undergoing assisted reproduction, a plethora of adjuncts are available; these are known as ‘add-ons’. Most add-ons are not supported by good quality randomised trial evidence of efficacy, with some proven to be ineffective. However, estimates suggest that over 70% of fertility clinics provide at least one add-on, often at e...
Objective To compare the cumulative live birth rate per egg retrieval between time lapse imaging (TLI) incubators and standard culture (SC) incubators both using a single-step culture medium Design Retrospective cohort study Setting A tertiary level fertility-centre Population Women undergoing an IVF cycle between November 2015 and December 2017 Me...
The literature suggests that ethnicity affects live birth rate (LBR) and preterm birth (PTB) rate after fresh but not frozen embryo transfer (FET). We analysed 64,530 FET cycles from 2000 to 2016 using the Human Fertilisation and Embryology Authority (HFEA) database. Ethnicity was recorded for 43,735 as White British, 3,034 as Indian, 1,946 as Paki...
Recently, fertility services have started resuming since COVID-19 was declared a pandemic, but there remains significant uncertainty in the way this care will be delivered in the United Kingdom. The objective of our study was to explore the impact of COVID-19 on individuals using fertility services in the United Kingdom. The study was conducted in...
Polycystic Ovary Syndrome (PCOS) is the commonest cause of subfertility, although IVF should be the treatment “of last resort” after lifestyle modification and ovulation induction (Balen, et al Human Reproduction Update 2016; 22: 687‐708). There are a number of PCOS phenotypes and associated endocrine and metabolic disturbances, which in turn vary...
Investing in clinical research and evidence-based medicine has helped to improve the care for women with polycystic ovary syndrome (PCOS). However, several important questions remain unanswered on the optimal prevention and management strategies for PCOS. Addressing this uncertainty is often hindered by suboptimal research conduct leading to ineffi...
This review aims to provide a summary of updates in fertility treatment for women with Polycystic Ovary Syndrome (PCOS). The mechanisms through with PCOS causes fertility impairment are summarised in the introductory section with the rest of the review focussing on the different fertility treatment options available in PCOS. The latest evidence on...
At present, there are no reliable data to identify the number of patients who present for infertility investigations and who are current users of illicit drugs. Therefore, the full extent of this problem remains hidden. Estimates can be made on the basis of population use, although this lacks rigour. The use of illicit drugs can impact on infertili...
Study question:
What are the key core outcomes to be reported in studies on polycystic ovary syndrome (PCOS)?
Summary answer:
We identified 3 generic and 30 specific core outcomes in 6 specialist domains: metabolic (8), reproductive (7), pregnancy (10), oncological (1), psychological (1) and long-term outcomes (1).
What is known already:
Resea...
Background:
Polycystic ovary syndrome (PCOS) is characterised by infrequent or absent ovulation, and high levels of androgens and insulin (hyperinsulinaemia). Hyperinsulinaemia occurs secondary to insulin resistance and is associated with an increased biochemical risk profile for cardiovascular disease and an increased prevalence of diabetes melli...
Objective:
To determine whether socioeconomic deprivation affects IVF outcome independent of the number of cycles undertaken DESIGN: A retrospective review of prospectively collected data SETTING: A tertiary level fertility clinic in the North of England POPULATION: All participants undergoing their first NHS-funded, single, fresh embryo transfer...
There is a transgenerational increase in the susceptibility of female offspring to developing PCOS that occurs via the female germline and is linked to fetal exposure to excess androgen.
Background:
Polycystic ovary syndrome (PCOS) is complex with reproductive, metabolic and psychological features. Infertility is a prevalent presenting feature of PCOS with approximately 75% of these women suffering infertility due to anovulation, making PCOS by far the most common cause of anovulatory infertility. Previous guidelines either lacked...
Polycystic ovary syndrome (PCOS) is a far reaching condition that has a number of reproductive and general health implications. There has been much debate in recent years about the diagnosis and definition of PCOS and a plethora of studies assessing its management, ranging from the psychosocial aspects of the conditions, to the treatment of hyperan...
Research question:
Does a woman's ethnicity affect her fresh and frozen embryo transfer outcomes differently?
Design:
A retrospective cohort study of the first fresh and first frozen embryo transfer per woman carried out at a single tertiary level fertility unit between 2010 and 2016 using data retrieved from an electronic database. Biochemical...
Subfertility, Reproductive Endocrinology and Assisted Reproduction - edited by Jane A. Stewart June 2019
Subfertility, Reproductive Endocrinology and Assisted Reproduction - edited by Jane A. Stewart June 2019
A central problem for the international governance of heritable germline gene editing is that there are important differences in attitudes and values as well as ethical and health care considerations around the world. These differences are reflected in a complicated and diverse regulatory landscape. Several publications have discussed whether repro...
Ovarian reserve (OR) decreases as women get older but there is considerable variation in the rate at which this occurs. Older women are at increased risk of complications during pregnancy. The aim of the study was to determine whether poor OR influences perinatal outcomes independent of age. All fresh IVF/ICSI cycles in which a single embryo was tr...
The Fertility Education Initiative was established in 2016 to provide education on fertility, modern families and reproductive science for young adults, teachers, health professionals, parents and adults. We report on our study to determine the feasibility and acceptability of using the arts to delivery fertility education in schools. The evaluatio...
