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Sample records for assisted reproduction treatment

  1. Assisted reproduction for the treatment of azoospermia.

    PubMed

    Safran, A; Reubinoff, B E; Porat-Katz, A; Schenker, J G; Lewin, A

    1998-12-01

    Azoospermia, the most severe form of male infertility, is caused by obstructions in the genital tract or by testicular failure. Microsurgical techniques are available for the correction of some of these obstructions but no effective treatment is available for testicular failure. In recent years, methods have been developed for direct surgical sperm sampling from either the epididymis or the testis to be used by intracytoplasmic sperm injection. The main approach proven to be effective for the retrieval of spermatozoa from the epididymis in patients with obstructive azoospermia is microsurgical epididymal sperm aspiration, although recently the retrieval of spermatozoa by fine needle aspiration was shown to be equally effective. Recovery of spermatozoa is also now performed in patients with severely deficient spermatogenesis using testicular open biopsy as well as aspiration by fine needle. The ultimate choice of sperm retrieval method in these patients will depend not only on sperm availability, but also on the physiological consequences of the different techniques on testicular function. This article summarizes the recent advances achieved in the treatment of azoospermic patients using these assisted reproduction surgical techniques.

  2. Assisted Reproductive Technology (ART)

    MedlinePlus

    ... American Society for Reproductive Medicine. (2012). Third-party reproduction (sperm, egg, and embryo donation and surrogacy): A ... from https://www.asrm.org/BOOKLET_Third-party_Reproduction [top] American Society for Reproductive Medicine. (2015). Assisted ...

  3. Treatment of luteal phase defects in assisted reproduction.

    PubMed

    Muñoz, Elkin; Taboas, Esther; Portela, Susana; Aguilar, Jesús; Fernandez, Iria; Muñoz, Luis; Bosch, Ernesto

    2013-07-01

    Abnormal luteal function is a common issue in assisted reproduction techniques associated with ovarian stimulation probably due to low levels of LH in the middle and in the late luteal phase. This defect seems to be associated with supraphysiological steroid levels at the end of follicular phase. The luteal phase insufficiency has not got a diagnostic test which has proven reliable in a clinical setting. Luteal phase after ovarian stimulation becomes shorter and insufficient, resulting in lower pregnancy rates. Luteal phase support with progesterone or hCG improves pregnancy outcomes and no differences are found among different routes of administration. However, hCG increases the risk of ovarian hyperstimulation syndrome. In relation to the length of luteal support, the day of starting it remains controversial and it does not seem necessary to continue once a pregnancy has been established. After GnRHa triggering ovulation, intensive luteal support or hCG bolus can overcome the defect in luteal phase, but more studies are needed to show the LH utility as support.

  4. Impact of infertility characteristics and treatment modalities on singleton pregnancies after assisted reproduction.

    PubMed

    Poikkeus, P; Unkila-Kallio, L; Vilska, S; Repokari, L; Punamäki, R-L; Aitokallio-Tallberg, A; Sinkkonen, J; Almqvist, F; Tulppala, M; Tiitinen, A

    2006-07-01

    Obstetric and neonatal outcomes of assisted reproduction and control singletons were evaluated after taking into account treatment characteristics and infertility background. The elective single embryo transfer (eSET) group (n = 45) was compared with the compulsory single embryo transfer (cSET; n = 52), double embryo transfer (DET; n = 227) and control (n = 304) groups. Infertility-related prognostic factors for neonatal outcomes were also analysed. Data were collected with structured questionnaires at gestational week 20 and 8 weeks after delivery. Spontaneous onset of delivery was more typical of the eSET group than of cSET and DET groups (68.9 versus 52.0%, P = 0.02). Mean (+/-SD) gestation at birth (39.3 +/- 1.6 weeks) and mean birth weight (3,470 +/- 505 g) of eSET singletons were comparable with other assisted reproduction groups, but gestational duration was lower than in the eSET group than in the control group (39.9 +/- 1.4; P < 0.05). However, numbers of preterm births and low birth weight infants were similar between groups. History of induced abortion increased risk of preterm birth (OR 4.5 and 95% CI 1.2-17.1) in assisted reproduction singletons. A small though clinically unimportant difference in gestational age at birth and birth weight between assisted reproduction and control singletons was found regardless of the number of embryos transferred.

  5. Psychosocial stress and treatment outcome following assisted reproductive technology.

    PubMed

    Sanders, K A; Bruce, N W

    1999-06-01

    This study investigated the association between psychosocial stress and outcome of in-vitro fertilization and gamete intra-Fallopian transfer treatment. Ninety women, enrolled for treatment at a private infertility clinic, completed two self-administered psychometric tests (Bi-polar Profile of Mood States, POMS; and State-Trait Anxiety Inventory, STAI) and a questionnaire to ascertain demographic and lifestyle characteristics before the start of treatment. Approximately 12 months later an outcome measure was determined for each participant in terms of whether she was pregnant or not pregnant and the number of treatment cycles undertaken to achieve clinical pregnancy. The women's scores on the psychological tests were similar to published normative scores. On univariate analysis, history of a previous pregnancy was positively related to the probability of pregnancy and full-time employment, a more 'hostile' mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable-hostile and elated-depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome but indicate that the relationships are complex. Further studies are required to validate whether these findings can be generalized to other populations.

  6. Economics of assisted reproduction: access to fertility treatments and valuing live births in economic terms.

    PubMed

    Connolly, Mark P; Ledger, William; Postma, Maarten J

    2010-03-01

    The intricate relationship between economic conditions and natural fertility is known to influence both the timing and number of children conceived. For infertile couples, the relationship between economics and fertility is more explicit because of the necessity for many couples to pay for treatment to achieve childbirth. Consequently, affordability often dictates whether or not someone is able to undergo treatment, as well as the types of treatments available. Economics can also be used to describe treatment outcomes achieved through the use of fertility treatments. While gynaecologists and couples speak of outcomes in terms of live births, economists are often inclined to view live births and their influence on society in economic terms. In this review we consider two distinct elements of economics and assisted reproduction. Firstly, how economics (i.e. affordability) can influence demand for, and access to, fertility treatments, and secondly, how methods for valuing live births achieved using assisted reproductive technologies in economic terms can highlight the importance of these children in the context of ageing populations. This review will attempt to illustrate that the economic benefits attributed to children conceived through fertility treatments are much greater than health costs required for conception and should be considered in future reimbursement decisions in this therapy area.

  7. Society for Assisted Reproductive Technology

    MedlinePlus

    The Society for Assisted Reproductive Technology PATIENTS Patient Information What Is SART? Risks of IVF Third Party Reproduction A ... Read Article View All News ©1996 - 2016 SART, Society for Assisted Reproductive Technology . All Rights Reserved. ASRM/ ...

  8. Preparing for Assisted Reproductive Technology

    MedlinePlus

    ... CDC Cancel Submit Search The CDC Assisted Reproductive Technology (ART) Note: Javascript is disabled or is not ... visit this page: About CDC.gov . Assisted Reproductive Technology (ART) What Is ART Patient Resources Preparing for ...

  9. FSH treatment in infertile males candidate to assisted reproduction improved sperm DNA fragmentation and pregnancy rate.

    PubMed

    Garolla, Andrea; Ghezzi, Marco; Cosci, Ilaria; Sartini, Barbara; Bottacin, Alberto; Engl, Bruno; Di Nisio, Andrea; Foresta, Carlo

    2016-07-27

    The purpose of this study is to evaluate whether follicle-stimulating hormone treatment improves sperm DNA parameters and pregnancy outcome in infertile male candidates to in-vitro fertilization.Observational study in 166 infertile male partners of couples undergoing in-vitro fertilization. Eighty-four patients were receiving follicle-stimulating hormone treatment (cases) and 82 refused treatment (controls). Semen parameters, sexual hormones, and sperm nucleus (fluorescence in-situ hybridization, acridine orange, TUNEL, and γH2AX) were evaluated at baseline (T0) and after 3 months (T1), when all subjects underwent assisted reproduction techniques. Statistical analysis was performed by analysis of variance.Compared to baseline, cases showed significant improvements in seminal parameters and DNA fragmentation indexes after follicle-stimulating hormone therapy (all P < 0.05), whereas no changes were observed in controls. Within cases, follicle-stimulating hormone treatment allowed to perform intrauterine insemination in 35 patients with a pregnancy rate of 23.2 %. Intracytoplasmic sperm injection was performed in all controls and in 49 patients from cases, with pregnancy rates of 23.2 and 40.8 %, respectively (P < 0.05). After 3 months (T0 vs. T1) of follicle-stimulating hormone therapy, cases with positive outcome had reduced DNA fragmentation index and lower double strand breaks (P < 0.05 and P < 0.001 vs. negative outcome, respectively).In this observational study, we showed that follicle-stimulating hormone treatment improves sperm DNA fragmentation, which in turn leads to increased pregnancy rates in infertile males undergoing in-vitro fertilization. In particular, double strand breaks (measured with γH2AX test) emerged as the most sensible parameter to follicle-stimulating hormone treatment in predicting reproductive outcome.

  10. HLA-G profile of infertile couples who underwent assisted reproduction treatment.

    PubMed

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Nardi, Fabiola Silva; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; da Graça Bicalho, Maria

    2016-12-01

    HLA-G codes for a non-classical class I (Ib) protein which is mainly expressed in trophoblast cells. Many pieces of evidence pointed out its essential role conferring immunological tolerance to the fetus. Some HLA-G alleles have been linked to enhanced or reduced HLA-G protein levels expression, which have been associated with reproductive failure. In this study 33 couples undergoing ART (assisted reproduction treatment; n=66) and 120 couples who conceived naturally (controls; n=240) were enrolled in the study. Genotyping was performed by SBT and tagged an 1837bp at 5'URR as well as exons 2, 3 and4 of HLA-G. Alleles, genotypes and haplotypes were compared between infertile and control groups using Fisher Exact Test. The haplotype HLA-G(∗)010101b/HLA-G(∗)01:01:01 showed statistically significant higher frequency in control groups. The immunogenetics of infertility is complex and might be dependent on different genes involved in the establishment of a successful pregnancy. A better understanding of HLA-G alleles and haplotypes structure and how the genetic diversity at their regulatory sites could impact on their level of expression and build up the susceptibility or protection conditions may shed light on the comprehension of immunogenetics mechanisms acting at the fetus-maternal interface.

  11. Soy food intake and treatment outcomes of women undergoing assisted reproductive technology

    PubMed Central

    Vanegas, Jose C.; Afeiche, Myriam C.; Gaskins, Audrey J.; Mínguez-Alarcón, Lidia; Williams, Paige L.; Wright, Diane L.; Toth, Thomas L.; Hauser, Russ; Chavarro, Jorge E.

    2014-01-01

    Objective To study the relation of dietary phytoestrogens intake and clinical outcomes of women undergoing infertility treatment with assisted reproductive technology (ART). Design Prospective cohort study. Setting Fertility center in an academic hospital. Participants 315 women who collectively underwent 520 ART cycles between 2007 and 2013. Interventions None Outcomes Primary outcomes were implantation, clinical pregnancy and live birth rates per initiated cycle. Results Soy isoflavones intake was positively related to live birth rates in ART. Compared to women who did not consume soy isoflavones, the multivariable-adjusted odds ratios of live birth (95% confidence interval) for women in increasing categories of soy isoflavone intake were 1.32 (0.76–2.27) for women consuming 0.54–2.63 mg/d, 1.87 (1.12–3.14) for women consuming 2.64- 7.55 mg/d, and 1.77 (1.03–3.03) for women consuming 7.56- 27.89 mg/d. Conclusions Dietary soy intake was positively related to the probability of having a live birth during infertility treatment with ART. PMID:25577465

  12. Men’s meat intake and treatment outcomes among couples undergoing assisted reproduction

    PubMed Central

    Xia, Wei; Chiu, Yu-Han; Williams, Paige L.; Gaskins, Audrey J.; Toth, Thomas L; Tanrikut, Cigdem; Hauser, Russ; Chavarro, Jorge E.

    2015-01-01

    Objective To study the relation of men’s meat intake and clinical outcomes in couples undergoing infertility treatment with the use of assisted reproductive technology (ART). Design Prospective cohort study. Setting Fertility center at an academic hospital. Patient(s) A total of 141 men whose female partners underwent 246 ART cycles from 2007 to 2014. Intervention(s) None. Total and specific types of meat intake were estimated from dietary questionnaires. Main Outcome Measure(s) Fertilization, implantation, clinical pregnancy, and live birth rates per initiated cycle. Mixed effect models account for multiple in vitro fertilization (IVF) cycles per woman. Result(s) There was a positive association between poultry intake and fertilization rate, with 13% higher fertilization rate among men in the highest quartile of poultry intake compared to those in the lowest quartile (78% vs. 65%). Processed meat intake was inversely related to fertilization rate in conventional IVF cycles, but not in IVF cycles using intracytoplasmic sperm injection (ICSI). The adjusted fertilization rates for men in increasing quartiles of processed meat intake were 82%, 67%, 70%, and 54% in conventional IVF cycles. Men’s total meat intake, including intake of specific types of meat, was not associated with implantation, clinical pregnancy, or live birth rates. Conclusion(s) Poultry intake was positively associated with fertilization rates, whereas processed meat intake was negatively associated with fertilization rates among couples undergoing conventional IVF. This, however, did not translate into associations with clinical pregnancy or live birth rates. PMID:26206344

  13. Outcomes of assisted reproduction treatment after dopamine agonist -cabergoline- for prevention of ovarian hyper stimulation syndrome

    PubMed Central

    Movahedi, Shohreh; Safdarian, Leili; Agahoseini, Marzieh; Aleyasin, Ashraf; Khodaverdi, Sepideh; Asadollah, Sara; Kord Valeshabad, Ali; Fallahi, Parvin; Rezaeeian, Zahra

    2016-01-01

    Background: Release of vascular endothelial growth factor (VEGF) by ovaries in response to HCG administration is one of the main mechanisms of ovarian hyper stimulation syndrome. Since Dopamine/dopamine receptor2 (Dp-r2) pathway activity -mediated by VEGF/ Vascular endothelial growth factor receptor 2 (VEGFR- 2) signaling-, is associated with angiogenic events, dopamine agonists were used for the management of severe forms of OHSS. In order to assess the effects of Cabergoline on angiogenesis in the human endometrium, and subsequently its impacts on the implantation rate this study was conducted. Methods: This historical cohort study was conducted based on existing data of 115 patients (20-40 years) whom underwent assisted reproductive treatment (ART) and with a high probability for developing OHSS between March 2007 and September 2008. Forty five cases received Cabergoline were compared to 70 control subjects. The statistical methods used were: Unpaired t-test for continuous variables and the chi-square test (or Fisher’s exact test if required) for categorical variables. Results: None of the patients (treatment or control group) developed OHSS. The etiologies of infertility and administration of GnRH agonist or antagonist protocols were similar in two groups (p>0.2). Number of transferred embryos and zygote intra-fallopian transfer (ZIFT) did not differ between the two groups (p≥0.06). Implantation rate in treatment (3.1%) and control (6.6%) subjects was similar (p=0.4). No significant difference was observed in fertilization rate, chemical, clinical and ongoing pregnancies between the two groups (p>0.5). Conclusion: Cabergoline can be safely administered in ART protocols to prevent OHSS, without compromising ART outcomes. PMID:27493915

  14. [Preparation for assisted reproductive technology in the course of infertility treatment in the female soldiers].

    PubMed

    Shmidt, A A; Molchanov, O L; Abashin, V G; Yarman, S A; Beskrovnyi, S V

    2016-04-01

    The level of obstetric morbidity in servicewomen remains high. Infertility occurs more often among the families of servicemen, than among the other families. The leading causative factor among the families suffering from infertility is tuboperitoneal or tubal (up to 85%). Assisted reproductive technologies are often the only possible mean to solve the problem of infertility in case of these forms of infertility.. The families of servicemen suffering from infertility were suggested the echelon principle of health care in military-medical institutions of the Ministry of Defence of the Russian Federation. Defined selection rules and directions, requiring the separation of the assisted reproductive technologies Clinic of Obstetrics and Gynaecology of the Kirov Military Medical Academy to carry out in vitro fertilization procedures.

  15. Changes in sex ratio from fertilization to birth in assisted-reproductive-treatment cycles

    PubMed Central

    2014-01-01

    Background In Western gender-neutral countries, the sex ratio at birth is estimated to be approximately 1.06. This ratio is lower than the estimated sex ratio at fertilization which ranges from 1.07 to 1.70 depending on the figures of sex ratio at birth and differential embryo/fetal mortality rates taken into account to perform these estimations. Likewise, little is known about the sex ratio at implantation in natural and assisted-reproduction-treatment (ART) cycles. In this bioessay, we aim to estimate the sex ratio at fertilization and implantation using data from embryos generated by standard in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in preimplantation genetic diagnosis cycles. Thereafter, we compare sex ratios at implantation and birth in cleavage- and blastocyst-stage-transfer cycles to propose molecular mechanisms accounting for differences in post-implantation male and female mortality and thereby variations in sex ratios at birth in ART cycles. Methods A literature review based on publications up to December 2013 identified by PubMed database searches. Results Sex ratio at both fertilization and implantation is estimated to be between 1.29 and 1.50 in IVF cycles and 1.07 in ICSI cycles. Compared with the estimated sex ratio at implantation, sex ratio at birth is lower in IVF cycles (1.03 after cleavage-stage transfer and 1.25 after blastocyst-stage transfer) but similar and close to unity in ICSI cycles (0.95 after cleavage-stage transfer and 1.04 after blastocyst-stage transfer). Conclusions In-vitro-culture-induced precocious X-chromosome inactivation together with ICSI-induced decrease in number of trophectoderm cells in female blastocysts may account for preferential female mortality at early post-implantation stages and thereby variations in sex ratios at birth in ART cycles. PMID:24957129

  16. Assisted reproductive practice: religious perspectives.

    PubMed

    Schenker, Joscph G

    2005-03-01

    It is important to those who practise reproductive techniques to learn about different religious perspectives related to reproductive health problems. Religious groups are active in influencing the public regarding bioethical positions, and this is particularly evident with issues concerning procreation, abortion and infertility therapy. The Jewish attitude towards procreation is derived from the first commandment of God to Adam to 'Be fruitful and multiply'. Judaism allows the practice of all techniques of assisted reproduction when the oocyte and spermatozoon originate from the wife and husband respectively. The attitude toward reproductive practice varies among Christian groups. While assisted reproduction is not accepted by the Vatican, it may be practised by Protestant, Anglican and other denominations. According to traditional Christian views, beginning at conception, the embryo has moral status as a human being, and thus most assisted reproductive technologies are forbidden. According to Islam, the procedures of IVF and embryo transfer are acceptable, although they can be performed only for husband and wife. Developments in science and technology and corresponding clinical applications raise new religious questions, often without clear answers. The role of theology in bioethics is integral to clarify perceived attitudes toward these developments for different religious communities. This paper presents the attitude of monotheistic religions to therapeutic procedures, such as IVF-embryo transfer, spermatozoa, oocytes, embryo donation, cryopreservation of genetic material, surrogacy, posthumous reproduction, gender preselection, reproductive and therapeutic cloning.

