Academic Papers

In this article, A/Prof Alex Polyakov addresses the important question of when it is safe to conceive after a miscarriage and outlines strategies for promoting a healthy subsequent pregnancy. Miscarriage can significantly impact a woman's physical and emotional health, and determining the right time to try again is crucial. 

In this paper, A/Prof Alex Polyakov and Dr Genia Rozen highlight how new reproductive medicine technologies often spark initial excitement but can lead to disappointment when prematurely adopted without thorough testing. It argues that overconfidence in unproven methods, fueled by the Dunning-Kruger effect, exacerbates this cycle and risks patient safety.

A 41-year-old woman with primary infertility and heavy menstrual bleeding was evaluated by A/Prof Alex Polyakov and Dr Genia Rozen. They found iron deficiency anaemia, a large intramural fibroid distorting the uterine cavity, normal ovarian reserve, and normal semen analysis. Management of her uterine fibroids and infertility included medical therapies to manage symptoms and surgical options to improve fertility. Myomectomy, especially for fibroids distorting the uterine cavity, may be recommended to enhance pregnancy rates.

This article, co-authored by A/Prof Alex Polyakov, Dr Genia Rozen, explores the ethical implications of employing novel embryo selection technologies in IVF. While these techniques offer potential benefits, premature adoption may pose risks and unintended consequences. The authors advocate for cautious implementation, prioritising embryo transfer based on proven advancements while avoiding discarding embryos solely due to unverified methods. They emphasise patient autonomy in decision-making and urge a balanced approach to ensure the benefits outweigh potential harms.

This paper explores posthumous conception, enabled by advancements in ART, in Australia, delving into its ethical and legal intricacies. Variations in state regulations create accessibility disparities, with some mandating written consent from the deceased while others lack explicit prohibitions. It discusses the clash between Will Theory and Interest Theory regarding reproductive autonomy post-demise, advocating for uniform legislation nationwide to address inconsistencies.

This article reviews fertility preservation (FP) for oncology patients, focusing on ethical considerations for those with poor prognoses. It acknowledges posthumous reproduction's complexity, examining legal, logistical, and ethical challenges. Distinctions between cryopreserved sperm and oocytes are discussed, along with issues faced by same-sex couples. Legal and regulatory aspects, including consent and parental rights, are highlighted, urging informed decision-making by healthcare professionals amidst varied global regulations.

Polyakov and Rozen critique Coyne et al. (2024) study on hysterectomy risk during myomectomy, highlighting methodological concerns. They argue the retrospective approach fails to acknowledge concurrent hysterectomy as possibly intended. Analysing surgical codes alone may misinterpret concurrent procedures as unintended complications. They challenge the assumption that concurrent hysterectomy during myomectomy is always unintended, suggesting a flawed premise in the study's conclusions.

A global survey examined fertility professionals' perspectives on egg donor compensation. Among 532 respondents from 88 countries, mainly Europe and Asia, most favored regulated compensation (60.3%), while only 13% supported unrestricted payments. Concerns for donors' welfare drove opposition (22.4%), especially regarding cross-border donations. Yet, for elective egg freezing donations, majority supported compensation (71.6%). The study highlights varied views depending on scenarios and regions.

The study compares obstetric complications among different embryo transfer strategies in IVF cycles. Analysing 23 studies, it finds that artificial thaw embryo transfer (ArtThawET) is associated with increased risks of hypertensive disorders, preterm birth, postpartum haemorrhage, and large for gestational age compared to natural thaw (NatThawET) and fresh embryo transfer (FreshET). The findings suggest avoiding ArtThawET as the first-line option to minimise complications.

Endometriosis, a chronic inflammatory condition, necessitates multidisciplinary care due to its multi-system impact. This systematic review analysed recent models and patient perspectives, finding that integrated care involving diverse specialists improves management. Nineteen studies highlighted the importance of reliable information, respect, and comprehensive support. Further research is needed to assess the impact of such care on quality of life improvements.

Persistent pelvic pain (PPP) is multifactorial and often undiagnosed during laparoscopy. This review assessed women's outcomes after negative laparoscopy for PPP, analysing pain, quality of life (QoL), and care satisfaction. Four studies of 200 women showed inconsistent results: most had persistent pain, while QoL impacts varied. The evidence remains insufficient to guide evidence-based practice, highlighting a significant knowledge gap.

