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自我监测尿液中的激素水平并结合远程医疗——医学辅助生殖中的及时综述和观点文章。

Self-Monitoring of Urinary Hormones in Combination with Telemedicine - a Timely Review and Opinion Piece in Medically Assisted Reproduction.

机构信息

Division of Obstetrics and Gynaecology, The University of Western Australia & Fertility Specialists of Western Australia, Perth, WA, Australia.

Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

出版信息

Reprod Sci. 2022 Nov;29(11):3147-3160. doi: 10.1007/s43032-021-00754-5. Epub 2021 Nov 15.

Abstract

Cycle monitoring via ultrasound and serum-based hormonal assays during medically assisted reproduction (MAR) can provide information on ovarian response and assist in optimizing treatment strategies in addition to reducing complications such as ovarian hyperstimulation syndrome (OHSS). Two surveys conducted in 2019 and 2020, including overall 24 fertility specialists from Europe, Asia and Latin America, confirmed that the majority of fertility practitioners routinely conduct hormone monitoring during MAR. However, blood tests may cause inconvenience to patients. The reported drawbacks of blood tests identified by the survey included the validity of results from different service providers, long waiting times and discomfort to patients due to travelling to clinics for tests and repeated venepunctures. Historically, urine-based assays were used by fertility specialists in clinics but were subsequently replaced by more practical and automated serum-based assays. A remote urine-based hormonal assay could be an alternative to current serum-based testing at clinics, reducing the inconvenience of blood tests and the frequency of appointments, waiting times and patient burden. Here we provide an overview of the current standard of care for cycle monitoring and review the literature to assess the correlation between urine-based hormonal assays and serum-based hormonal assays during MAR. In addition, in this review, we discuss the evidence supporting the introduction of remote urine-based hormonal monitoring as part of a novel digital health solution that includes remote ultrasound and tele-counselling to link clinics and patients at home.

摘要

在医学辅助生殖(MAR)过程中通过超声和基于血清的激素检测进行周期监测,可以提供卵巢反应的信息,并有助于优化治疗策略,此外还可以减少卵巢过度刺激综合征(OHSS)等并发症。2019 年和 2020 年进行的两项调查包括来自欧洲、亚洲和拉丁美洲的 24 名整体生育专家,证实大多数生育医生在 MAR 期间常规进行激素监测。然而,血液检测可能会给患者带来不便。调查中确定的血液检测的缺点包括不同服务提供商的结果有效性、较长的等待时间以及由于到诊所进行检测和反复静脉穿刺而给患者带来的不适。从历史上看,生育专家在诊所中使用基于尿液的检测,但随后被更实用和自动化的基于血清的检测所取代。远程基于尿液的激素检测可以替代当前诊所中的基于血清的检测,减少血液检测的不便以及预约、等待时间和患者负担的频率。在这里,我们提供了周期监测的当前标准护理概述,并回顾了文献,以评估 MAR 期间基于尿液的激素检测与基于血清的激素检测之间的相关性。此外,在本次综述中,我们讨论了支持引入远程基于尿液的激素监测的证据,作为包括远程超声和远程咨询在内的新型数字健康解决方案的一部分,以将诊所和患者在家中联系起来。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50f1/9646588/0ab303c44b5d/43032_2021_754_Fig1_HTML.jpg

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