  17. Religious aspects of assisted reproduction

    PubMed Central

    Sallam, HN; Sallam, NH

    2016-01-01

    Abstract Human response to new developments regarding birth, death, marriage and divorce is largely shaped by religious beliefs. When assisted reproduction was introduced into medical practice in the last quarter of the twentieth century, it was fiercely attacked by some religious groups and highly welcomed by others. Today, assisted reproduction is accepted in nearly all its forms by Judaism, Hinduism and Buddhism, although most Orthodox Jews refuse third party involvement. On the contrary assisted reproduction is totally unacceptable to Roman Catholicism, while Protestants, Anglicans, Coptic Christians and Sunni Muslims accept most of its forms, which do not involve gamete or embryo donation. Orthodox Christians are less strict than Catholic Christians but still refuse third party involvement. Interestingly, in contrast to Sunni Islam, Shi’a Islam accepts gamete donation and has made provisions to institutionalize it. Chinese culture is strongly influenced by Confucianism, which accepts all forms of assisted reproduction that do not involve third parties. Other communities follow the law of the land, which is usually dictated by the religious group(s) that make(s) the majority of that specific community. The debate will certainly continue as long as new developments arise in the ever-evolving field of assisted reproduction. PMID:27822349

  18. Epigenetics and assisted reproductive technologies.

    PubMed

    Pinborg, Anja; Loft, Anne; Romundstad, Liv B; Wennerholm, Ulla-Britt; Söderström-Anttila, Viveca; Bergh, Christina; Aittomäki, Kristiina

    2016-01-01

    Epigenetic modification controls gene activity without changes in the DNA sequence. The genome undergoes several phases of epigenetic programming during gametogenesis and early embryo development, coinciding with assisted reproductive technologies (ART) treatments. Imprinting disorders have been associated with ART techniques, but disentangling the influence of the ART procedures per se from the effect of the reproductive disease of the parents is a challenge. Epidemiological human studies have shown altered birthweight profiles in ART compared with spontaneously conceived singletons. Conception with cryopreserved/thawed embryos results in a higher risk of large-for-gestational-age babies, which may be due to epigenetic modification. Further animal studies have shown altered gene expression profiles in offspring conceived by ART related to altered glucose metabolism. It is controversial whether human adolescents conceived by ART have altered lipid and glucose profiles and thereby a higher long-term risk of cardiovascular disease and diabetes. This commentary describes the basic concepts of epigenetics and gives a short overview of the existing literature on the association between imprinting disorders, epigenetic modification and ART.

  19. Racial and ethnic differences in assisted reproduction treatment outcomes: the benefit of racial admixture.

    PubMed

    Braga, Daniela Paes Almeida Ferreira; Setti, Amanda S; Iaconelli, Assumpto; Taitson, Paulo Franco; Borges, Edson

    2015-01-01

    The goal of the present study was to determine whether racial and ethnic differences affect the outcomes of assisted reproductive technology in the Brazilian population. 1497 patients undergoing intracytoplasmic sperm injection (ICSI) cycles were split into groups according to the patient's ethnicity: Caucasian (n = 2131), Mestizo (n = 358), Asian (n = 174), Black (n = 115) and Indian (n = 260). ICSI outcomes were compared among the groups. Body mass index was highest in the Black group, followed by the Mestizo, Indian, Caucasian and Asian groups (p > 0.001). The FSH dose (p > 0.001) was highest among Indians, followed by Asians and Caucasians, and the dose was lowest among Blacks and Mestizos. In contrast, the oocyte yield was highest among Mestizos, followed by Indians, Blacks and Caucasians, and lowest among Asians (p = 0.005). The fertilisation rate was highest among Mestizos, followed by Blacks, Indians and Caucasians, whereas Asians had the lowest fertilisation rate (p = 0.004). Pregnancy and implantation rates were also highest among Mestizos, followed by Blacks, Indians and Caucasians, whereas the Asian patients had the lowest rates (p = 0.008 and p > 0.001, respectively). In conclusion, our evidence suggests a possible beneficial effect of racial admixture on ICSI outcomes.

  20. [Adoption: an alternative to assisted reproductive techniques?].

    PubMed

    Blanchy, S

    2011-09-01

    Information on adoption must be given to couples who seek treatment for medically-assisted procreation. But is adoption a real alternative? What are the chances for a couple who consults to see its desire for adoption be achieved according to its own situation, the characteristics of the child he wants, and the general situation of adoption? Can adoption, just like assisted procreation, often described by the couples as a "obstacle course", go parallel? Or should one try adoption once assisted reproduction failed? Is the couple willing to suffer the social and legal control of adoption after having supported the medical control of the ART? In all cases, the reality is that two out of three couples engaged in assisted reproduction will have a child whereas scarcely more than one candidate to adoption will be offered to adopt a child after three or four-years procedure.

  1. Assisted reproductive travel: UK patient trajectories.

    PubMed

    Hudson, Nicky; Culley, Lorraine

    2011-11-01

    Media reporting of 'fertility tourism' tends to portray those who travel as a cohesive group, marked by their desperation and/or selfishness and propensity towards morally questionable behaviour. However, to date little has been known about the profile of those leaving the UK for treatment. This paper discusses the first UK-based study of patient assisted reproduction travel that was designed to explore individual travel trajectories. It is argued that existing ways of conceptualizing cross-border reproductive care as 'fertility or reproductive tourism' are in danger of essentializing what the data suggest are diverse, complex and often ambiguous motivations for reproductive travel. The concept of seriality is used to suggest that, whilst 'reproductive tourists' share some characteristics, they also differ in significant ways. This paper argues that, through an examination of the personal landscapes of fertility travel, the diverse processes involved in reproductive travel can be better understood and policymakers can be assisted to avoid what might be regarded as simplistic responses to cross-border reproductive care.

  2. Assisted reproduction and distributive justice.

    PubMed

    Panitch, Vida

    2015-02-01

    The Canadian province of Quebec recently amended its Health Insurance Act to cover the costs of In Vitro Fertilization (IVF). The province of Ontario recently de-insured IVF. Both provinces cited cost-effectiveness as their grounds, but the question as to whether a public health insurance system ought to cover IVF raises the deeper question of how we should understand reproduction at the social level, and whether its costs should be a matter of individual or collective responsibility. In this article I examine three strategies for justifying collective provisions in a liberal society and assess whether public reproductive assistance can be defended on any of these accounts. I begin by considering, and rejecting, rights-based and needs-based approaches. I go on to argue that instead we ought to address assisted reproduction from the perspective of the contractarian insurance-based model for public health coverage, according to which we select items for inclusion based on their unpredictability in nature and cost. I argue that infertility qualifies as an unpredictable incident against which rational agents would choose to insure under ideal conditions and that assisted reproduction is thereby a matter of collective responsibility, but only in cases of medical necessity or inability to pay. The policy I endorse by appeal to this approach is a means-tested system of coverage resembling neither Ontario nor Quebec's, and I conclude that it constitutes a promising alternative worthy of serious consideration by bioethicists, political philosophers, and policy-makers alike.

  3. Bioethical dilemmas of assisted reproduction in the opinions of Polish women in infertility treatment: a research report.

    PubMed

    Dembinska, Aleksandra

    2012-12-01

    Infertility Accepted treatment is replete with bioethical dilemmas regarding the limits of available medical therapies. Poland has no legal acts regulating the ethical problems associated with infertility treatment and work on such legislation has been in progress for a long time, arousing very intense emotions in Polish society. The purpose of the present study was to find out what Polish women undergoing infertility treatment think about the most disputable and controversial bioethical problems of assisted reproduction. An Attitudes towards Bioethical Problems of Infertility Scale was constructed specifically for this study. Items were taken from the Bioethics Bills currently under discussion in Polish Parliament (Seym). 312 women were enrolled in the study. Women experiencing infertility favoured more liberal legislation. Participants disagreed, for example, with the following regulations: prohibition of embryo freezing, prohibition of preimplantation genetic diagnosis of embryos, age limits for women using in vitro fertilisation and prohibition of in vitro fertilisation for single women. The opinions of patients undergoing infertility treatment are an important voice in the Polish debate on the Bioethics Bills.

  4. Diagnostic value of sperm DNA fragmentation and sperm high-magnification for predicting outcome of assisted reproduction treatment

    PubMed Central

    López, Gemma; Lafuente, Rafael; Checa, Miguel A; Carreras, Ramón; Brassesco, Mario

    2013-01-01

    Over the last years, major improvements in the field of male infertility diagnosis have been achieved. The aim of this study was to determine the diagnostic usefulness of sperm DNA integrity and sperm vacuolisation for predicting outcome in infertile couples undergoing in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) treatments. A cohort study from 152 infertile couples undergoing sperm DNA fragmentation and high-magnification tests prior to an assisted reproduction treatment was designed. We found that the most predictive cutoff for pregnancy was 25.5% of DNA fragmentation with a negative predictive value of 72.7% (P=0.02). For the degree of vacuolisation, the best predictor of pregnancy was 73.5% of vacuolated sperm grades III+IV with a negative predictive value of 39.4% (P=0.09), which was not statistically significant. In conclusion, sperm DNA fragmentation greater than 25.5% could be associated with higher probability of failure IVF treatment. Regarding the results of the sperm analysis at high magnification, they do not allow us to predict whether or not patients will become pregnant. PMID:23912311

  5. Diagnostic value of sperm DNA fragmentation and sperm high-magnification for predicting outcome of assisted reproduction treatment.

    PubMed

    López, Gemma; Lafuente, Rafael; Checa, Miguel A; Carreras, Ramón; Brassesco, Mario

    2013-11-01

    Over the last years, major improvements in the field of male infertility diagnosis have been achieved. The aim of this study was to determine the diagnostic usefulness of sperm DNA integrity and sperm vacuolisation for predicting outcome in infertile couples undergoing in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) treatments. A cohort study from 152 infertile couples undergoing sperm DNA fragmentation and high-magnification tests prior to an assisted reproduction treatment was designed. We found that the most predictive cutoff for pregnancy was 25.5% of DNA fragmentation with a negative predictive value of 72.7% (P=0.02). For the degree of vacuolisation, the best predictor of pregnancy was 73.5% of vacuolated sperm grades III+IV with a negative predictive value of 39.4% (P=0.09), which was not statistically significant. In conclusion, sperm DNA fragmentation greater than 25.5% could be associated with higher probability of failure IVF treatment. Regarding the results of the sperm analysis at high magnification, they do not allow us to predict whether or not patients will become pregnant.

  6. [Assisted reproductive technologies in urology].

    PubMed

    Loran, O B; Segal, A S; Pushkar', D Iu; Zdanovskiĭ, V M; Tagobetskiĭ, A S; Iudovskiĭ, S O; Epifanova, E A

    2001-01-01

    Since 1996 the authors have examined and treated 42 infertile married couples (the husbands had azoospermia). To obtain spermatozoa directly from the testes or epididymis and subsequent ICSI, 42 patients underwent 53 interventions: TESE (n = 38), PESA (n = 10), MESA (n = 5). Spermatozoa were obtained from 32(76.1%) of 42 patients, fertilization occurred in 21(50%) cases, 10(23.8%) wives got pregnant. Assisted reproductive technologies expand potentialities of correcting severe forms of male infertility including azoospermia. The armory of the operative procedures in male infertility was replenished with MESA, TESE, PESA.

  7. [Assisted reproductive technologies and ethics].

    PubMed

    Belaisch-Allart, Joëlle

    2014-01-01

    Since the first birth after in vitro fertilization more than 5 million of IVF babies are born in the world. Assisted reproductive technologies captivate the public, they allow maternity without ovary (oocyte donation), without uterus (surrogate mother), paternity without spermatozoids (sperm donation), parentality without limits of age, parentality after death and homoparentality. These technologies arise a lot of ethics questions, the problem is that the answers are not the same all-round the world, laws are based on morals, beliefs, faiths, and convictions. Theses variations arise themselves questions on the value of these non-universal answers.

  8. In Vitro Antioxidant Treatment of Semen Samples in Assisted Reproductive Technology: Effects of Myo-Inositol on Nemaspermic Parameters

    PubMed Central

    Papale, Palma; Della Ragione, Antonietta; Quaranta, Giuseppa; Russo, Giovanni; Russo, Sabatino

    2016-01-01

    Male infertility and the poor quality of sperm seem to be influenced by oxidative stress. In particular, the reactive oxygen species (ROS) mainly produced by morphologically altered spermatozoa affect sperm motility, morphology, and integrity. The aim of this study was to evaluate the efficacy of Myo-Inositol (Myo-Ins) on a number of parameters such as viscosity and total and progressive motility of spermatozoa, in order to better validate its possible practical application in vitro, in order to improve the capacitation protocols commonly used in Assisted Reproductive Technology (ART). A total of 100 fresh and 25 thawed semen samples were analyzed in vitro prior to and after addition of Myo-Ins. Treatment of samples with Myo-Ins showed an increase in the sperm total and progressive motility in both fresh and thawed samples. Furthermore, Myo-Ins proved to be well tolerated by spermatozoa in vitro, demonstrating that it can be efficiently and safely used as antioxidant in the laboratory practice and for preparation of semen samples in ART. PMID:27672392

  9. Banning reproductive travel: Turkey's ART legislation and third-party assisted reproduction.

    PubMed

    Gürtin, Zeynep B

    2011-11-01

    In March 2010, Turkey became the first country to legislate against the cross-border travel of its citizens seeking third-party reproductive assistance. Although the use of donor eggs, donor spermatozoa and surrogacy had been illegal in Turkey since the introduction of a regulatory framework for assisted reproductive treatment in 1987, men and women were free to access these treatments in other jurisdictions. In some cases, such travel for cross-border reproductive care (CBRC) was even facilitated by sophisticated arrangements between IVF clinics in Turkey and in other countries, particularly in Cyprus. However, new amendments to Turkey's assisted reproduction legislation specifically forbid travel for the purposes of third-party assisted reproduction. This article outlines the cultural context of assisted reproductive treatment in Turkey; details the Turkish assisted reproduction legislation, particularly as it pertains to third-party reproductive assistance; explores Turkish attitudes towards donor gametes and surrogacy; assesses the existence and extent of CBRC prior to March 2010; and discusses some of the legal, ethical and practical implications of the new legislation. As CBRC becomes an increasingly pertinent issue, eliciting debate and discussion at both national and international levels, it is important to carefully consider the particular circumstances and potential consequences of this unique example.

  10. Assisted reproductive technology--IVF treatment in Ireland: a study of couples with successful outcomes.

    PubMed

    Mahon, Evelyn; Cotter, Noelle

    2014-09-01

    This article describes the experiences of twelve Irish couples who had successful IVF treatment in Ireland. Irish Medical guidelines specify that IVF may only be used when no other treatment is likely to be effective. This article is based on data drawn from a longitudinal research study by Cotter (2009) which tells the stories of 34 couples who sought fertility treatment. Initially, the women assumed that they would become pregnant when they stopped using contraception. As a couple, it was the 'right time' for them to have a child--they were ready, socially and financially. For several months they were patient, hoping it would happen naturally. With envy and some despair they watched as their friends had babies. Infertility came as a shock to most of them. They were reluctant to talk about it to anyone, and over time their anxieties were accompanied by feelings of regret, stigma and social exclusion. They finally sought medical treatment. The latter involved a series of diagnostic treatments, which eventually culminated in IVF which offered them a final chance of having a 'child of their own'. While IVF can be clinically assessed in terms of cycle success rates, their stories showed treatment as a series of discoveries, as an extensive range of diagnostic tests and procedures helped to reveal to them where their problems might lie. They described their treatments as a series of sequential 'hurdles' that they had to overcome, which further strengthened their resolve to try IVF. Much more knowledgeable at that stage, they embraced IVF as a final challenge with single minded dedication while drawing on all their psychological and biological resources to promote a successful outcome. Of the 34 couples who took part in the study, twelve got pregnant. Unfortunately, two children died shortly after birth but eighteen babies survived (see Table I). The findings suggest that health policy should raise awareness of infertility, and advise women to become aware of it

  11. [Contemporaneous history: complex techniques of assisted reproduction].

    PubMed

    Alvarez Díaz, Jorge Alberto

    2007-05-01

    The work begins with historical considerations about the development of embryology at the beginning of the twentieth century and the vast advance obtained to the arriving of complex assisted reproductive techniques. Afterwards it is reviewed the development of variants and possibilities of the techniques. Finally, it is proposed four historic periods regarding the development of complex assisted reproductive technologies.

  12. 21 CFR 884.6140 - Assisted reproduction micropipette fabrication instruments.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction micropipette fabrication... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6140 Assisted reproduction micropipette fabrication instruments. (a)...

  13. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction micromanipulators and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6150 Assisted reproduction micromanipulators and microinjectors. (a)...

  14. 21 CFR 884.6140 - Assisted reproduction micropipette fabrication instruments.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction micropipette fabrication... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6140 Assisted reproduction micropipette fabrication instruments. (a)...

  15. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction micromanipulators and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6150 Assisted reproduction micromanipulators and microinjectors. (a)...

  16. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction micromanipulators and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6150 Assisted reproduction micromanipulators and microinjectors. (a)...

  17. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction micromanipulators and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6150 Assisted reproduction micromanipulators and microinjectors. (a)...

  18. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction micromanipulators and... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6150 Assisted reproduction micromanipulators and microinjectors. (a)...

  19. 21 CFR 884.6140 - Assisted reproduction micropipette fabrication instruments.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction micropipette fabrication... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6140 Assisted reproduction micropipette fabrication instruments. (a)...

  20. 21 CFR 884.6140 - Assisted reproduction micropipette fabrication instruments.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction micropipette fabrication... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6140 Assisted reproduction micropipette fabrication instruments. (a)...

  1. 21 CFR 884.6140 - Assisted reproduction micropipette fabrication instruments.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction micropipette fabrication... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6140 Assisted reproduction micropipette fabrication instruments. (a)...