Obesity increases the risk for endometrial cancer and its precursor, endometrial hyperplasia (EH). This systematic review evaluated weight loss as a treatment for EH in women with obesity. Analysing six studies, primarily involving bariatric surgery, showed 71% of women with EH achieved complete histological resolution post-weight loss. However, due to limited data quality, further research is needed to confirm weight loss's therapeutic role.

The critique of a recent study on prednisone use in IVF patients questions its inclusion criteria for repeated implantation failure (RIF). While immune conditions may be a factor in some cases, defining RIF statistically could better identify underlying issues. The study's findings suggest potential bias and underestimation of IVF success rates, cautioning against dismissing prednisone's value. It advocates for targeted research on immune dysfunction in RIF patients for more effective interventions.

This study evaluated the effectiveness of primary medical therapy for retained products of conception (RPOC) in women with secondary postpartum hemorrhage (PPH). Out of 41 patients, 29% were successfully managed medically, while 71% required surgery. Greater endometrial thickness significantly predicted the need for surgical intervention. Higher sonographic RPOC volume was also linked to medical management failure.

This article delves into the ramifications of social media influencers endorsing healthcare services, using a case study of an influencer's sponsored promotion of egg-freezing at a Victorian fertility clinic. It uncovers ethical dilemmas, commercialisation concerns, and legal violations in healthcare advertising regulations. The influence of biased information on followers' healthcare decisions and the need for regulatory intervention to prioritise patient welfare are emphasised.

This study explores the impact of estrogen receptor (ER) status on fertility preservation outcomes in breast cancer patients. Analysing data from 214 women, it finds that those with ER-positive cancer had a higher mean number of oocytes frozen compared to ER-negative patients, despite being older. No significant differences were observed in other ovarian stimulation parameters. ER-positive breast cancer may correlate with better preservation outcomes.

Polyakov and Rozen commend the expert consensus on recurrent implantation failure (RIF), recognising the significance of addressing this complex clinical issue amid confusion and minimal evidence. They acknowledge the necessity of a consensus from renowned experts in the field, emphasising its overdue importance in guiding clinical practice effectively.

This retrospective cohort study aimed to enhance understanding and prevention of ovarian hyperstimulation syndrome (OHSS) in IVF patients. It proposed a novel classification system for inpatient settings, analysed OHSS admissions in a tertiary centre, and assessed preventability strategies. Results suggest a low prevalence of hospital-admitted OHSS cases, indicating the need for improved risk prediction and preventive measures to minimise severe OHSS and hospitalisations.

This study compared live birth rates (LBR) and clinical pregnancy rates (CPR) between fresh and vitrified blastocyst transfer cycles in assisted reproduction. While univariate analysis showed no difference, multivariate analysis revealed significantly lower LBR and CPR in vitrified transfers. Factors like participant age and blastocyst quality influenced outcomes. The findings caution against a universal freeze-all strategy without appropriate indication, advocating for individualised approaches.

This study examines how IVF patients perceive treatment efficacy based on upstream outcomes versus live-birth rates. Through a global survey, patients showed a strong willingness to use a hypothetical treatment, 'FertiSure', even without evidence of live-birth rate improvement. Disclosure of limited evidence or potential risks reduced willingness but didn't deter usage significantly. The findings emphasize the importance of providing comprehensive information to patients considering IVF treatments.

This article addresses barriers to achieving reproductive goals among couples in Australia, emphasising the role of general practitioners (GPs) in identifying and mitigating these barriers. Key factors include age-related concerns and access to fertility treatment. GPs play a crucial role in discussing future fertility, conducting evaluations, and providing support and education to patients, ultimately optimising outcomes through multidisciplinary reproductive care.

This article discusses the practical management of elective oocyte freezing, addressing patient counseling and selection. Studies suggest that younger women are less likely to use their frozen oocytes successfully. While oocyte cryopreservation doesn't guarantee pregnancy and poses financial and health risks, proper patient selection, counseling, and realistic expectations are essential for maximising its benefits.

This paper discussing oocyte banking for anticipated gamete exhaustion (AGE banking) amid delayed childbearing. Concerns include low utilisation, costs, and ethical dilemmas. Concurrently, there's a rising demand for donor oocytes, prompting medical and financial challenges. The authors propose a solution: repurposing oocytes from AGE banking as donor oocytes, benefiting donors, recipients, and society at large.