The objective of this study was to investigate the role of Body Mass Index (BMI) in influencing ethnic variation in IVF outcomes. This retrospective cohort study included women (having BMI between 19 to 30 kg/m²) undergoing their first IVF cycle with fresh blastocyst transfer at a single IVF unit between 2010 and 2015. In summary, South Asian women...
STUDY QUESTION
What is the recommended assessment and management of infertile women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertize and consumer preference?
SUMMARY ANSWER
International evidence-based guidelines, including 44 recommendations and practice points, addressed prioritized questions to pro...
The current understanding of polycystic ovary syndrome (PCOS) is that it is a condition that presents with ovarian dysfunction and endocrine problems and is also associated with hyperinsulinaemia and metabolic disease. PCOS encompasses symptoms of menstrual cycle disturbance and as such is the commonest cause of secondary amenorrhoea and also of an...
Study Question
What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference?
Summary Answer
International evidence‐based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote cons...
Study question:
What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise and consumer preference?
Summary answer:
International evidence-based guidelines, including 166 recommendations and practice points, addressed prioritized questions to promote...
Study question:
What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference?
Summary answer:
International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote...
Advanced technology now allows young women to freeze and store oocytes with a realistic chance of future pregnancy. Vitrification has revolutionized oocyte preservation, with comparable pregnancy rates to fresh oocyte use. Traditionally used for women who were about to undergo sterilizing oncology treatment, now the opportunity has been extended fo...
Objective:
Comparison of live birth rates and the perinatal outcomes after fresh and frozen embryo transfer between time lapse imaging (TLI) and standard culture (SC) incubators.
Design:
Retrospective cohort study.
Setting:
A single tertiary level IVF unit.
Population:
Women undergoing IVF between January 2014 and October 2015.
Methods:
Co...
Background:
Polycystic ovary syndrome (PCOS) is characterised by infrequent or absent ovulation, and high levels of androgens and insulin (hyperinsulinaemia). Hyperinsulinaemia occurs secondary to insulin resistance and is associated with increased risk of cardiovascular disease and diabetes mellitus. Insulin-sensitising agents such as metformin m...
Iron is a ‘one-way’ element and the primary point of regulation of body iron stores is at the level of intestinal iron absorption. Repeated blood transfusions for congenital anaemias bypass this regulatory checkpoint and inevitably lead to iron overload in the long-term. Iron overload causes multi-organ dysfunction of the heart, liver, pancreas and...
Key content
The symptoms of polycystic ovary syndrome (PCOS) include menstrual cycle disturbance and features of hyperandrogenism (hirsutism, acne and alopecia), with associated fertility problems, obesity and psychological issues.
There are ethnic variations in expression of PCOS related to differences in insulin metabolism and this may impact upo...
Women and men globally are delaying the birth of their first child. In the UK, the average age of first conception in women is 29 years. Women experience age-related fertility decline so it is important that men and women are well-informed about this, and other aspects of fertility. A group of UK stakeholders have established the Fertility Educatio...
This review attempts to summarize the known literature on high responders to ovarian stimulation during assisted reproductive techniques (ART). Response to gonadotrophins is subject to significant interindividual and intercycle variation, thus carrying a risk of high response or poor response to ovarian stimulation regimens. The main risk for high...
Adolescence is a distinctive stage in human development during which many simple and complex medical conditions can present for the first time. Paediatric and adolescent gynaecological conditions need careful multidisciplinary clinical management with a sensitive approach understanding the patients’ psychological and physiological circumstances. Th...
PurposeGametocyte-specific factor 1 has been shown in other species to be required for the silencing of retrotransposons via the Piwi-interacting RNA (piRNA) pathway. In this study, we aimed to isolate and assess expression of transcripts of the gametocyte-specific factor 1 (GTSF1) gene in the human female germline and in preimplantation embryos. M...
Study question:
Does 'metformin' reduce the incidence of ovarian hyperstimulation syndrome (OHSS) for women with polycystic ovary syndrome (PCOS) undergoing a GnRH antagonist assisted conception treatment cycle?
Summary answer:
A short course of metformin does not reduce the incidence of OHSS for women with PCOS undergoing a GnRH antagonist trea...
Objective:
To examine the relationship between Anti-Müllerian Hormone (AMH) and the severity of the phenotype of patients with Polycystic Ovary Syndrome (PCOS) and whether AMH can act as a diagnostic marker for PCOS?
Design:
A prospective diagnostic utility study of AMH as a marker of PCOS.
Patients:
A consecutive series of women presenting to...
BACKGROUND
Here we describe the consensus guideline methodology, summarise the evidence-based recommendations we provided to the World Health Organisation (WHO) for their consideration in the development of global guidance and present a narrative review on the management of anovulatory infertility in women with polycystic ovary syndrome (PCOS).
OB...
It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional DSD team. In most cases, particularly in the case of the newborn, the...
Polycystic ovary syndrome (PCOS) is a prevalent heterogeneous disorder linked with disturbances of reproductive, endocrine and metabolic function. The definition and aetiological hypotheses of PCOS are continually developing to incorporate evolving evidence of the syndrome, which appears to be both multifactorial and polygenic. The pathophysiology...
Polycystic ovary syndrome is the most common endocrine disturbance to affect women, with approximately 10–15% of women experiencing this problem. It involves a spectrum of signs and symptoms, which include menstrual cycle disturbance and infertility, dermatological problems of acne and hirsutism (sometimes alopecia), and being overweight. The latte...