  2. Cancer in Women after Assisted Reproductive Technology

    PubMed Central

    Luke, Barbara; Brown, Morton B.; Spector, Logan G.; Missmer, Stacey A.; Leach, Richard E.; Williams, Melanie; Koch, Lori; Smith, Yolanda; Stern, Judy E.; Ball, G. David; Schymura, Maria J.

    2015-01-01

    Objective To evaluate the risk of cancer after assisted reproductive technology (ART) therapy. Design Longitudinal cohort of New York, Texas, and Illinois residents between 2004-09, treated with ART, and whose cycles were reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS). Setting Not applicable Patients Cycles of 113,226 women, including 53,859 women without prior ART treatment, were linked to their respective Cancer Registries. Standardized incidence ratios (SIR) and their 95% confidence intervals were calculated, comparing the observed to expected cancer cases based on age-specific cancer rates in the general population of each State. Among the cohort of women without prior ART therapy, hazard ratios (HR) and 95% confidence intervals were calculated for treatment parameters and reproductive history factors. Intervention None Main Outcome Measures Diagnosis of cancer, as reported to the State Cancer Registry Results Mean follow-up was 4.87 years; among women without prior ART, 450 women developed 460 cancers. Women treated with ART had significantly lower risks for all cancers (for all women: SIR 0.78, 0.73-0.83; and women without prior ART: SIR 0.75, 0.68-0.82), breast cancer, and all female genital cancers; nonsignificant lower risks for endocrine and uterine cancer; and nonsignificant higher risks for melanoma and ovarian cancer. Among women without prior ART, there were no significant increased HRs by parity, number of cycles, cumulative FSH dosage, or cycle outcome. Conclusions These results suggest no greater risks for developing cancer after nearly 5 years of follow-up compared to the general population, and to other women treated with ART. Capsule These results suggest no greater short-term risks for developing cancer compared to the general population, and to other women treated with ART. PMID:26271227

  3. Do assisted-reproduction twin pregnancies require additional antenatal care?

    PubMed

    Jauniaux, E; Ben-Ami, I; Maymon, R

    2013-02-01

    Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women <45 years of age are not associated with a notable increase in antenatal complication rates and thus do not require additional antenatal care compared with spontaneous twins. The risks of maternal and fetal morbidity and mortality associated with assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous

  4. 21 CFR 884.6200 - Assisted reproduction laser system.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction laser system. 884.6200... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6200 Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a...

  5. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction accessories. 884.6120... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6120 Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group...

  6. 21 CFR 884.6200 - Assisted reproduction laser system.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction laser system. 884.6200... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6200 Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a...

  7. 21 CFR 884.6160 - Assisted reproduction labware.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction labware. 884.6160 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6160 Assisted reproduction labware. (a) Identification. Assisted reproduction labware consists of...

  8. 21 CFR 884.6100 - Assisted reproduction needles.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction needles. 884.6100 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6100 Assisted reproduction needles. (a) Identification. Assisted reproduction needles are devices used in...

  9. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction accessories. 884.6120... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6120 Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group...

  10. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction accessories. 884.6120... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6120 Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group...

  11. 21 CFR 884.6200 - Assisted reproduction laser system.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction laser system. 884.6200... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6200 Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a...

  12. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  13. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction microtools. 884.6130 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6130 Assisted reproduction microtools. (a) Identification. Assisted reproduction microtools are pipettes...

  14. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction accessories. 884.6120... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6120 Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group...

  15. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  16. 21 CFR 884.6160 - Assisted reproduction labware.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction labware. 884.6160 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6160 Assisted reproduction labware. (a) Identification. Assisted reproduction labware consists of...

  17. 21 CFR 884.6160 - Assisted reproduction labware.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction labware. 884.6160 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6160 Assisted reproduction labware. (a) Identification. Assisted reproduction labware consists of...

  18. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction accessories. 884.6120... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6120 Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group...

  19. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction microtools. 884.6130 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6130 Assisted reproduction microtools. (a) Identification. Assisted reproduction microtools are pipettes...

  20. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  1. 21 CFR 884.6100 - Assisted reproduction needles.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction needles. 884.6100 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6100 Assisted reproduction needles. (a) Identification. Assisted reproduction needles are devices used in...

  2. 21 CFR 884.6160 - Assisted reproduction labware.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction labware. 884.6160 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6160 Assisted reproduction labware. (a) Identification. Assisted reproduction labware consists of...

  3. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  4. 21 CFR 884.6110 - Assisted reproduction catheters.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction catheters. 884.6110 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6110 Assisted reproduction catheters. (a) Identification. Assisted reproduction catheters are devices used in...

  5. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction microtools. 884.6130 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6130 Assisted reproduction microtools. (a) Identification. Assisted reproduction microtools are pipettes...

  6. 21 CFR 884.6200 - Assisted reproduction laser system.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction laser system. 884.6200... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6200 Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a...

  7. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction microtools. 884.6130 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6130 Assisted reproduction microtools. (a) Identification. Assisted reproduction microtools are pipettes...

  8. 21 CFR 884.6160 - Assisted reproduction labware.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction labware. 884.6160 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6160 Assisted reproduction labware. (a) Identification. Assisted reproduction labware consists of...

  9. 21 CFR 884.6100 - Assisted reproduction needles.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction needles. 884.6100 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6100 Assisted reproduction needles. (a) Identification. Assisted reproduction needles are devices used in...

  10. 21 CFR 884.6100 - Assisted reproduction needles.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction needles. 884.6100 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6100 Assisted reproduction needles. (a) Identification. Assisted reproduction needles are devices used in...

  11. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction microtools. 884.6130 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6130 Assisted reproduction microtools. (a) Identification. Assisted reproduction microtools are pipettes...

  12. 21 CFR 884.6100 - Assisted reproduction needles.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction needles. 884.6100 Section... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6100 Assisted reproduction needles. (a) Identification. Assisted reproduction needles are devices used in...

  13. 21 CFR 884.6200 - Assisted reproduction laser system.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction laser system. 884.6200... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6200 Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a...

  14. Female ageing and reproductive outcome in assisted reproduction cycles

    PubMed Central

    Tan, Tse Yeun; Lau, Matthew Sie Kuei; Loh, Seong Feei; Tan, Heng Hao

    2014-01-01

    INTRODUCTION Fertility in women declines with increasing age. With the deferment of marriage and childbearing, couples are turning to assisted reproductive technology to counteract this decline. We aimed to evaluate the results of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) in women of different age groups, and highlight the cost-effectiveness of IVF treatment in these groups while assessing its implications on the national healthcare provision model. METHODS Retrospective analysis of 3,412 stimulated IVF/ICSI cycles in a hospital-based IVF centre was performed from January 2008 to December 2010. Patients were stratified into seven age groups: < 30 years; 30–35 years; 36–37 years; 38 years; 39 years; 40–44 years; and ≥ 45 years. RESULTS Age had a significant effect on the number of cycles leading to embryo transfer (p < 0.001). The number of oocytes retrieved decreased across the various age groups (p < 0.001) and was the highest among women aged < 30 (mean 18.5 ± 10.3) years. With increasing age, there was a trend toward a lower fertilisation rate. Age also had a significant effect on the rates of clinical pregnancy, live birth and multiple pregnancies (p < 0.001). CONCLUSION Patients aged < 30 years had the best IVF outcomes, reflecting optimal reproductive capacity. Age-related decline in fertility starts after 30 years. Women opting for IVF should be counselled about age-specific success rates while taking into account individual risk factors. PMID:25017405

  15. Restricting Access to ART on the Basis of Criminal Record : An Ethical Analysis of a State-Enforced "Presumption Against Treatment" With Regard to Assisted Reproductive Technologies.

    PubMed

    Thompson, Kara; McDougall, Rosalind

    2015-09-01

    As assisted reproductive technologies (ART) become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or child protection order, are given a "presumption against treatment." This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a "presumption against treatment" is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child.

  16. Current and future issues in assisted reproduction.

    PubMed

    Walters, LeRoy

    1996-12-01

    The last quarter of the twentieth century has given rise to reproductive technologies and arrangements that in the earlier part of the century could only be dreamed of by the authors of science fiction. We stand in the middle of this reproductive revolution, trying to cope with the developments that have already occurred but with an uneasy sense that the future may be even more complicated ethically than the past and the present. In this brief essay, I will survey recent ethical and public-policy discussions of two reproductive techniques (assisted insemination and in vitro fertilization) and one reproductive arrangement (surrogate motherhood). After distinguishing three phases in the normative debate, I will briefly comment on some of the characteristics of, and continuing ambiguities in, the ethical debate of the past 25 years. At the conclusion of the essay, I will attempt to anticipate three future issues in ethics and reproduction.

  17. Islam, Assisted Reproduction, and the Bioethical Aftermath.

    PubMed

    Inhorn, Marcia C; Tremayne, Soraya

    2016-04-01

    Assisted reproductive technologies (ARTs), including in vitro fertilization to overcome infertility, are now widely available across the Middle East. Islamic fatwas emerging from the Sunni Islamic countries have permitted many ARTs, while prohibiting others. However, recent religious rulings emanating from Shia Muslim-dominant Iran have created unique avenues for infertile Muslim couples to obtain donor gametes through third-party reproductive assistance. The opening of Iran to gamete donation has had major impacts in Shia-dominant Lebanon and has led to so-called reproductive tourism of Sunni Muslim couples who are searching for donor gametes across national and international borders. This paper explores the "bioethical aftermath" of donor technologies in the Muslim Middle East. Other unexpected outcomes include new forms of sex selection and fetal "reduction." In general, assisted reproduction in the Muslim world has been a key site for understanding how emerging biomedical technologies are generating new Islamic bioethical discourses and local moral responses, as ARTs are used in novel and unexpected ways.

  18. Bioethics for clinicians: 26. Assisted reproductive technologies

    PubMed Central

    Shanner, Laura; Nisker, Jeffrey

    2001-01-01

    ASSISTED REPRODUCTIVE TECHNOLOGIES (ARTs) can be very helpful for certain patients, but ethical concerns have been raised about the inherent nature of specific techniques and the contexts in which many techniques are used. Physicians play important roles in supporting those who wish to become parents and in educating patients about impediments to fertilization and ways to promote conception. We discuss various ethical issues surrounding ARTs, including family relationships, informed choice, gender issues, embryo status and the commercialization of reproduction, as well as legal and policy issues. We examine the empirical evidence of the effectiveness of ARTs and suggest ways to approach ARTs in practice. PMID:11402801

  19. [Thrombosis and assisted reproductive techniques (ART)].

    PubMed

    Conard, J; Plu-Bureau, G; Horellou, M-H; Samama, M-M; Gompel, A

    2011-06-01

    Assisted reproductive techniques (ART) concern procedures designed to increase fertility of couples: artificial insemination, in vitro fertilization (IVF), either classical or after intracytoplasmic sperm injection (ICSI), transfer of frozen embryos, or gamete intrafallopian transfer. Their use has greatly increased these last years. They may be associated with severe ovarian hyperstimulation syndrome and one possible major complication is venous or arterial thrombosis. Thromboses are rare but potentially serious with important sequellae. They are mostly observed in unusual sites such as head and neck vessels and the mechanism is still unknown although hypotheses have been proposed. This review is an update of our knowledge and an attempt to consider guidelines for the prevention and treatment of ART-associated thromboses, which frequently occur when the woman is pregnant. Prevention of severe ovarian hyperstimulation by appropriate stimulation procedures, detection of women at risk of hyperstimulation and of women at high risk of thrombosis should allow reduction of the risk of thrombosis, possibly by administration of a thromboprophylaxis at a timing and dose which can be only determined by extrapolation.

  20. Review: Embryo- and endometrium-derived exosomes and their potential role in assisted reproductive treatments-liquid biopsies for endometrial receptivity.

    PubMed

    Homer, Hayden; Rice, Gregory E; Salomon, Carlos

    2016-12-09

    Multiple pregnancies resulting from the transfer of more than one embryo pose a significant threat to offspring born through Assisted Reproductive Treatments (ART). Transferring one embryo at a time would eliminate this risk. However, current approaches of identifying the highest quality embryo to transfer are either unreliable (e.g. morphology assessment) or highly invasive and potentially detrimental to embryos (e.g. PGD). Approaches for non-invasive embryo selection would be a major advancement that would increase efficiency and reduce both the costs and the risks associated with ART. Exosomes are a particular subtype of extracellular vesicles (EVs) that are secreted from a wide range of cells, including placental and endometrium cells. Exosomes are very stable vesicles that contain a broad spectrum of molecules, including proteins, mRNAs and miRNAs. Very little is known about this form of cell-to-cell communication in the context of ovarian follicular biology and implantation, but emerging data suggest that exosomes secreted by the blastocyst could influence gene expression and receptivity of endometrial cells thereby controlling its own implantation. Here we review emerging findings regarding exosomal signalling in reproductive biology and the prospects for mapping blastocyst-derived exosomal profiles as a means for supporting single embryo transfer policies.

  1. Computer-assisted reproductive surgery: microsurgery for the digital age.

    PubMed

    Choussein, S; Srouji, S S; Lipskind, S T; Gargiulo, A R

    2014-02-01

    Although considerable progress has been made in the field of medically assisted reproduction, minimally invasive surgery remains of vital importance in optimizing and preserving fertility, as well as treating infertility. By definition, reproductive surgery employs microsurgical techniques with the objective of restoring natural fertility or enhancing assisted reproductive technologies. The avant-garde minimalist philosophy of this branch of gynecology has made it the natural trailblazer of laparoscopic surgery. Minimally invasive conservative treatment of uterine, tubal, ovarian and peritoneal pathology has long been the gold standard for women of reproductive age and those seeking fertility preservation. Robust surgical outcome data acknowledge clear advantages of advanced laparoscopic surgery over laparotomy. However, this comes at the cost of significant technical challenges. Computer-assisted laparoscopy, also known as robotic surgery, is posed to address the practical limitations of conventional laparoscopic surgery and bridge this technical gap. This enabling technology is a conceptual fusion of the practicality of conventional open surgery and the minimally invasive nature of laparoscopic surgery. With this comes the promise of simplifying complex minimally invasive fertility-sparing procedures so that they can be performed in a safe and reproducible manner by reproductive specialists.

  2. [Criminal code and assisted human reproduction].

    PubMed

    Cortés Bechiarelli, Emilio

    2009-01-01

    The Spanish Criminal Code punishes in the article 161 the crime of assisted reproduction of the woman without her assent as a form of crime relative to the genetic manipulation. The crime protects a specific area of the freedom of decision of the woman, which is the one that she has dealing with the right to the procreation at the moment of being fertilized. The sentence would include the damages to the health provoked by the birth or the abortion. The crime is a common one--everyone can commit it--and it is not required a result of pregnancy, but it is consumed by the mere intervention on the body of the woman, and its interpretation is contained on the Law 14/2006, of may 26, on technologies of human assisted reproduction. The aim of the work is to propose to consider valid the assent given by the sixteen-year-old women (and older) in coherence with the Project of Law about sexual and reproductive health and voluntary interruption of the pregnancy that is studied at this moment, in Spain, in order to harmonize the legal systems.

  3. Steroids pretreatment in assisted reproduction cycles.

    PubMed

    Sobotka, V; Streda, R; Mardesic, T; Tosner, J; Heracek, J

    2014-01-01

    The objective is to present an overview of trials and appreciate the relevant data on the effect of steroids pretreatment (oral contraceptives, 17β-estradiol and estradiol valerate) in assisted reproduction cycles. The subject of the study is to evaluate the clinical characteristics during steroids pretreatment cycles focused on the prevention of ovarian cysts, the positive contraceptive effect on the onset of regular period during long gonadotropin releasing hormone agonist protocol. In gonadotropin releasing hormone antagonist protocol the review is interested in supporting ovarian stimulation in low responders, the idea of cycle scheduling and improving treatment outcomes. The method is a review from MEDLINE/Pubmed database between 1994 and July 2012. We identified 15 randomised controlled trials (n=3069 patients). One trail (n=83 patients) assessed GnRH agonist protocol with or without steroids pretreatment, 8 trials (n=1884 patients) assessed GnRH antagonist protocols with or without steroids pretreatment and 6 trials (n=1102 patients) assessed GnRH antagonist protocols versus agonist ones with steroid pretreatment. Data demonstrates that oral contraceptives offer the effective prevention of functional ovarian cysts, the predictable onset of period during desensitisation. Existing data suggest that pretreatment with oral contraceptive pills or estradiol valerate give no advantage concerning number of oocytes or pregnancy rate. Pretreatment with oral contraceptive pills aiming to avoid weekend oocytes retrievals has to be more elucidated. In low responders oral contraceptive pill pretreatment may be beneficial in improving ovarian responses by reducing the amount of gonadotropins and the number of days required for ovarian stimulation. Current research indicates that also 17β-estradiol may be encouraging pretreatment in low responders and in cycle scheduling. This article is part of a Special Issue entitled 'Pregnancy and Steroids'.

  4. Society for Assisted Reproductive Technology and assisted reproductive technology in the United States: a 2016 update.

    PubMed

    Toner, James P; Coddington, Charles C; Doody, Kevin; Van Voorhis, Brad; Seifer, David B; Ball, G David; Luke, Barbara; Wantman, Ethan

    2016-09-01

    The Society for Assisted Reproductive Technology (SART) was established within a few years of assisted reproductive technology (ART) in the United States, and has not only reported on the evolution of infertility care, but also guided it toward improved success and safety. Moving beyond its initial role as a registry, SART has expanded its role to include quality assurance, data validation, practice and advertising guidelines, research, patient education and advocacy, and membership support. The success of ART in this country has greatly benefited from SART's role, as highlighted by a series of graphs. SART continues to set the standard and lead the way.

  5. Results of assisted reproduction techniques in Latin America.

    PubMed

    Zegers-Hochschild, F; Mackenna, A; Fernández, E; Sepúlveda, M S

    2001-01-01

    The fact that today it is possible to write a comprehensive report on assisted reproduction technologies in Latin America is the result of a serious and systematic effort, accomplished by more than 80 centres, from Mexico to Chile. Over the past 10 years, these centres representing the vast majority of assisted reproductive treatment cycles performed in Latin America, have agreed voluntarily to report their work to our regional registry using a pre-established format. Furthermore, during 1999 and part of 2000, all centres were visited by a team of biologists and clinicians, who evaluated for consistencies in the data reported. This activity also included an evaluation of personnel, facilities, etc. It can be proudly said that the data reported are a true reflection of the actual situation in our region.

  6. Seminal anti-Müllerian hormone levels during recombinant human follicle-stimulating hormone treatment in men with idiopathic infertility undergoing assisted reproduction cycles.