(2023) 'Do serum progesterone levels on day of embryo transfer influence pregnancy outcomes in artificial frozen-thaw cycles?' authored by A/Prof Alex Polyakov and Dr Genia Rozen | ResearchGate

A/Prof Alex Polyakov and Dr Genia Rozen co-authored a study investigating progesterone (P4) levels on the day of frozen-thawed embryo transfer (FET) and pregnancy outcomes. Analyzing 2010 FETs, they found no significant differences in pregnancy rates between P4 levels below and above 10 ng/mL. Even at 20 ng/mL, outcomes didn't improve significantly. However, P4 levels below 5 ng/mL correlated with lower live birth rates, suggesting a critical threshold for successful FET cycles.

A/Prof Alex Polyakov and Dr Genia Rozen contributed to a study investigating the efficacy of intracytoplasmic sperm injection (ICSI) in cases without male factor infertility. Analyzing 3363 cycles from 2009-2015, they found higher fertilization, pregnancy, and live birth rates with standard IVF compared to ICSI, despite controlling for significant factors. ICSI resulted in approximately 30% fewer pregnancies, highlighting potential detriments to clinical outcomes when used without clear indication in normospermic men.

This study examined whether serum progesterone levels on embryo transfer day affect live birth rates (LBR) in fresh embryo transfer IVF cycles. Analysing 825 cycles, no correlation was found between progesterone concentrations and LBR, regardless of progesterone thresholds. Live birth chances remained consistent across groups, suggesting that progesterone levels on transfer day do not impact IVF success.

This study aimed to determine the endometrial thickness warranting sampling in asymptomatic postmenopausal women with thickened endometrium. Analysing 404 cases, 2.2% had endometrial carcinoma and 1.7% had atypical hyperplasia. The optimal threshold for sampling was identified as ≥9 mm, providing 83.3% sensitivity and 63.8% specificity for detecting pre-malignant or malignant pathology. This threshold aids clinical decision-making for hysteroscopy referrals.

Savulescu et al. critique the exceptional treatment of reproductive tissues, arguing it impedes research and patient care. They assert that embryos not intended for pregnancy should be treated like other human tissues, requiring no extra ethical oversight. The unnecessary restrictions delay life-changing treatments and harm patients by obstructing research progress, while protecting tissue providers' confidentiality and consent remains adequate.

Recent advancements in human genetics have led to the development of polygenic risk scores (PRS) derived from genome-wide association studies, enabling the estimation of disease risk. Applied to embryo selection in IVF, PRS lacks sufficient evidence for efficacy and raises ethical concerns. Further research and ethical considerations are necessary before PRS-based embryo selection is widely implemented outside of research contexts.

A novel clinic model for managing postmenopausal bleeding (PMB) using virtual assessments and outpatient hysteroscopy was tested in a randomised trial. Comparing this model to traditional care, the intervention group had a significantly reduced median time from referral to discharge (55 days vs. 84 days). Additionally, in-person visits were fewer, and 96% of respondents reported high satisfaction.

This double-blind randomised pilot study in Melbourne aimed to evaluate the impact of pre-operative sublingual misoprostol on intra-operative blood loss during abdominal myomectomy. Results showed no significant difference in blood loss between the misoprostol and placebo groups. Fibroid volume consistently predicted blood loss. This study serves as a preliminary exploration, paving the way for future randomized clinical trials.

Endometriosis affects one in nine reproductive-age Australian women, often causing pain and infertility. This study reviewed 300 cases to identify reasons for initial specialist referral. Pain was a common referral reason (61.7%), yet 36.7% of Stage IV cases lacked pain in referral letters. Severe disease correlated with age and ovarian cysts/masses, but not pain. Broader diagnostic criteria are recommended.

Recurrent (or repeated) implantation failure is an imprecisely defined and disputed clinical disorder that is characterised by failure to achieve pregnancy after repeated embryo transfers. It can be defined as a failed embryo implantation, where beta-hCG is in the negative range, after a number of embryo transfers.

This meta-analysis reviewed nine publications to assess the impact of corpus luteum presence on treatment outcomes in thaw cycles with blastocyst embryo transfer. While human chorionic gonadotropin and clinical pregnancy rates were similar, live birth rates were higher with a corpus luteum. Biochemical and clinical pregnancy losses were lower with a corpus luteum. Favoring cycles with a functional corpus luteum is suggested pending further high-quality research.

This review addresses progesterone luteal phase support (LPS) timing in natural frozen embryo transfer (FET) cycles, lacking comparative studies. Based on ovulation physiology, the authors propose starting progesterone supplementation 36 hours post-LH surge or HCG administration, with blastocyst transfer after 5 days of supplementation. Randomised trials are needed to validate these suggestions for optimal progesterone timing in natural FET cycles.