    PubMed

    Caprio, F; De Franciscis, P; Trotta, C; Ianniello, R; Mele, D; Colacurci, N

    2015-09-01

    A prospective study was designed to investigate the effects of recombinant human follicle-stimulating hormone (rhFSH) on seminal anti-Müllerian hormone (AMH) levels in men with idiopathic oligoasthenoteratozoospermia (iOAT), researching possible relationships between the seminal AMH behavior and the response to the treatment. Thirty-nine men who were candidates for intracytoplasmic sperm injection (ICSI) because of iOAT were enrolled. Patients were treated on alternately days with 150 IU of rhFSH for at least 3 months before assisted reproduction cycles. Main outcome measures were seminal AMH concentrations before and after rhFSH therapy. After treatment, 16 subjects (responders) showed an improvement in their sperm count compared to baseline (7.6 ± 2.9 vs. 19.3 ± 7.7, p < 0.01) whereas 23 men (non-responders) experienced no sperm modifications. Baseline seminal AMH concentrations were significantly higher in responders than in non-responders (53.0 ± 30.6 vs. 34.6 ± 18.5, p < 0.025). Following therapy, a greater increase in AMH levels was observed in responders compared to non-responders (Δ = 24.8 ± 36.4 vs. Δ = 6.4 ± 11.2, p < 0.028). Seminal AMH levels significantly and positively correlated with sperm count (after rhFSH treatment rho = 0.647, p < 0.001). Our study suggests that rhFSH improves sperm count in a quota of iOAT men, and the subjects who respond to the treatment have higher baseline seminal AMH concentrations than the patients who are not responsive. Seminal AMH could be helpful to select those infertile men who may benefit from rhFSH treatment.

  7. Hyaluronic Acid Binding Sperm Selection for assisted reproduction treatment (HABSelect): study protocol for a multicentre randomised controlled trial

    PubMed Central

    Witt, K D; Beresford, L; Bhattacharya, S; Brian, K; Coomarasamy, A; Hooper, R; Kirkman-Brown, J; Khalaf, Y; Lewis, S E; Pacey, A; Pavitt, S; West, R

    2016-01-01

    Introduction The selection of a sperm with good genomic integrity is an important consideration for improving intracytoplasmic sperm injection (ICSI) outcome. Current convention selects sperm by vigour and morphology, but preliminary evidence suggests selection based on hyaluronic acid binding may be beneficial. The aim of the Hyaluronic Acid Binding Sperm Selection (HABSelect) trial is to determine the efficacy of hyaluronic acid (HA)-selection of sperm versus conventionally selected sperm prior to ICSI on live birth rate (LBR). The mechanistic aim is to assess whether and how the chromatin state of HA-selected sperm corresponds with clinical outcomes—clinical pregnancy rate (CPR), LBR and pregnancy loss (PL). Methods and analysis Couples attending UK Centres will be approached, eligibility screening performed and informed consent sought. Randomisation will occur within 24 hours prior to ICSI treatment. Participants will be randomly allocated 1:1 to the intervention arm (physiological intracytoplasmic sperm injection, PICSI) versus the control arm using conventional methods (ICSI). The primary clinical outcome is LBR ≥37 weeks' gestation with the mechanistic study determining LBR's relationship with sperm DNA integrity. Secondary outcomes will determine this for CPR and PL. Only embryologists performing the procedure will be aware of the treatment allocation. Steps will be taken to militate against biases arising from embryologists being non-blinded. Randomisation will use a minimisation algorithm to balance for key prognostic variables. The trial is powered to detect a 5% difference (24–29%: p=0.05) in LBR ≥37 weeks' gestation. Selected residual sperm samples will be tested by one or more assays of DNA integrity. Ethics and dissemination HABSelect is a UK NIHR-EME funded study (reg no 11/14/34; IRAS REF. 13/YH/0162). The trial was designed in partnership with patient and public involvement to help maximise patient benefits. Trial findings will be

  8. The future of male infertility management and assisted reproduction technology.

    PubMed

    Mortimer, D

    2000-12-01

    Intracytoplasmic sperm injection (ICSI) is undoubtedly a powerful, and sometimes the only effective, form of infertility treatment. Nonetheless, it is a non-specific treatment that, combined with increasingly heroic techniques to recover male germinal cells, has led to perceptions of men as just providers of gametes in the infertility equation. In response to this nihilist attitude, where women are investigated extensively and scant attention is paid to men, there is a re-emerging awareness of andrology--particularly in countries with limited healthcare resources. Structured management strategies, using diagnostic information to recognize causative factors amenable to simpler, even systemic, therapies with reasonable chances of pregnancy rather than resorting prematurely to assisted reproduction technology, represent rational, cost-effective approaches to infertility management. Furthermore, genetic testing (particularly cystic fibrosis gene defects and Y-chromosome microdeletions) is essential for couples to make fully informed decisions on their options. Recognition that free radical-induced damage to the sperm genome (e.g. from smoking or in-vitro sperm manipulation) underlies deleterious paternal effects on preimplantation development promotes further synergy between andrology and embryology. Although societies strike different balances between considerations of affordability and cost-effectiveness of assisted reproduction technology, ICSI represents a last resort, to be used when less-invasive, lower-cost treatments have been deemed inappropriate or have failed. Consequently, rather than assisted reproduction technology eliminating the need for andrology, the future will see increasingly tighter integration of multidisciplinary infertility care, embracing careful diagnosis and patient education before obtaining truly informed consent and embarking upon cost-effective treatment.

  9. Analyses of optimal body mass index for infertile patients with either polycystic or non-polycystic ovary syndrome during assisted reproductive treatment in China

    PubMed Central

    Wang, Fang; Dai, Wei; Yang, Xin-hong; Guo, Yi-hong; Sun, Ying-pu

    2016-01-01

    We observed the effect of body mass index (BMI) on pregnancy outcomes in Chinese patients undergoing assisted reproductive treatment (ART). All the patients were divided into polycystic ovary syndrome (PCOS) group and non-PCOS group, and then according to BMI, each group was subdivided into 6 subgroups: group 1 (BMI < 18 kg/m2), group 2 (18–20 kg/m2), group 3 (20–22 kg/m2), group 4 (22–24 kg/m2), group 5 (24–26 kg/m2) and group 6 (BMI > 26.0 kg/m2). We found that in 20 to 25-year-old patients, the pregnancy rate was not significantly correlated with BMI in PCOS patients; while in non-POCS patients, the pregnancy rate significantly decreased at the BMI cut-off point value of 24–26 kg/m2. The pregnancy rate significantly declined at the BMI cut-off point values of 22–24 kg/m2 and 18–20 kg/m2, respectively in 25 to 35-year-old and in over 35-year-old PCOS patients; while in over 25-year-old non-PCOS patients, no significant correlation between pregnancy rate and BMI was observed. We conclude that for under 25-year-old non-PCOS patients, ART should be performed after BMI is controlled under 26 kg/m2. For PCOS patients, if age is 25 to 35 years or over 35 years, BMI should be controlled below 24 kg/m2 or below 20 kg/m2, respectively. PMID:27686055

  10. Treatment. Technical Assistance Packet.

    ERIC Educational Resources Information Center

    Join Together, Boston, MA.

    Treatment is one component of a strategy to reduce substance abuse. It can include detoxification; inpatient counseling; outpatient counseling; therapeutic communities; and self help groups. Referrals can take place in settings such as emergency rooms; employee assistance programs; churches; and physicians' offices. Unmet treatment needs can cause…

  11. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction.... Assisted reproduction microscopes and microscope accessories (excluding microscope stage warmers, which are classified under assisted reproduction accessories) are optical instruments used to enlarge images of...

  12. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction.... Assisted reproduction microscopes and microscope accessories (excluding microscope stage warmers, which are classified under assisted reproduction accessories) are optical instruments used to enlarge images of...

  13. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction.... Assisted reproduction microscopes and microscope accessories (excluding microscope stage warmers, which are classified under assisted reproduction accessories) are optical instruments used to enlarge images of...

  14. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction.... Assisted reproduction microscopes and microscope accessories (excluding microscope stage warmers, which are classified under assisted reproduction accessories) are optical instruments used to enlarge images of...

  15. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction.... Assisted reproduction microscopes and microscope accessories (excluding microscope stage warmers, which are classified under assisted reproduction accessories) are optical instruments used to enlarge images of...

  16. Italy enacts new law on medically assisted reproduction.

    PubMed

    Boggio, Andrea

    2005-05-01

    In 2004, the Italian Parliament enacted a law regulating medically assisted reproduction. Although the law recognizes as legal certain assisted reproduction techniques, several other procedures are implicitly or expressly banned: oocyte and sperm donation, using embryos for the scientific research purposes and reproductive cloning. In this article, I outline the new legal framework, pointing out some of the shortcomings of its provisions, such as the failure to define what an 'embryo' is, the contradictions between this law and the law on abortion, the opportunity for Italian couples to circumvent some of the prohibitions by resorting to 'reproductive tourism', and the central role that physicians play in the new legal framework.

  17. Medically assisted reproduction and ethical challenges

    SciTech Connect

    Kaeaeriaeinen, Helena . E-mail: helena.kaariainen@utu.fi; Evers-Kiebooms, Gerry; Coviello, Domenico

    2005-09-01

    Many of the ethical challenges associated with medically assisted reproduction are societal. Should the technique be restricted to only ordinary couples or could it be used also to single females or couples of same sex? Should the future child be entitled to know the identity of the gamete donor? Should there be age limits? Can embryos or gametes be used after the death of the donor? Can surrogate mothers be part of the process? Can preimplantation diagnostics be used to select the future baby's sex? In addition, there are several clearly medical questions that lead to difficult ethical problems. Is it safe to use very premature eggs or sperms? Is the risk for some rare syndromes caused by imprinting errors really increased when using these techniques? Do we transfer genetic infertility to the offspring? Is the risk for multiple pregnancies too high when several embryos are implanted? Does preimplantation diagnosis cause some extra risks for the future child? Should the counselling of these couples include information of all these potential but unlikely risks? The legislation and practices differ in different countries and ethical discussion and professional guidelines are still needed.

  18. Childhood outcomes of assisted reproductive technology.

    PubMed

    Savage, Tim; Peek, John; Hofman, Paul L; Cutfield, Wayne S

    2011-09-01

    There is a large population of children conceived via assisted reproductive technology (ART), which continues to increase worldwide, without a clear understanding of associated long-term outcomes. ART children are more likely to be the result of multiple pregnancies, and thus to be born prematurely or low birthweight. There is growing evidence that ART children are phenotypically and biochemically different from naturally conceived children, but the mechanism(s) leading to these changes have not been elucidated. There is a possible increased risk of rare imprinted gene disorders in these children. However, it remains unclear whether more subtle changes in DNA methylation occur commonly, leading to differences in gene expression and phenotype in ART children. Although an increased risk of cancer among ART children has been reported, the role of ART in the development of cancer has not been demonstrated. Further research and ongoing surveillance of ART children is essential to better understand the possible effects of ART on the long-term health of this population.

  19. Should HIV discordant couples have access to assisted reproductive technologies?

    PubMed Central

    Spriggs, M; Charles, T

    2003-01-01

    In this paper we identify and evaluate arguments for and against offering assisted reproductive technologies (ART), specifically IVF, to HIV discordant couples (male partner HIV positive, female partner HIV negative). The idea of offering ART to HIV discordant couples generates concerns about safety and public health and raises questions such as: what is an acceptable level of risk to offspring and should couples who want this assistance be subject to selection criteria; should they undergo scrutiny about their suitability as parents when those who are able to conceive naturally face no such scrutiny and people with other illnesses are given access to ART? We conclude that offering ART to HIV discordant couples is likely to produce more benefit than harm and violates no ethical principles. Nevertheless, a decision to deny treatment need not constitute unjustified discrimination. PMID:14662810

  20. Pregnancy outcomes after assisted human reproduction.

    PubMed

    Okun, Nanette; Sierra, Sony

    2014-01-01

    Objectif : Analyser l’effet du recours à la procréation assistée (PA) sur les issues périnatales, identifier les aspects propres aux issues de naissance et à la PA qui nécessitent des recherches approfondies, et fournir des lignes directrices permettant l’optimisation de la prise en charge obstétricale et du counseling des parents potentiels canadiens. Issues : Le présent document compare les issues périnatales constatées dans le cadre de différents types de grossesse attribuable à la PA les unes aux autres, ainsi qu’à celles qui sont constatées dans le cadre des grossesses conçues de façon spontanée. Les cliniciens seront mieux renseignés au sujet des issues indésirables associées à la PA qui ont été documentées, y compris les complications obstétricales, les issues périnatales indésirables, les gestations multiples, les anomalies congénitales structurelles, les anomalies chromosomiques et les troubles de l’empreinte génomique. Résultats : La littérature publiée a été récupérée par l’intermédiaire de recherches menées dans MEDLINE et The Cochrane Library entre janvier 2005 et décembre 2012 au moyen d’un vocabulaire contrôlé et de mots clés appropriés (« assisted reproduction », « assisted reproductive technology », « ovulation induction », « intracytoplasmic sperm injection », « embryo transfer » et « in vitro fertilization »). Les résultats n’ont pas été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles; les études (tous devis confondus) publiées en anglais entre janvier 2005 et décembre 2012 ont été analysées, et des publications additionnelles ont été identifiées à partir des bibliographies de ces études. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu’en août 2013. La littérature grise (non publiée) a

  1. DNA methylation errors in imprinting disorders and assisted reproductive technology.

    PubMed

    Chiba, Hatsune; Hiura, Hitoshi; Okae, Hiroaki; Miyauchi, Naoko; Sato, Fumi; Sato, Akiko; Arima, Takahiro

    2013-10-01

    There have been increased incident reports of rare imprinting disorders associated with assisted reproductive technology (ART). ART is an important treatment for infertile people of reproductive age and is increasingly common. The identification of epigenetic changes at imprinted loci in ART infants has led to the suggestion that the techniques themselves may predispose embryos to acquisition of imprinting errors and disease. It is still unknown, however, at what point(s) these imprinting errors arise, or the risk factors. In this review it was hypothesized that the particular steps of the ART process may be prone to induction of imprinting methylation errors during gametogenesis, fertilization and early embryonic development. In addition, imprinting diseases and their causes are explained. Moreover, using a Japanese nationwide epidemiological study of imprinting diseases, their association with ART is determined. Epigenetic studies are required to understand the pathogenesis of this association; the ART-related risk factor(s); and the precautions that can be taken to prevent the occurrence of these syndromes. It is hoped that the constitution of children born after ART will indicate the safest and most ethical approach to use, which will be invaluable for the future development of standard ART treatment.

  2. Cryopreservation of embryos and oocytes in human assisted reproduction.

    PubMed

    Konc, János; Kanyó, Katalin; Kriston, Rita; Somoskői, Bence; Cseh, Sándor

    2014-01-01

    Both sperm and embryo cryopreservation have become routine procedures in human assisted reproduction and oocyte cryopreservation is being introduced into clinical practice and is getting more and more widely used. Embryo cryopreservation has decreased the number of fresh embryo transfers and maximized the effectiveness of the IVF cycle. The data shows that women who had transfers of fresh and frozen embryos obtained 8% additional births by using their cryopreserved embryos. Oocyte cryopreservation offers more advantages compared to embryo freezing, such as fertility preservation in women at risk of losing fertility due to oncological treatment or chronic disease, egg donation, and postponing childbirth, and eliminates religious and/or other ethical, legal, and moral concerns of embryo freezing. In this review, the basic principles, methodology, and practical experiences as well as safety and other aspects concerning slow cooling and ultrarapid cooling (vitrification) of human embryos and oocytes are summarized.

  3. Assisted reproduction on treacherous terrain: the legal hazards of cross-border reproductive travel.

    PubMed

    Storrow, Richard F

    2011-11-01

    The growing phenomenon of cross-border reproductive travel has four significant legal dimensions. First, laws that ban or inhibit access to assisted reproductive procedures in one country lead patients and physicians to travel to other countries to acquire, to contribute to or to provide assisted reproductive services. Such laws may include provisions that criminalize those who assist or advise patients to undertake such travel. Second, the law may expressly criminalize crossing borders to obtain, to be a donor for or to perform certain procedures. Third, the law may interfere with the ultimate goal of reproductive travellers by refusing to recognize them as the parents of the child they have crossed borders to conceive. Finally, facilitating cross-border reproductive travel may expose physicians, attorneys and brokers to malpractice or other civil liability. This article explores these legal dimensions of cross-border reproductive care and uses the legal doctrines of proportionality, extraterritoriality and comity to assess the legality and normative validity of governmental efforts to curb or limit assisted reproductive practices.

  4. [Assisted Reproductive Technology in Female Transplant Recipients: Experience of a Reproductive Medicine Unit and Literature Review].

    PubMed

    Vale-Fernandes, Emídio; Póvoa, Ana Margarida; Soares, Sandra; Calejo, Lucinda; Xavier, Pedro; Sousa, Sónia; Beires, Jorge; Montenegro, Nuno

    2016-01-01

    Diseases in end stage typically occur with hypothalamic-pituitary-ovarian axis disorders, with consequent anovulation and infertility. The solid organ transplantation increased survival of patients with end-stage organs disease and the vast majority of women improve their reproductive capacity after transplantation. Although adoption can always be a possibility, the transplanted infertile woman has the right to self-reproductive determination using assisted reproductive techniques. While it is known that pregnancies in transplantedwomen are at high risk, there is no evidence of differences in pregnancy outcome in pregnant transplanted subject to technical, compared with spontaneous pregnancies. The use of assisted reproductive techniques in transplanted women is a medical, ethical and psychosocial challenge, whose approach must be multidisciplinary, to ensure reproductive success without compromising the function of the transplanted organ or maternal health, allowing the birth of a healthy child. The literature remains scarce. Three clinical cases are presented.

  5. [Guidelines on medically assisted reproduction: legal issues and professional liability].

    PubMed

    Molinelli, A; Motroni Gherardi, S M; Picchioni, D M; Ventura, F

    2007-08-01

    The authors analyze the legal and medico-legal issues deriving from the recent Law No. 40 of February 19, 2004 concerning the Medically Assisted Reproduction. In particular, they analyze the contrasting points between the dispositions of Law No. 40/2004 and those of Law No. 194/1978 on the voluntary interruption of pregnancy, and they analyze the guidelines about the procedures and the techniques of the Medically Assisted Reproduction, issued by the Ministry of Health with D.M. of July 21, 2004. The Guidelines, as well as some sentences of several courts, lead to some reflections also about the consent and the professional liability, in particular considering the various moments of the medical action, from the first interview to the carrying out of the assisted reproduction techniques.

  6. Current status of assisted reproductive technology in Korea, 2009.

    PubMed

    Choi, Young Min; Chun, Sang Sik; Han, Hyuck Dong; Hwang, Jung Hye; Hwang, Kyung Joo; Kang, In Soo; Kim, Dong Won; Kim, Ki Chul; Kim, Tak; Kwon, Hyuck Chan; Lee, Won Don; Lee, Jung Ho; Lee, Kyu Sup; Lee, Gyoung Hoon; Lee, Sang-Hoon; Lee, Yu Il; Min, Eung Gi; Moon, Hwa Sook; Moon, Shin Yong; Roh, Sung Il; Yoon, Tae Ki

    2013-11-01

    Great advances have been made in the field of assisted reproductive technology (ART) since the first in vitro fertilization (IVF) baby was born in Korea in the year of 1985. However, it deserve to say that the invaluable data from fertility centers may serve as a useful source to find out which factors affect successful IVF outcome and to offer applicable information to infertile patients and fertility clinics. This article intended to report the status of ART in 2009 Korean Society of Obstetrics and Gynecology surveyed. The current survey was performed to assess the status and success rate of ART performed in Korea, between January 1 and December 31, 2009. Reporting forms had been sent out to IVF centers via e-mail, and collected by e-mail as well in 2012. With International Committee Monitoring Assisted Reproductive Technologies recommendation, intracytoplasmic sperm injection (ICSI) and non-ICSI cases have been categorized and also IVF-ET cases involving frozen embryo replacement have been surveyed separately. Seventy-four centers have reported the treatment cycles initiated in the year of 2009, and had performed a total of 27,947 cycles of ART treatments. Among a total of 27,947 treatment cycles, IVF and ICSI cases added up to 22,049 (78.9%), with 45.3% IVF without ICSI and 54.7% IVF with ICSI, respectively. Among the IVF and ICSI patients, patients confirmed to have achieved clinical pregnancy was 28.8% per cycle with oocyte retrieval, and 30.9% per cycle with embryo transfer. The most common number of embryos transferred in 2009 is three embryos (40.4%), followed by 2 embryos (28.4%) and a single embryo transferred (13.6%). Among IVF and ICSI cycles that resulted in multiple live births, twin pregnancy rate was 45.3% and triple pregnancy rate was 1.1%. A total of 191 cases of oocyte donation had been performed to result in 25.0% of live birth rate. Meanwhile, a total of 5,619 cases of frozen embryo replacement had been performed with 33.7% of clinical

  7. Biological versus chronological ovarian age: implications for assisted reproductive technology

    PubMed Central

    Alviggi, Carlo; Humaidan, Peter; Howles, Colin M; Tredway, Donald; Hillier, Stephen G

    2009-01-01

    Background Women have been able to delay childbearing since effective contraception became available in the 1960s. However, fertility decreases with increasing maternal age. A slow but steady decrease in fertility is observed in women aged between 30 and 35 years, which is followed by an accelerated decline among women aged over 35 years. A combination of delayed childbearing and reduced fecundity with increasing age has resulted in an increased number and proportion of women of greater than or equal to 35 years of age seeking assisted reproductive technology (ART) treatment. Methods Literature searches supplemented with the authors' knowledge. Results Despite major advances in medical technology, there is currently no ART treatment strategy that can fully compensate for the natural decline in fertility with increasing female age. Although chronological age is the most important predictor of ovarian response to follicle-stimulating hormone, the rate of reproductive ageing and ovarian sensitivity to gonadotrophins varies considerably among individuals. Both environmental and genetic factors contribute to depletion of the ovarian oocyte pool and reduction in oocyte quality. Thus, biological and chronological ovarian age are not always equivalent. Furthermore, biological age is more important than chronological age in predicting the outcome of ART. As older patients present increasingly for ART treatment, it will become more important to critically assess prognosis, counsel appropriately and optimize treatment strategies. Several genetic markers and biomarkers (such as anti-Müllerian hormone and the antral follicle count) are emerging that can identify women with accelerated biological ovarian ageing. Potential strategies for improving ovarian response include the use of luteinizing hormone (LH) and growth hormone (GH). When endogenous LH levels are heavily suppressed by gonadotrophin-releasing hormone analogues, LH supplementation may help to optimize treatment

  8. Assisted reproduction in a cohort of same-sex male couples and single men.

    PubMed

    Grover, Stephanie A; Shmorgun, Ziva; Moskovtsev, Sergey I; Baratz, Ari; Librach, Clifford L

    2013-08-01

    To date, there is limited published data on same-sex male couples and single men using assisted reproduction treatment to build their families. The objective of this retrospective study was to better understand treatment considerations and outcomes for this population when using assisted reproduction treatment. A total of 37 same-sex male couples and eight single men (seven homosexual and one heterosexual) who attended the CReATe Fertility Centre for assisted reproduction services were studied. There was a 21-fold increase in the number of same-sex male couples and single men undergoing assisted reproduction treatment since 2003. The mean age was 46years (24-58). Twenty-eight couples (76%) chose to use spermatozoa from both partners to fertilize their donated oocytes. Most men (32 same-sex male couples and seven single men; 87%) obtained oocytes from an anonymous donor, whereas five couples and one single man (13%) had a known donor. Anonymous donors who were open to be contacted by the child after the age of 18 were selected by 67% of patients. Of all 25 deliveries, eight (32%) were sets of twins. All of the twins were half genetic siblings.

  9. Assisted Reproductive Technology and Risk for Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Zachor, Ditza A.; Itzchak, E. Ben

    2011-01-01

    Epidemiologic studies on maternal and pregnancy risk factors for autism spectrum disorder (ASD), including use of assisted reproductive technology (ART), found conflicting results. This study included the following aims: to assess frequencies of ART in a large ASD group; to examine confounding birth and familial risk factors in the ASD with ART…

  10. Emergent Legal Definitions of Parentage in Assisted Reproductive Technology

    ERIC Educational Resources Information Center

    Robinson, Cherylon; Miller, Michael V.

    2004-01-01

    State statutes and court cases involving Assisted Reproductive Technology (ART) are examined to determine legal definitions of father and mother. While traditional definitions are not disturbed overall by statutes and cases involving use of artificial insemination by donor among married couples, complications and disputes between parties involved…

  11. Influence of Paternal Age on Assisted Reproduction Outcome

    ClinicalTrials.gov

    2007-08-01

    We Will Retrospectively Assess Our Databases in Our Clinic:; Instituto Valenciano de Infertilidad in Valencia (Spain); Searching for Assisted Reproduction Procedures; (IUI, Standard IVF/ICSI Cycles and Ovum Donation IVF/ICSI Cycles); Who Were Referred to Our Unit to Cryopreserve Sperm During the Period; From January 2000 to December 2006.

  12. Cryopreservation in assisted reproductive technology: new trends.

    PubMed

    Nawroth, Frank; Rahimi, Gohar; Isachenko, Eugenia; Isachenko, Vladimir; Liebermann, Maike; Tucker, Michael J; Liebermann, Juergen

    2005-11-01

    During the last few years, cryopreservation has become a relevant addition to therapeutic concepts in reproductive medicine. New data and publications have made it difficult to maintain an overview of all of the new developments and their results. The focus of interest more recently, especially with the cryopreservation of human oocytes and human ovarian tissue, has been vitrification as an interesting alternative to slow freezing methods. Even though studies investigating the slow freezing of human mature oocytes have resulted in very different survival rates, it could be an option for donor oocyte programs, in the case of threatened ovarian loss or when there is an objection to embryo freezing. An optimal freezing protocol and later use of thawed human ovarian tissue is still a point of discussion. There are encouraging results regarding different kinds of autotransplantation, and recently the first birth after orthotopic autotransplantation of cryopreserved/thawed human ovarian tissue was described in the literature. Independent of any objections to cryopreservation in general, vitrification is a potential and effective alternative to conventional slow cryopreservation, especially for oocytes and embryos. Vitrification might be also be an option for human ovarian tissue; however this is only in its infancy and requires much additional investigation. Our article discusses new trends and results of actual studies regarding these issues.

  13. In whose interest? Policy and politics in assisted reproduction.

    PubMed

    Donchin, Anne

    2011-02-01

    This paper interprets the British legislative process that initiated the first comprehensive national regulation of embryo research and fertility services and examines subsequent efforts to restrain the assisted reproduction industry. After describing and evaluating British regulatory measures, I consider successive failures to control the assisted reproduction industry in the US. I discuss disparities between UK and US regulatory initiatives and their bearing on regulation in other countries. Then I turn to the political and social structures in which the assisted reproduction industry is embedded. I argue that regulatory bodies are seldom neutral arbiters. They tend to respond most readily to special interests and neglect strategies that could more effectively meet the health needs of the people they represent. Neither national nor international bodies have aggressively pursued policies to harness the industry, reduce infertility rates, or meet the needs of people whose fertility is threatened by substandard healthcare and environmental neglect. In conclusion, I consider recent initiatives by activist groups to mount an alternative response to the industry's current practices and build a transnational reproductive justice movement.

  14. 21 CFR 884.6170 - Assisted reproduction water and water purification systems.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Assisted reproduction water and water purification... Devices § 884.6170 Assisted reproduction water and water purification systems. (a) Identification. Assisted reproduction water purification systems are devices specifically intended to generate high...

  15. 21 CFR 884.6170 - Assisted reproduction water and water purification systems.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Assisted reproduction water and water purification... Devices § 884.6170 Assisted reproduction water and water purification systems. (a) Identification. Assisted reproduction water purification systems are devices specifically intended to generate high...

  16. 21 CFR 884.6170 - Assisted reproduction water and water purification systems.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproduction water and water purification... Devices § 884.6170 Assisted reproduction water and water purification systems. (a) Identification. Assisted reproduction water purification systems are devices specifically intended to generate high...

  17. 21 CFR 884.6170 - Assisted reproduction water and water purification systems.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Assisted reproduction water and water purification... Devices § 884.6170 Assisted reproduction water and water purification systems. (a) Identification. Assisted reproduction water purification systems are devices specifically intended to generate high...

  18. 21 CFR 884.6170 - Assisted reproduction water and water purification systems.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Assisted reproduction water and water purification... Devices § 884.6170 Assisted reproduction water and water purification systems. (a) Identification. Assisted reproduction water purification systems are devices specifically intended to generate high...

  19. Toward a gender-sensitive assisted reproduction policy.

    PubMed

    Donchin, Anne

    2009-01-01

    The recent case of the UK woman who lost her legal struggle to be impregnated with her own frozen embryos, raises critical issues about the meaning of reproductive autonomy and the scope of regulatory practices. I revisit this case within the context of contemporary debate about the moral and legal dimensions of assisted reproduction. I argue that the gender neutral context that frames discussion of regulatory practices is unjust unless it gives appropriate consideration to the different positions women and men occupy in relation to reproductive processes and their options for autonomous choice. First, I consider relevant legal rulings, media debate, and scholarly commentary. Then I discuss the concept of reproductive autonomy imbedded in this debate. I argue that this concept conflates informed consent and reproductive autonomy, thereby providing an excessively narrow reading of autonomy that fails to give due regard to relations among individuals or the social, political and economic environment that shapes their options. I contrast this notion of autonomy with feminist formulations that seek to preserve respect for the agency of individuals without severing them from the conditions of their embodiment, their surrounding social relationships, or the political contexts that shape their options. Taking these considerations into account I weigh the advantages of regulation over the commercial market arrangement that prevails in some countries and suggest general guidelines for a regulatory policy that would more equitably resolve conflicting claims to reproductive autonomy.

  20. Assisted reproductive technology in China: compliance and non-compliance

    PubMed Central

    2014-01-01

    According to the WHO, infertility and sterility will be the third-most serious disease worldwide in the 21st century, after cancer and cardiovascular diseases. In contrast to developed countries, assisted reproductive technology (ART) were not offered in China until the mid-1980s with the first in vitro fertilization (IVF) infant born in Taiwan in 1985, then Hong Kong in 1986, and mainland China in 1988, respectively. Since those inceptions, the practice of ART in China has evoked a variety of social, cultural, political and one-child policy responses that have resulted in restrictions on the number of IVF cycles performed annually. According to recent survey, an estimate 40-50 million women and 45 million men suffered from infertility, which is estimated that more than ten million Chinese infertile couples require ART treatment. However, it has limited access to ART facilities, many of them may not have a child are whirling to all types of fertility therapies. Exposure to radiation, pesticides and other environmental pollutants, work-related stress and unhealthy lifestyles are believed to contribute to the increasing incidence of infertility in China. The aim of this first report is to provide China nationwide ART data and government policy in compliance and 
non-compliance, particularly related to family plan policy in China. PMID:26835327

  1. Magnetic activated cell sorting (MACS): utility in assisted reproduction.

    PubMed

    Makker, Kartikeya; Agarwal, Ashok; Sharma, Rakesh K

    2008-07-01

    Assisted reproductive techniques (ART) have now been extensively incorporated in the management of infertile couples. But even after rapid methodological and technological advances the success rates of these procedures have been below expectations. This has led to development of many sperm preparation protocols to obtain an ideal semen sample for artificial reproduction. Sperm apoptosis has been heavily linked to failures in reproductive techniques. One of the earliest changes shown by apoptotic spermatozoa is externalization of phosphatidyl serine. Magnetic activated cell sorting (MACS) is a novel sperm preparation technique that separates apoptotic and non-apoptotic spermatozoa based on the expression of phosphatidylserine. This has led to the incorporation of MACS as a sperm preparation technique. The review highlights the principle and mechanism of this novel technique and enumerates its advantages as a sperm preparation technique. Its utility in ART as an efficient tool for sperm recovery and its application in cryopreservation of semen samples is also explained.

  2. "Baby oh baby"--advances in assisted reproductive technology.

    PubMed

    Solursh, D S; Schorer, J W; Solursh, L P

    1997-01-01

    It is estimated that one couple in six in the United States has to deal with issues of infertility. It is assumed that worldwide rates are comparable. In 35% of cases, the infertility is caused by female reproductive problems, in 35% by male reproductive problems, in 15% by multiple factors and in 15% the cause is unknown. Medical and scientific advances in Assisted Reproductive Technology (ART) have created 12 different pregnancy producing options for infertile couples. An ART infant could have as many as five parents (i.e. a donor father, a donor mother, a surrogate or gestational mother, and the couple actually rearing the child). These technical, medical, and moral complexities have resulted in a nightmare of accompanying legal complexities: anonymous donors versus those with identification disclosed, parental rights, grandparental rights, the rights of siblings and of the extended families; sperm, ovum and embryo "ownership", custody, visitation and inheritance rights and multiple other issues challenge a system of laws that evolves far slower than the technological realities to which it applies. This presentation will describe Assisted Reproductive Technology advances and the legal implications inherent in them. Case histories will be discussed.

  3. Outcomes from infancy to adulthood after assisted reproductive technology.

    PubMed

    Shankaran, Seetha

    2014-05-01

    The outcomes of assisted reproductive technology (ART) should be not only the evaluation of successful initiation of pregnancy but also the birth of healthy infants and the evaluation of long-term outcomes of the offspring of the couple undergoing therapy. Maternal and neonatal outcomes are reported in another article in this series. This article will review the infant, childhood, adolescent, and young adult outcomes published after ART. The recent literature will be reviewed.

  4. Assisted Reproductive Technology after the Birth of Louise Brown

    PubMed Central

    Kamel, Remah Moustafa

    2013-01-01

    Background Public interest in Assisted Reproductive Technology (ART) has remained high since the birth of the world’s first in vitro fertilization baby, Louise Brown, in the United Kingdom. ART allows scientists to manipulate the fertilization process in order to bypass some pathological obstacles such as blocked fallopian tubes and non-functioning ovaries in the females, and blocked vas deferens and low sperm count in the males. The purpose was to provide a historical outline and identify the researches that most contributed to ART. Methods A review of published experimental and clinical studies of assisted reproduction carried out at the University of Bristol library website (MetaLib®). A cross-search of seven different medical databases (AMED-Allied and Complementary Medicine Database, BIOSIS Previews on Web of Knowledge, Cochrane Library, Embase, and the Medline on Web of Knowledge, OvidSP and PubMed) was completed by using the key words to explore the major milestones and progress in the development and implementation of ART. Results A speedy advancement in the development of different assisted reproductive techniques makes infertility problem more treatable than it ever had been. Conclusion Although no other field in the medicine has integrated new knowledge into the daily practice more quickly than ART yet, there is a need for social research to counterbalance the dominance of biomedical one, in particular the people’s actual experiences and expectations of ART. PMID:24163793

  5. [Parenting stress in women who concieved using assisted reproductive technology].

    PubMed

    Yu, Y C; Kuo, B J

    2001-06-01

    Infertile women suffer chronic stress, which may negatively impact their parenting relationships if they later succeed in bearing children. The purpose of this study was to explore the parenting stress of mothers attending assisted an reproductive program and to compare it with the parenting stress of mothers with natural pregnancies. A purposive sampling method was used to recruit 54 mothers attending an In Vitro Fertilization/Embryo Transfer and Tubal Embryo Transfer program at an infertility center in central Taiwan. Three instruments were used to collect data: the Demographic Data Form, Parenting Stress Index-Short Form and Family Adaptation Partnership Growth Affective Relation Index. The data were analyzed by descriptive and inferential statistical methods. (1) The results indicated that the highest average score in parenting stress for mothers receiving reproductive technology was for "parental distress". These results revealed that the main source of parenting stress was their parental role. (2) Family function varied significantly with parenting stress. (3) Parenting stress was significantly greater in mothers with natural pregnancy than in mothers attending the assisted reproductive program. Recommendations for clinical application and future research are also made. The implications of the study may be used to assist infertile women in coping with parenting roles. Furthermore, a qualitative study is suggested to understand the factors which cause parenting stress.

  6. Tracking Official Development Assistance for Reproductive Health in Conflict-Affected Countries

    PubMed Central

    Patel, Preeti; Roberts, Bayard; Guy, Samantha; Lee-Jones, Louise; Conteh, Lesong

    2009-01-01

    Background Reproductive health needs are particularly acute in countries affected by armed conflict. Reliable information on aid investment for reproductive health in these countries is essential for improving the efficiency and effectiveness of aid. The purpose of this study was to analyse official development assistance (ODA) for reproductive health activities in conflict-affected countries from 2003 to 2006. Methods and Findings The Creditor Reporting System and the Financial Tracking System databases were the chosen data sources for the study. ODA disbursement for reproductive health activities to 18 conflict-affected countries was analysed for 2003, 2004, 2005, and 2006. An average of US$20.8 billion in total ODA was disbursed annually to the 18 conflict-affected countries between 2003 and 2006, of which US$509.3 million (2.4%) was allocated to reproductive health. This represents an annual average of US$1.30 disbursed per capita in the 18 sampled countries for reproductive health activities. Non-conflict-affected least-developed countries received 53.3% more ODA for reproductive health activities than conflict-affected least-developed countries, despite the latter generally having greater reproductive health needs. ODA disbursed for HIV/AIDS prevention and treatment increased by 119.4% from 2003 to 2006. The ODA disbursed for other direct reproductive health activities declined by 35.9% over the same period. Conclusions This study provides evidence of inequity in disbursement of reproductive health ODA between conflict-affected countries and non-conflict-affected countries, and between different reproductive health activities. These findings and the study's recommendations seek to support initiatives to make aid financing more responsive to need in the context of armed conflict. PMID:19513098

  7. Spectacular reproduction: Ron's Angels and mechanical reproduction in the age of ART (assisted reproductive technology).

    PubMed

    Hafstein, Valdimar Tr

    2007-03-01

    Ron Harris captured the popular imagination in October 1999 with a website where he auctioned off the ova of fashion models to the highest bidder. This article treats the controversy surrounding Harris' site within a dual frame of critical theory's approach to reproduction and a folkloristic approach to discourse. The website fuses traditional narrative motifs and structures with the logic of advertising, seventies television, family-values rhetoric, and the fertility industry. I argue that the great attraction of ronsangels.com is that it put into relief the intervention of mechanical reproduction in human fertility together with the state of genetics at the turn of the 21st century. The result is not only a disconcerting aestheticization and commodification of biological reproduction, but also the biological reproduction of a particular aesthetic and moral code--a generation of reality by model.

  8. [Activities and responsibilities of workers in embryologic and andrologic laboratories in assisted reproduction centers].

    PubMed

    Záková, J; Trávník, P; Malenovská, A; Hűttelová, R

    2013-11-01

    This paper presents the current status and rules for the laboratory staff activities and their competences in the centers of assisted reproduction. The rules were processed by the members of the Association of Reproductive Embryology (ARE) committee under the current legislation. Committee members of the Czech Sterility and Assisted Reproduction Society and Czech Gynecology and Obstetric Society approved these rules as obligatory for assisted reproduction centres in Czech Republic.

  9. "It just alienated us": a case study to explore the impact of assisted reproductive technology on family relationships.

    PubMed

    Peters, Kathleen; Jackson, Debra; Rudge, Trudy

    2007-01-01

    New reproductive technologies have the capacity to impact on both personal and healthcare relationships. This article utilizes a case study approach to unpack experiences of one couple who encountered immense and unforeseen difficulties as a result of treatment with assisted reproductive technology. Findings of this case reveal both difficulties and breaches in obtaining informed consent and the consequences these breaches have on relationships. Comprehensive information contributes to positive relationships between patients and healthcare providers. Maintaining supportive relationships between all parties concerned with assisted reproductive technology services is essential, as rifts in these relationships can be devastating and long-lasting.

  10. The Greek Orthodox position on the ethics of assisted reproduction.

    PubMed

    Nikolaos, Metropolitan

    2008-01-01

    In dealing with reproduction, the Church believes that every human being has a beginning but has no end; this is why conception constitutes an event of unique importance. The exact moment of the beginning of life is unknown to man, but the logic of sexual intercourse without reproduction and of reproduction without sexual intercourse must be seen with concern. Irrespective of the way it is conceived, the embryo has both a human beginning and a human perspective and in it, along with cellular multiplication, another process takes place, the beginning and development of its soul. Although modern technology has greatly contributed to health research, its irrational use threatens to desacralize man and to treat him as a machine. For this reason, all modern techniques of artificial fertilization have ethical and spiritual parameters that compel the Church to state Her reservations. The Church cannot recommend assisted reproduction as the solution to infertility; instead, She proposes a non-secularized perception on life that guarantees simplicity, peace, abstinence and mutual trust between spouses. She does not oppose resorting to medical help, but, at the same time, suggests that men and women render their life into the hands of God.

  11. Ethics and regulation of inter-country medically assisted reproduction: a call for action.

    PubMed

    Shalev, Carmel; Moreno, Adi; Eyal, Hedva; Leibel, Michal; Schuz, Rhona; Eldar-Geva, Talia

    2016-01-01

    The proliferation of medically assisted reproduction (MAR) for the treatment of infertility has brought benefit to many individuals around the world. But infertility and its treatment continue to be a cause of suffering, and over the past decade, there has been a steady growth in a new global market of inter-country medically assisted reproduction (IMAR) involving 'third-party' individuals acting as surrogate mothers and gamete donors in reproductive collaborations for the benefit of other individuals and couples who wish to have children. At the same time there is evidence of a double standard of care for third-party women involved in IMAR, violations of human rights of children and women, and extreme abuses that are tantamount to reproductive trafficking. This paper is the report of an inter-disciplinary working group of experts who convened in Israel to discuss the complex issues of IMAR. In Israel too IMAR practices have grown rapidly in recent years, mainly because of restrictions on access to domestic surrogacy for same sex couples and a chronically insufficient supply of egg cells for the treatment of couples and singles in need. Drawing upon local expertise, the paper describes documented practices that are harmful, suggests principles of good practice based on an ethic of care, and calls for action at the international, national and professional levels to establish a human rights based system of international governance for IMAR based on three regulatory models: public health monitoring, inter-country adoption, and trafficking in human beings, organs and tissues.

  12. [The French Biomedicine Agency and medically assisted reproduction].

    PubMed

    Camby, Carine

    2008-01-01

    The French Biomedicine Agency was created in May 2005 by the August 2004 revision of the Bioethics Law. The Agency replaced the French Transplant Establishment, itself created by the first bioethics law in 1994. The Biomedicine Agency took over responsibility for organ, tissue and cell harvest and transplantation, but its remit now also covers medically assisted reproduction, antenatal diagnosis, human genetics, and embryo research, which it is required to "monitor, evaluate and control ". More generally, the Biomedicine Agency contributes to establishing regulations and to improving the quality and safety of healthcare practices and patient management. It is also responsible for promoting transparency in these fields, by preparing and distributing data on medically assisted reproduction and its results, and by keeping the public informed Finally, the Agency licenses and inspects healthcare professionals working in the fields of medically assisted reproduction, antenatal diagnosis and genetics. The Agency has bolstered its internal and external expertise in these new areas by calling on healthcare professionals and their scientific societies. It has thus created several task forces of healthcare professionals, who contribute their experience and their knowledge of day-to-day issues, with the aim of improving both regulations and practices. Finally, in order to constitute a solid framework for its development, the Agency has signed a performance contract with the ministry of health. This contract, covering the period 2007 to 2010, precisely defines the Agency's strategic objectives and actions, indicators for follow-up, and assessments of the means the Agency needs to carry out its missions. The Biomedicine Agency also actively seeks input from patients and user associations, especially with respect to the information it provides to the public.

  13. Experience with ISO quality control in assisted reproductive technology.

    PubMed

    Alper, Michael M

    2013-12-01

    Assisted reproductive technology (ART) programs are complex organizations requiring the integration of multiple disciplines. ISO 9001:2008 is a quality management system that is readily adaptable to an ART program. The value that ISO brings to the entire organization includes control of documents, clear delineation of responsibilities of staff members, documentation of the numerous processes and procedures, improvement in tracking and reducing errors, and overall better control of systems. A quality ART program sets quality objectives and monitors their progress. ISO provides a sense of transparency within the organization and clearer understanding of how service is provided to patients. Most importantly, ISO provides the framework to allow for continual improvement.

  14. Misconduct in third-party assisted reproduction: a committee opinion.

    PubMed

    2014-01-01

    Physicians who are told or discover information that would be material to another party's participation in an assisted reproductive technology (ART) arrangement (such as lawyer's, donor's, gestational carrier's, or intended parent's) should encourage disclosure to that party. In some instances, it is ethically and legally permissive for the physician to either disclose material information to an affected party or to transfer care of a patient to another willing provider. In all cases involving the legal status or rights of the parties, referral to legal professionals is advised.

  15. What is the most relevant standard of success in assisted reproduction? The next step to improving outcomes of IVF: consider the whole treatment.

    PubMed

    Heijnen, E M E W; Macklon, N S; Fauser, B C J M

    2004-09-01

    Changing the way in which successful IVF treatment is defined offers a tool to improve efficacy while reducing costs and complications of treatment. Crucial to this paradigm shift is the move away from considering outcomes in terms of the single IVF cycle, and towards the started IVF treatment as a whole. We propose the most informative end-point of success in IVF to be the term singleton birth rate per started IVF treatment (or per given time period) in the overall context of patient discomfort, complications and costs. These end-points are important not only for patients, but also for clinicians, health economists and policy makers. Such an approach would encourage the development of patient-friendly and cheaper stimulation protocols with less stress, discomfort and side effects. The combination of mild ovarian stimulation with single embryo transfer may provide the same overall pregnancy rate per total IVF treatment, achieved in the same amount of time for similar direct costs, but with reduced patient stress and discomfort, and the near complete elimination of multiple pregnancies. This would offer major health and indirect cost benefits. If IVF success rates were to be expressed in terms of delivery of a term single baby per IVF treatment (or in a given treatment period), the introduction of single embryo transfer on a large scale would be facilitated.

  16. Successful Pregnancy Following Assisted Reproduction in Woman With Systemic Lupus Erythematosus and Hypertension: A Case Report.

    PubMed

    de Macedo, José Fernando; de Macedo, Gustavo Capinzaiki; Campos, Luciana Aparecida; Baltatu, Ovidiu Constantin

    2015-09-01

    Patients with systemic lupus erythematosus have a poor prognosis of pregnancy, since it is associated with significant maternal and fetal morbidity, including spontaneous miscarriage, pre-eclampsia, intrauterine growth restriction, fetal death and pre-term delivery. We report a case with successful pregnancy in a patient with systemic lupus erythematosus and hypertension. A 39-year-old nulliparous woman presented with systemic lupus erythematosus with antinuclear and antiphospholipid antibodies, hypertension and recurrent pregnancy loss presented for assisted reproduction. The patient responded well to enoxaparin and prednisone during both assisted reproduction and prenatal treatment. This case report indicates that prescription of immunosuppressant and blood thinners can be safely recommended throughout the whole prenatal period in patients with systemic lupus erythematosus. Enoxaparin and prednisone may be prescribed concurrently during pregnancy.

  17. Assisted reproductive technology (ART) in humans: facts and uncertainties.

    PubMed

    Ménézo, Y J; Veiga, A; Pouly, J L

    2000-01-15

    Since the first in vitro fertilization (IVF) in human, the number of patients using Assisted Reproductive Technologies (ART) has increased tremendously. ART technologies have increased in number and their spectrum has also widened. The first IVF babies are now more than 20 years old. All the retrospective analyses have demonstrated that the obstetrical and pediatrical impact has not really affected single births. The main problems observed occur with multiple pregnancies, including high costs for the couples and for society. The decrease in the number of embryos transferred has improved the situation and moreover does not impair the final results. IntraCytoplasmic Sperm Injection (ICSI) is a more debatable and questionable technique with a real negative genetic impact. The main problem is chromosome abnormalities more specifically related to the sex chromosomes. The question of a systematic genetic work-up on the patients entering ICSI programs is discussed. No negative impact of cryopreservation has been demonstrated even though some controversy arises from time to time. Pre-implantation Genetic Diagnosis (PGD) is now a interesting tool for patients carrying genetic defects. Blastocyst biopsy now has a future role in reproductive medicine. Gender selection through sperm sorting is also now a reality. As with the other developing bio-technologies related to reproduction, there are ethical questions. The decisions concerning these technologies do not belong solely to scientists but are rather a matter for society to decide.

  18. [Being a family today - ethics for assisted reproductive techniques].

    PubMed

    Mathieu, S

    2013-09-01

    Currently in France, all the children born as a result of an assisted reproduction procedure, represent 2.5% of all births. Although this proportion is not high, it is not to be neglected, particularly with regard to the sociological issues raised by assisted reproduction technologies (ART) - i.e. removing anonymity of gamete donation, post mortem insemination, ART access to single women and gay couples, surrogacy - to name four of the most prominent debates. What is new with ART is that a new therapeutic target of medicine is being developed, in other words procreation. Now it is no longer necessary for a man and a woman to resort to sex to have a child. This is a profound questioning of the representation of what appeared to be intangible, with some sort of divine aura. How, in this context, developing an ethics for ART? From a fethnographic field survey, we show here how this ethos of ART develops and how, therefore, we consider the multiple ways of being a family today.

  19. A woman's choice? On women, assisted reproduction and social coercion.

    PubMed

    Petersen, Thomas Sobirk

    2004-02-01

    This paper critically discusses an argument that is sometimes pressed into service in the ethical debate about the use of assisted reproduction. The argument runs roughly as follows: we should prevent women from using assisted reproduction techniques, because women who want to use the technology have been socially coerced into desiring children--and indeed have thereby been harmed by the patriarchal society in which they live. I call this the argument from coercion. Having clarified this argument, I conclude that although it addresses important issues, it is highly problematic for the following reasons. First, if women are being coerced to desire to use AR, we should eradicate the coercive elements in pro-natalist ideology, not access to AR. Second, the argument seems to have the absurd implication that we should prevent all women, whether fertile or not, to try to have children. Third, it seems probable that women's welfare will be greater if we let well informed and decision-competent women decide for themselves whether they want to use AR.

  20. Spermbots: potential impact for drug delivery and assisted reproductive technologies.

    PubMed

    Magdanz, Veronika; Schmidt, Oliver G

    2014-08-01

    Micromotors and nanomotors are an emerging research field that aims at achieving locomotion on the microscale for a variety of applications such as drug delivery, single cell manipulation, microsensors and lab-on-a-chip devices, just to point out a few. The enthusiastic development of hybrid micromotors harnessing biological power sources for physiologically compatible nano/microdevices has recently brought a lot of attention to the international research community that is looking for a solution for the actuation and locomotion on the microscale. This article describes the potential of sperm-driven micro-bio-robots in the biomedical field such as drug delivery or single cell manipulation. Herein, a specific potential of the sperm-driven micro-bio-robot is described that might have impact on the development of assisted reproductive technologies.

  1. Trends in Global Assisted Reproductive Technologies Research: a Scientometrics study

    PubMed Central

    Okhovati, Maryam; Zare, Morteza; Zare, Fatemeh; Bazrafshan, Maliheh Sadat; Bazrafshan, Azam

    2015-01-01

    Introduction This study illustrated the global contribution to assisted reproductive technologies (ARTs) research in MEDLINE database from 1998 to 2014. Methods In March 2015, the MEDLINE database was searched for research publications indexed under ‘reproductive techniques, assisted’ (including the following MeSH headings: in vitro fertilization [IVF]; intracytoplasmic sperm injections; cryopreservation; and ovulation induction), with the following expressions in the fields of title or abstract: intrauterine insemination; sperm donation; embryo/egg donation and surrogate mothers. The number of publications in MEDLINE database was recorded for each individual year, 1998–2014, and for each country. The following countries were arbitrarily selected for data retrieval: United States, United Kingdom, France, Germany, Canada, Italy, Japan (G7 countries), Brazil, Russia, India, China (BRIC countries), Egypt, Turkey, Israel and Iran. Results The absolute number of publications for each country from 1998 to 2014 ranged from 75 to 16453, with a median of 2024. The top five countries were the US (16453 publications), the UK (5427 publications), Japan (4805), China (4660) and France (3795). ART (20277), cryopreservation (11623) and IVF (11209) were the most researched areas. Conclusion Global research on ARTs were geographically distributed and highly concentrated among the world’s richest countries. Cryopreservation and IVF were the most productive research domains among ARTs. PMID:26813255

  2. Assisted Reproduction versus Spontaneous Conception: A Comparison of the Developmental Outcomes in Twins

    ERIC Educational Resources Information Center

    Kelly-Vance, Lisa; Anthis, Kristine S.; Needelman, Howard

    2004-01-01

    The use of assisted reproductive technology is increasing rapidly. Research, although sparse, has resulted in inconsistent findings as to the developmental prognosis for infants conceived by assisted reproductive techniques such as in vitro fertilization and the use of fertility drugs. In the present study, the authors compared twins who were…

  3. Assisted Reproduction: What factors interfere in the professional's decisions? Are single women an issue?

    PubMed Central

    2011-01-01

    father as the reason to withhold treatment. Conclusion The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws. PMID:21627812

  4. Global Health Care Justice, Delivery Doctors and Assisted Reproduction: Taking a Note From Catholic Social Teachings.

    PubMed

    Richie, Cristina

    2015-12-01

    This article will examine the Catholic concept of global justice within a health care framework as it relates to women's needs for delivery doctors in the developing world and women's demands for assisted reproduction in the developed world. I will first discuss justice as a theory, situating it within Catholic social teachings. The Catholic perspective on global justice in health care demands that everyone have access to basic needs before elective treatments are offered to the wealthy. After exploring specific discrepancies in global health care justice, I will point to the need for delivery doctors in the developing world to provide basic assistance to women who hazard many pregnancies as a priority before offering assisted reproduction to women in the developed world. The wide disparities between maternal health in the developing world and elective fertility treatments in the developed world are clearly unjust within Catholic social teachings. I conclude this article by offering policy suggestions for moving closer to health care justice via doctor distribution.

  5. Lifestyle and Outcomes of Assisted Reproductive Techniques: A Narrative Review

    PubMed Central

    Zeinab, Hamzehgardeshi; Zohreh, Shahhosseini; Gelehkolaee, Keshvar Samadaee

    2015-01-01

    Background: Studies reveal that lifestyles such as physical activity patterns, obesity, nutrition, and smoking, are factors that affect laboratory test results and pregnancy outcomes induced by assisted fertility techniques in infertile couples. The present study is a narrative review of studies in this area. Methods: In this study, researchers conducted their computer search in public databases Google Scholar general search engine, and then more specific: Science Direct, ProQuest, SID, Magiran, Irandoc, Pubmed, Scopus, cochrane library, and Psych info; Cumulative Index to Nursing and Allied Health Literature (CINAHL), using Medical Subject Headings (MeSH) keywords: infertility (sterility, infertility), lifestyle (life behavior, lifestyle), Assisted Reproductive Techniques (ART), antioxidant and infertility, social health, spiritual health, mental health, Alcohol and drug abuse, preventive factors, and instruments., and selected relevant articles to the study subject from 2004 to 2013. Firstly, a list of 150 papers generated from the initial search. Then reviewers studied titles and abstracts. Secondly, 111 papers were included. Finally, quality assessment of full text studies was performed by two independent reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 62 full articles to compile this review paper. Results: Review of literature led to arrangement of 9 general categories of ART results’ relationship with weight watch and diet, exercise and physical activity, psychological health, avoiding medications, alcohol and drugs, preventing diseases, environmental health, spiritual health, social health, and physical health. Conclusion: The following was obtained from review of studies: since lifestyle is among important, changeable, and influential factors in fertility, success of these methods can be greatly helped through assessment of lifestyle patterns of infertile couples, and design and implementation of healthy lifestyle

  6. Corticotomy-assisted orthodontic treatment

    PubMed Central

    Hassan, Ali H.; Al-Saeed, Samar H.; Al-Maghlouth, Basma A.; Bahammam, Maha A.; Linjawi, Amal I.; El-Bialy, Tarek H.

    2015-01-01

    Objectives: To systematically review the literature to assess the quality of evidence related to corticotomy-assisted orthodontic treatment (CAOT) as adjunctive treatment in orthodontics. Methods: The study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between 2013 and 2014. Various electronic databases were searched and abstracts were retrieved. Defined inclusion criteria were then applied to the obtained original articles for further evaluation by 2 examiners independently. The criteria of selection included human, or animal studies, which assessed some aspects of CAOT and/or the biological principles behind it. Case reports and series were excluded. The quality of the studies was evaluated by the methodological score for clinical trials developed. Results: Fourteen articles were retrieved initially, but only 12 articles were finally selected for the study. The CAOT was found to accelerate tooth movement by 2-2.5 folds when compared with conventional orthodontic tooth movement. The CAOT was found safe on periodontal health and exhibits no or little risk of root resorption. A localized turnover of alveolar spongiosa and the absence of a hyalinized zone was the acceptable biological explanation of CAOT. There is no evidence to support that CAOT enhances the movement of ankylosed teeth, closing old extraction sites, post-orthodontic stability, or transverse expansion. Conclusions: Corticotomy-assisted orthodontic treatment should be considered with caution. Long term randomized clinical trials are still needed. PMID:26108582

  7. Training in reproductive endocrinology and infertility and assisted reproductive technologies: options and worldwide needs.

    PubMed

    de Ziegler, Dominique; de Ziegler, Nathalie; Sean, Sokteang; Bajouh, Osama; Meldrum, David R

    2015-07-01

    Standardized, high-quality training in reproductive endocrinology, infertility, and assisted reproductive technologies (REI-ART) faces challenges owing to the high-tech nature of ART and the important country-to-country differences in clinical practice and regulations overseeing training. Moreover, while the training capacity of the classical by-fellowship training platforms is shrinking, an increasing demand for REI-ART specialists is coming from emerging countries. To meet this expanding need for REI-ART specialists, we propose a novel by-network model linking a reference training center to satellite practical training sites. Simulation should be used more extensively to achieve competency before initiating live clinical experience, analogous to the highly effective training systems that have been used in aviation for decades. Large ART databases that exist because of obligations to report ART activity and results constitute unique yet so far untapped sources for developing by-scenario simulation training models. Online training materials incorporating these state-of-the-art information technology tools could be developed as a means of fulfilling training needs worldwide.

  8. Regulatory framework in assisted reproductive technologies, relevance and main issues.

    PubMed

    Merlet, Françoise

    2009-01-01

    Assisted reproductive technologies (ART) have changed life for the past 25 years and many ethical and social issues have emerged following this new method of conception. In order to protect individuals against scientific and ethical abuses without inhibiting scientific progress, a specific legal framework is necessary. The first French law on Bioethics was voted after an extensive debate in 1994 then reviewed in 2004. This review previously scheduled every five years is currently being discussed. Legal provisions applying to ART are part of a large framework including the protection of the patients' rights and biomedical research. The key principles consist of respect for human life and ban on commercial practices of human body parts, eugenic practices and any kind of cloning. These key principles apply to ART. Donation is anonymous and free. Created in 2004, the Agence de la biomédecine is a government agency and one of the main tools of the French regulations. The missions focus on improving the quality and the safety of the management of ART. Evaluation of activities is available to all from the annual report. The agency represents the French competent authority for medical and scientific aspects of ART. Substantial differences in European legislations exist from the open-up "laissez faire" to the most restrictive one. As a consequence a large reproductive tourism has developed particularly for egg donation or surrogacy. The medical and ethical conditions of management of patients and donors represent the main critical points. In order to avoid ethical abuses, homogenization regarding the key principles is necessary in Europe. It is an opportunity to reassert that human body parts should not be a source of financial gain.

  9. Vitamin D and assisted reproduction technologies: current concepts.

    PubMed

    Vanni, Valeria S; Vigano', Paola; Somigliana, Edgardo; Papaleo, Enrico; Paffoni, Alessio; Pagliardini, Luca; Candiani, Massimo

    2014-05-31

    Accumulating evidence from animal and human studies suggests that vitamin D is involved in many functions of the human reproductive system in both genders, but no comprehensive analysis of the potential relationship between vitamin D status and Assisted Reproduction Technologies (ART) outcomes is currently available. On this basis, the purpose of this systematic review and meta-analysis was to perform an in-depth evaluation of clinical studies assessing whether vitamin D status of patients undergoing ART could be related to cycle outcome variables. This issue is of interest considering that vitamin D deficiency is easily amenable to correction and oral vitamin D supplementation is cheap and without significant side effects. Surprisingly, no studies are currently available assessing vitamin D status among male partners of couples undergoing ART, while seven studies on vitamin D status of women undergoing controlled ovarian hyperstimulation (COH) for ART were found and included in the review. Results show that vitamin D deficiency is highly prevalent among women undergoing COH, ranging from 21% to 31% across studies conducted in Western countries and reaching 75-99% in Iranian studies. Data on vitamin D deficiency (25-hydroxyvitamin D serum levels <20 ng/ml) in relation to ART outcomes could be extracted from three studies and included in the meta-analysis, yielding a common risk ratio (RR) of 0.89 (95% CI 0.53-1.49) and showing a lower but not statistically significant likelihood of clinical pregnancy for vitamin-D-deficient women compared with vitamin-D-sufficient patients. In conclusion, there is insufficient evidence to support the routine assessment of vitamin D status to predict the clinical pregnancy rate in couples undergoing ART. The partly conflicting results of the available studies, potentially explaining the lack of statistical significance for a negative influence of vitamin D deficiency on clinical pregnancy rate, are likely secondary to confounders

  10. The expanding role of recombinant gonadotropins in assisted reproduction.

    PubMed

    Adams, T E; Boime, I

    2008-07-01

    Using recombinant gonadotropins for assisted reproduction of domestic species is still in its infancy. Yet, the purity, potency and pathogen-free nature of recombinant gonadotropins make them attractive alternatives to tissue-derived gonadotropic agents. In this study, the authors summarize the work to date using recombinant gonadotropins to enhance the - fertility of domestic animals and they discussed their recent studies examining the biopotency of single chain analogues of human gonadotropins. In these studies, single chain analogues of follicle stimulating hormone (Fc alpha), chorionic gonadotropin (CG beta alpha) or a gonadotropin construct with dual activity (FcCG beta alpha) were administered to sheep pre-treated with antisera directed against GnRH. Ovulation was induced 3 days after analogue administration using hCG (1000 IU, iv). Although Fc alpha or CG beta alpha alone induced only modest oestradiol production during the pre-hCG period, serum concentrations of oestradiol were markedly increased (p < 0.05) 3 days after administration of FcCG beta alpha or the Fc alpha + CG beta alpha combination. Final ovarian weight was significantly increased (p < 0.05) in animals receiving Fc alpha, Fc alpha + CG beta alpha or FcCG beta alpha. Collectively, these observations demonstrate that the single chain analogues of the human gonadotropins are active in sheep.

  11. Epigenetics and assisted reproductive technology: a call for investigation.

    PubMed

    Niemitz, Emily L; Feinberg, Andrew P

    2004-04-01

    A surprising set of recent observations suggests a link between assisted reproductive technology (ART) and epigenetic errors--that is, errors involving information other than DNA sequence that is heritable during cell division. An apparent association with ART was found in registries of children with Beckwith-Wiedemann syndrome, Angelman syndrome, and retinoblastoma. Here, we review the epidemiology and molecular biology behind these studies and those of relevant model systems, and we highlight the need for investigation of two major questions: (1) large-scale case-control studies of ART outcomes, including long-term assessment of the incidence of birth defects and cancer, and (2) investigation of the relationship between epigenetic errors in both offspring and parents, the specific methods of ART used, and the underlying infertility diagnoses. In addition, the components of proprietary commercial media used in ART procedures must be fully and publicly disclosed, so that factors such as methionine content can be assessed, given the relationship in animal studies between methionine exposure and epigenetic changes.

  12. Association between Thrombophilia and Repeated Assisted Reproductive Technology Failures

    PubMed Central

    Hamdi, Kobra; Vaezi, Maryam; Dagigazar, Behrooz; Mehrzad Sadagiani, Mahzad; Farzadi, Laya; Pashaei-Asl, Maryam

    2012-01-01

    Purpose: This study was performed to investigate the incidence of thrombophilic gene mutations in repeated assisted reproductive technology (ART) failures. Methods: The prevalence of mutated genes in the patients with a history of three or more previous ART failures was compared with the patients with a history of successful pregnancy following ARTs. The study group included 70 patients, 34 with three or more previously failed ARTs (A) and control group consisted of 36 patients with successful pregnancy following ARTs (B). All patients were tested for the presence of mutated thrombophilic genes including factor V Leiden (FVL), Methylenetetrahydrofolate reductase (MTHFR) and Prothrombin (G20210A) using real-time polymerase chain reaction (RT- PCR). Results: Mutation of FVL gene was detected in 5.9% women of group A (2 of 34) compared with 2.8% women (1 of 36) of control group (P = 0.6). Mutation of MTHFR gene was found in 35.3% (12 cases) as compared with 50% (18 cases) of control (35.3% versus 50%; P = 0.23). Regarding Prothrombin, only control group had 5.6% mutation (P = 0.49). No significant differences were detected in the incidences of FVL, Prothrombin and MTHFR in the study group A compared with the control group B. Conclusion: The obtained results suggest that thrombophilia does not have a significant effect in ART failures. PMID:24312798

  13. Assisted reproductive technologies and equity of access issues.

    PubMed

    Peterson, M M

    2005-05-01

    In Australia and other countries, certain groups of women have traditionally been denied access to assisted reproductive technologies (ARTs). These typically are single heterosexual women, lesbians, poor women, and those whose ability to rear children is questioned, particularly women with certain disabilities or who are older. The arguments used to justify selection of women for ARTs are most often based on issues such as scarcity of resources, and absence of infertility (in lesbians and single women), or on social concerns: that it "goes against nature"; particular women might not make good mothers; unconventional families are not socially acceptable; or that children of older mothers might be orphaned at an early age. The social, medical, legal, and ethical reasoning that has traditionally promoted this lack of equity in access to ARTs, and whether the criteria used for client deselection are ethically appropriate in any particular case, are explored by this review. In addition, the issues of distribution and just "gatekeeping" practices associated with these sensitive medical services are examined.

  14. Epigenetic Alterations in Density Selected Human Spermatozoa for Assisted Reproduction

    PubMed Central

    Yu, Bolan; Zhou, Hua; Liu, Min; Zheng, Ting; Jiang, Lu; Zhao, Mei; Xu, Xiaoxie; Huang, Zhaofeng

    2015-01-01

    Epidemiological evidence indicates that assisted reproductive technologies (ART) may be associated with several epigenetic diseases such as Beckwith-Wiedemann syndrome (BWS) or Silver-Russell syndrome (SRS). Selection of sperm by density-gradients in ART has improved DNA integrity and sperm quality; however, epigenetic alterations associated with this approach are largely unknown. In the present study, we investigated DNA methylation and histone retention profiles in raw sperm and selected sperm derived from the same individual and separated by using density-gradients. Results from a study group consisting of 93 males demonstrated that both global DNA methylation and histone retention levels decreased in density selected sperm. Compared to unselected raw sperm, histone transition rates decreased by an average of 27.2% in selected sperm, and the global methylation rate was 3.8% in unselected sperm and 3.3% in the selected sperm. DNA methylation and histone retention location profiling analyses suggested that these alterations displayed specific location patterns in the human genome. Changes in the pattern of hypomethylation largely occurred in transcriptional factor gene families such as HOX, FOX, and GATA. Histone retention increased in 67 genes, whereas it was significantly clustered in neural development-related gene families, particularly the olfactory sensor gene family. Although a causative relationship could not be established, the results of the present study suggest the possibility that sperm with good density also possess unique epigenetic profiles, particularly for genes involved in neural and olfactory development. As increasing evidence demonstrates that epigenetics plays a key role in embryonic development and offspring growth characteristics, the specific epigenetic alterations we observed in selected sperm may influence the transcriptional process and neural development in embryos. PMID:26709917

  15. Assisted Reproductive Technology and Early Intervention Program Enrollment

    PubMed Central

    Gopal, Daksha; Cabral, Howard; Belanoff, Candice; Declercq, Eugene R.; Kotelchuck, Milton; Luke, Barbara; Stern, Judy E.

    2016-01-01

    OBJECTIVES: We examined the prevalence of Early Intervention (EI) enrollment in Massachusetts comparing singleton children conceived via assisted reproductive technology (ART), children born to mothers with indicators of subfertility but no ART (Subfertile), and children born to mothers who had no indicators of subfertility and conceived naturally (Fertile). We assessed the natural direct effect (NDE), the natural indirect effect (NIE) through preterm birth, and the total effect of ART and subfertility on EI enrollment. METHODS: We examined maternal and infant characteristics among singleton ART (n = 6447), Subfertile (n = 5515), and Fertile (n = 306 343) groups and characteristics associated with EI enrollment includingpreterm birth using χ2 statistics (α = 0.05). We estimated the NDE and NIE of the ART–EI enrollment relationship by fitting a model for enrollment, conditional on ART, preterm and the ART-preterm delivery interaction, and covariates. Similar analyses were conducted by using Subfertile as the exposure. RESULTS: The NDE indicated that the odds of EI enrollment were 27% higher among the ART group (odds ratioNDE = 1.27; 95% confidence interval (CI): 1.19 – 1.36) and 20% higher among the Subfertilegroup (odds ratioNDE = 1.20; 95% CI: 1.12 – 1.29) compared with the Fertile group, even if the rate of preterm birth is held constant. CONCLUSIONS: Singleton children conceived through ART and children of subfertile mothers both have elevated risks of EI enrollment. These findings have implications for clinical providers as they counsel women about child health outcomes associated with ART or subfertility. PMID:26908668

  16. Assisted reproduction: a comparative review of IVF policies in two pro-natalist countries.

    PubMed

    Balabanova, Ekaterina; Simonstein, Frida

    2010-06-01

    Policies on reproduction have become an increasingly important tool for governments seeking to meet the so-called demographic 'challenge' created by the combination of low fertility and lengthening life expectancies. However, the tension between the state and the market in health care is present in all countries around the world due to the scare resources available and the understandable importance of the health issues. The field of assisted reproduction, as part of the health care system, is affected by this tension with both-the state's and the market's involvements-carrying important implications. Bulgaria and Israel share the same size of population, are markedly paternalistic and both have strong pro-natalist cultures by which large families are expected. For a range of reasons the two countries contrast sharply, however, in terms of their capacity to intervene in the health system, and also in terms of the political will to act on matters of reproduction. This paper examines how assisted reproduction, as reflected by present policies in both countries, influences women's welfare and considers whose interests the practices of assisted reproduction in these countries actually serve. By reviewing some of the present data on women's status in Bulgaria and Israel and assessing both states' policies and involvement in assisted reproduction this paper helps to identify some of the intended and unintended consequences of assisted reproduction policies in different countries.

  17. Ovarian control for assisted reproduction in the domestic cat and wild felids.

    PubMed

    Pelican, Katharine M; Wildt, David E; Pukazhenthi, Budhan; Howard, JoGayle

    2006-07-01

    Of the 37 felid species, all but the domestic cat are classified as threatened with extinction in all or part of their native range. Additionally, the domestic cat is a valuable model for human biomedical research. Propagating some wild felids as well as domestic cat populations serving as human models is a major challenge primarily due to difficulties in transporting animals between facilities to ensure the pairing of genetically matched individuals, behavioral incompatibility between pairs and low fertility. Artificial insemination (AI) and in vitro fertilization/embryo transfer (IVF/ET) are powerful tools for helping manage rare populations. Developing successful assisted reproductive techniques requires knowledge of the female reproductive cycle and precise control of ovarian activity. Successful ovarian stimulation for AI and IVF/ET has been achieved in at least one-third of all cat species. However, sensitivity to a given gonadotropin treatment appears highly species-specific, and poor responses are common, particularly in felid species that exhibit spontaneous ovulations. Furthermore, current gonadotropin regimens have been demonstrated to perturb female reproductive function often leading to reduced fertility. Overall, ovarian response to exogenous hormonal stimulation has been highly variable, and pregnancy success after AI or IVF/ET remains low (<20%) in most species. Therefore, there is an immediate need to develop improved regimens that would allow more predictable ovarian responses in felids. We contend that recent research involving the use of progestins to control the ovary prior to gonadotropin stimulation shows promise for providing consistent ovarian stimulation in felids.

  18. Zinc protects sperm from being damaged by reactive oxygen species in assisted reproduction techniques.

    PubMed

    Wu, Jinxiang; Wu, Shiqiang; Xie, Yuanzhi; Wang, Zhengyao; Wu, Ruiyun; Cai, Junfeng; Luo, Xiangmin; Huang, Suzhen; You, Liuxia

    2015-04-01

    The aim of this study was to explore the effect of zinc on hydrogen peroxide-induced sperm damage in assisted reproduction techniques. First, sperms were selected from semen samples of 20 healthy men prepared by density gradient centrifugation. Selected sperm were treated with either 0.001% H(2)O(2), 12.5 nM ZnCL(2), 0.001% H(2)O(2) + 12.5 nM ZnCL(2) or 0.9% NaCl(2) (control). After this treatment, the motility, viability, membrane integrity and DNA fragmentation of sperms in each group were analysed by Goodline sperm detection system, optical microscopy and sperm DNA fragmentation assay. Poorer motility, vitality, membrane integrity and more DNA damage were found in sperms treated by H(2)O(2), compared with control. When sperms were treated with both H(2)O(2) and zinc, however, all indicators were improved compared with H(2)O(2) alone. There was a close association between oxidative stimulation and sperm injury; zinc could inhibit hydrogen peroxide-induced damage of sperm in assisted reproductive technology. However, the presence of zinc in culture medium can decrease the sperm quality without addition of peroxide.

  19. Assisted reproductive technology, epigenetics, and long-term health: a developmental time bomb still ticking.

    PubMed

    Grace, Kristen S; Sinclair, Kevin D

    2009-09-01

    Live birthrates following assisted reproduction account for 1 to 3% of pregnancies in developed countries, and these figures seem set to rise. Concerns regarding the safe use of assisted reproductive technology (ART) for the treatment of infertility have been voiced for several years, yet, to date, the vast majority of children conceived using these techniques are apparently normal. Controversy surrounding reports of epigenetic alterations to genomic imprinting following human ART in recent years has fueled the ongoing debate. In contrast, both the incidence and severity of such anomalies are more apparent following ART in comparative animal species. The reasons for this are not known. By and large, the confounding effects of infertility and advanced maternal age do not apply to animal studies, which report better pregnancy rates following embryo transfer. Perhaps the incidence of imprinting disorders is increased when procedures such as ovarian stimulation, in vitro maturation, or both are used in conjunction with extended periods of embryo culture; this frequently occurs in animal but rarely in human ART. The focus of attention on imprinting, however, may have served to distract the scientific community from more subtle epigenetic modifications to nonimprinted loci in gametes and the preimplantation embryo, with health-related consequences that do not manifest until adulthood. Accumulating evidence from animal studies indicates that such effects, not yet apparent in human subjects, exist; and this may ultimately transpire to be the true developmental legacy of human ART. This article discusses these issues in the context of epigenetic and developmental abnormalities following ART in animals.

  20. The devil we know: the implications of bill C-38 for assisted human reproduction in Canada.

    PubMed

    Cattapan, Alana; Cohen, Sara R

    2013-07-01

    In June 2012, the Canadian House of Commons passed the so-called omnibus budget bill, making several important changes to the governance of assisted reproduction in Canada. The bill (Bill C-38) was widely criticized for its unwieldy size and rapid passage through Parliament, preventing adequate parliamentary debate and public scrutiny. Given the substantive nature of the amendments to the Assisted Human Reproduction Act made by Bill C-38, and the lack of relevant discussion about these changes both before and following its passage, this commentary is intended to identify how Bill C-38 may alter the governance of reproductive technologies in Canada. In this commentary, we address some of the more significant changes made by Bill C-38 to the regulation of reproductive medicine in Canada. We identify the benefits and challenges of closing Assisted Human Reproduction Canada, noting that doing so eliminates a much-needed forum for stakeholder consultation in this field. Further, we explore the implications of moving the regulation of donor semen from the Food and Drugs Act to the Assisted Human Reproduction Act; these include increased liability for physicians, and opportunities to expand the existing regulations to account for the needs of lesbian, gay, bisexual, trans, and queer Canadians using donor gametes and recent advances in reproductive technologies. Overall, we argue that although the implementation of a policy framework in this field remains highly dependent on yet-to-be written regulations, the changes to the Assisted Human Reproduction Act enabled by Bill C-38 may significantly alter how Canadians interact with reproductive technologies.

  1. Pituitary function following treatment with reproductive toxins

    SciTech Connect

    Cooper, R.L.; Goldman, J.M.; Rehnberg, G.L.

    1986-12-01

    Appropriate regulation of reproductive processes are dependent upon the integrity of pituitary function. In this selected review, the authors evaluate the evidence that certain environmental compounds exert their effect on reproductive function via a direct action on the pituitary gland. They also discuss examples of changes in pituitary hormone secretion that occur in response to changes in neuronal or gonadal control of the pituitary. A limited number of studies suggest that measures of pituitary hormone secretion provide an early and sensitive measure of a compound's potential effects on the reproductive system. However, the most striking aspect of this area is the sparse and inconsistent information describing pituitary function following exposure to environmental pollutants.

  2. The German IVF Register as an Instrument to Document Assisted Reproductive Technologies.

    PubMed

    Kadi, S; Wiesing, U

    2016-06-01

    The German IVF Register (Deutsches IVF-Register [D.I.R]) has been collecting and publishing data on the use of IVF and related methods in Germany since 1982. It is the only institution which provides information for all of Germany on procedures and their success rates. For this reason it plays an important role in the provision of information to the public, to patients, political decision-makers and the scientific community. However, the register does not have the data of all centers offering treatment in Germany nor does it have complete datasets on all reported treatments. The register accepts retrospective data entries, it does not publish the success rates of individual centers and up until 2015 it did not provide a summary of information which was suitable for non-specialists. The D.I.R has been the focus of criticism in the past. Even today, the information it provides to the scientific community, the public, political decision-makers and potential patients on the outcomes of assisted reproduction is insufficient. The documentation of reproductive medicine procedures in other countries is much more meaningful.

  3. Assisted reproductive technologies and fertility "tourism": examples from global Dubai and the Ivy League.

    PubMed

    Inhorn, Marcia C; Shrivastav, Pankaj; Patrizio, Pasquale

    2012-01-01

    What motivates the global movements of infertile people searching for assisted reproductive technologies (ARTs)? In this article, we attempt to answer this question by exploring infertile patients' practices of so-called "fertility tourism." Based on ethnographic research carried out with nearly 300 infertile travelers in two major ART centers--one in the global hub of the United Arab Emirates and the other at a major East Coast Ivy League university--we examine a diverse set of reasons for reproductive travel. We argue that reproductive "tourism" should be reconceptualized as reproductive "exile" in that infertile couples feel barred from accessing ARTs in their home countries. Listening to reproductive travel stories is key to understanding infertile couples' transnational "quests for conception." Stories of two couples, one from Lebanon and one from Italy, demonstrate the poignancy of these quests and begin to shed light on the complex calculus of factors governing this global movement of reproductive actors.

  4. Cryobiology in human assisted reproductive technology. Would Hippocrates approve?

    PubMed

    Bredkjaer, H E; Grudzinskas, J G

    2001-07-01

    and colon? Should we cryopreserve oocytes/sperm/embryos for the purposes of PGD once the markers are available? Cryobiology indeed provides hope now for women and men with neoplastic diseases, who are about to receive oncotherapy for malignancies which inevitably will render them sterile. Men may now freeze epididymal, testicular as well as ejaculatory sperm as ICSI has revolutionalised the treatment of male infertility. It might be likely that testicular tissue from prepubertal boys can be cryopreserved with a reasonable expectation that techniques will soon be developed to effect maturation of spermatogonia in-vivo or in-vitro13. The greatest advance is likely to be for women suffering from reproductive cancer, who may now consider mature and immature oocytes being frozen or vitrified with a reasonable chance of fertilisation by ICSI later, as well as the cryopreservation and storage of ovarian cortex tissue biopsies. Work is proceeding still to refine techniques of in-vitro maturation of frozen-thawed immature oocytes, and the frozen-thawed ovarian cortex tissue slices. The potential benefits will not only be to female fertility for the latter conditions but endocrine disorders as well as by autotransplantation (1999)9. Currently, ovarian tissue banking8 is being considered by women undergoing procedures or treatment which could destroy ovarian function with quite realistic but cautious expectations of preserving ovarian function, but tomorrow women may consider banking ovarian tissue as insurance against childlessness because of the risk of disorders in the reproductive tract (endometriosis, simple recurrent ovarian cysts) and even advancing years. For those who have conceived with surplus oocytes cryopreserved, anonymous oocyte donation is a possibility for the solution of ethical and legal problems. All over Europe, the age of women having their first child is dramatically increasing now being in their late twenties, with likely significant implications in the

  5. Pituitary function following treatment with reproductive toxins.

    PubMed Central

    Cooper, R L; Goldman, J M; Rehnberg, G L

    1986-01-01

    Appropriate regulation of reproductive processes are dependent upon the integrity of pituitary function. In this selected review, we evaluate the evidence that certain environmental compounds exert their effect on reproductive function via a direct action on the pituitary gland. We also discuss examples of changes in pituitary hormone secretion that occur in response to changes in neuronal or gonadal control of the pituitary. A limited number of studies suggest that measures of pituitary hormone secretion provide an early and sensitive measure of a compound's potential effects on the reproductive system. However, the most striking aspect of this area is the sparse and inconsistent information describing pituitary function following exposure to environmental pollutants. PMID:3830104

  6. The appeal to nature implicit in certain restrictions on public funding for assisted reproductive technology.

    PubMed

    Carter, Drew; Braunack-Mayer, Annette

    2011-10-01

    Certain restrictions on public funding for assisted reproductive technology (ART) are articulated and defended by recourse to a distinction between medical infertility and social infertility. We propose that underlying the prioritization of medical infertility is a vision of medicine whose proper role is to restore but not to improve upon nature. We go on to mark moral responses that speak of investments many continue to make in nature as properly an object of reverence and gratitude and therein (sometimes) a source of moral guidance. We draw on the work of Ludwig Wittgenstein in arguing for the plausibility of an appeal to nature in opposition to the charge that it must contain a logical fallacy. We also invite consideration of the moral plausibility of some appeal to nature. Finally, we examine what follows in the case of ART. Should medicine respect as natural limits that should not be overcome: the need for a man and a woman in reproduction; menopause; and even declining fertility with age? We must first ask ourselves to what degree we should defer to nature in the conduct of medicine, at least in the particular if not the general case. This will involve also asking ourselves what we think is natural and in what instances and spirit might we defy nature. Divergent opinions and policies concerning who should receive ART treatment and public funding are more easily understood in view of the centrality, complexity and fundamental nature of these questions.

  7. A review of luteinising hormone and human chorionic gonadotropin when used in assisted reproductive technology.

    PubMed

    Ezcurra, Diego; Humaidan, Peter

    2014-10-03

    Gonadotropins extracted from the urine of post-menopausal women have traditionally been used to stimulate folliculogenesis in the treatment of infertility and in assisted reproductive technology (ART). Products, such as human menopausal gonadotropin (hMG), consist not only of a mixture of the hormones, follicle-stimulating hormone (FSH), luteinising hormone (LH) and human chorionic gonadotropin (hCG), but also other biologically active contaminants, such as growth factors, binding proteins and prion proteins. The actual amount of molecular LH in hMG preparations varies considerably due to the purification process, thus hCG, mimicking LH action, is added to standardise the product. However, unlike LH, hCG plays a different role during the natural human menstrual cycle. It is secreted by the embryo and placenta, and its main role is to support implantation and pregnancy. More recently, recombinant gonadotropins (r-hFSH and r-hLH) have become available for ART therapies. Recombinant LH contains only LH molecules. In the field of reproduction there has been controversy in recent years over whether r-hLH or hCG should be used for ART. This review examines the existing evidence for molecular and functional differences between LH and hCG and assesses the clinical implications of hCG-supplemented urinary therapy compared with recombinant therapies used for ART.

  8. Assisted reproductive techniques in Latin America: the Latin American Registry, 2013.

    PubMed

    Zegers-Hochschild, Fernando; Schwarze, Juan Enrique; Crosby, Javier A; Musri, Carolina; Urbina, Maria Teresa

    2016-06-01

    Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.

  9. Assisted reproductive techniques in Latin America: The Latin American Registry, 2013.

    PubMed

    Zegers-Hochschild, Fernando; Schwarze, Juan Enrique; Crosby, Javier A; Musri, Carolina; Urbina, Maria Teresa

    2016-05-01

    Multinational data on assisted reproduction techniques undertaken in 2013 were collected from 158 institutions in 15 Latin American countries. Individualized cycle-based data included 57,456 initiated cycles. Treatments included autologous IVF and intracytoplasmic sperm injection (ICSI), frozen embryo transfers, oocyte donations. In autologous reproduction, 29.22% of women were younger than 35 years, 40.1% were 35-39 years and 30.6% were 40 years or older. Overall delivery rate per oocyte retrieval was 20.6% for ICSI and 25.4% for IVF. Multiple births included 20.7% for twins and 1.1% for triplets and over. In oocyte donations, twins reached 30% and triplets 1.4%. In singletons, pre-term births were 7.5%: 36.58% in twins and 65.52% in triplets. The relative risk for prematurity was 4.9 (95% CI 4.5 to 5.3) in twins and 8.7 (95% CI 7.6 to 10.0) in triplets and above. Perinatal mortality was 29.4 per 1000 in singletons, 39.9 per 1000 in twins and 71.6 per 1000 in high order multiples. Elective single embryo transfer represented only 2% of cycles, with delivery rate of 39.1% in women aged 34 years or less. Given the effect of multiple births and prematurity, it is mandatory to reduce the number of embryos transferred in the region.

  10. Piezocision-assisted Invisalign treatment.

    PubMed

    Keser, Elif I; Dibart, Serge

    2011-03-01

    In today's fast-paced, esthetic-conscious society, the orthodontic treatment of the adult patient can sometimes be a challenge. Considerable time spent in treatment as well as the use of brackets often deter patients from seeking treatment. The authors illustrate how piezocision combined with Invisalign can be used in selected cases to successfully treat adults who would otherwise not pursue orthodontic treatment.

  11. Right to assisted reproductive technology: overcoming infertility in low-resource countries.

    PubMed

    Inhorn, Marcia C

    2009-08-01

    This article examines the high prevalence of primary and secondary infertility in low-resource countries. Provision of assisted reproductive technology (ART) to overcome both female and male infertility is in line with the reproductive rights agenda developed at the International Conference on Population and Development (ICPD) in Cairo 15 years ago. In addition to the right to control fertility, reproductive rights must encompass the right to facilitate fertility when fertility is threatened. Facilitation of fertility may require resort to ART, among both men and women. Egypt is highlighted as a positive example of progress in this regard.

  12. Psychological stress and adjustment in pregnancy following assisted reproductive technology and spontaneous conception: A systematic review.

    PubMed

    Gourounti, Kleanthi

    2016-01-01

    The aim of this review was to examine studies describing the psychological stress and adjustment in pregnancy after an assisted reproductive technology (ART) treatment. A systematic search of the electronic databases was performed. This review considered only quantitative, primary studies in the English language, published during the period 2000-2014 and relevant to the objective. The population of interest was previously infertile pregnant women. Outcome variables were general anxiety, depressive symptoms, pregnancy-specific anxiety, quality of life, self-esteem, pregnancy attitudes and adjustment, and maternal-fetal attachment. Twenty studies met the inclusion and methodological criteria and were included in the review. The review revealed that compared to women who conceive naturally or to general norms, women who conceive after an in vitro fertilization treatment had greater pregnancy-specific anxiety, poorer quality of life, either the same or less depressive symptomatology, the same level of self-esteem, more positive attitudes toward pregnancy demands, and higher levels of maternal-fetal attachment. However, the evidence regarding the general anxiety levels in pregnancy after an ART treatment was inconclusive. Methodological limitations and differences across studies may explain the inconsistencies in their findings regarding the impact of ART. This review provides an insight into psychological reactions and adjustment in pregnancy after an ART treatment.

  13. Impact of men's dairy intake on assisted reproductive technology outcomes among couples attending a fertility clinic

    PubMed Central

    Xia, Wei; Chiu, Yu-Han; Afeiche, Myriam C.; Williams, Paige L.; Ford, Jennifer B.; Tanrikut, Cigdem; Souter, Irene; Hauser, Russ; Chavarro, Jorge E.

    2015-01-01

    SUMMARY Intake of full-fat dairy has been linked to lower semen quality but whether this leads to decreased fertility is unknown. To address this question, we prospectively evaluated the association of men's dairy intake with treatment outcomes of subfertile couples undergoing assisted reproductive technology (ART). We followed 142 men from couples undergoing infertility treatment with ART at an academic fertility center between 2007 and 2014. Couples completed dietary assessments prior to treatment, and the female partners underwent a total of 248 ART cycles. Multivariable generalized linear mixed models were used to examine the association of dairy intake with fertilization, implantation, clinical pregnancy and live birth rates adjusting for age, body mass index (BMI), smoking status, total exercise time, dietary patterns, alcohol, caffeine, total energy intake, and female dairy intake. Intake of dairy foods, regardless of their fat content, was not associated with fertilization, implantation, clinical pregnancy, or live birth rates. The adjusted live birth rates (95% Confidence Interval) for couples in increasing quartiles of men's dairy intake were 0.42 (0.25, 0.60), 0.25 (0.13, 0.42), 0.26 (0.15, 0.41), and 0.44 (0.27, 0.63) (p, linear trend = 0.73). Results remained similar after adjustment for female partner intake of dairy foods. Overall, men's dairy intake was not associated with treatment outcomes of couples undergoing ART. PMID:26825777

  14. Impact of men's dairy intake on assisted reproductive technology outcomes among couples attending a fertility clinic.

    PubMed

    Xia, Wei; Chiu, Yu-Han; Afeiche, Myriam C; Williams, Paige L; Ford, Jennifer B; Tanrikut, Cigdem; Souter, Irene; Hauser, Russ; Chavarro, Jorge E

    2016-03-01

    Intake of full-fat dairy has been linked to lower semen quality but whether this leads to decreased fertility is unknown. To address this question, we prospectively evaluated the association of men's dairy intake with treatment outcomes of subfertile couples undergoing assisted reproductive technology (ART). We followed 142 men from couples undergoing infertility treatment with ART at an academic fertility centre between 2007 and 2014. Couples completed dietary assessments prior to treatment, and the female partners underwent a total of 248 ART cycles. Multivariable generalized linear mixed models were used to examine the association of dairy intake with fertilization, implantation, clinical pregnancy and live birth rates adjusting for age, body mass index, smoking status, total exercise time, dietary patterns, alcohol, caffeine, total energy intake, and female dairy intake. Intake of dairy foods, regardless of their fat content, was not associated with fertilization, implantation, clinical pregnancy or live birth rates. The adjusted live birth rates (95% confidence interval) for couples in increasing quartiles of men's dairy intake were 0.42 (0.25, 0.60), 0.25 (0.13, 0.42), 0.26 (0.15, 0.41), and 0.44 (0.27, 0.63) (p linear trend = 0.73). Results remained similar after adjustment for female partner intake of dairy foods. Overall, men's dairy intake was not associated with treatment outcomes of couples undergoing ART.

  15. The effect of the 2004 Italian law on outcomes of assisted reproduction technology in severe male factor infertility.

    PubMed

    La Sala, G B; Nicoli, A; Capodanno, F; Rondini, I; Villani, M T; Iannotti, F

    2010-01-01

    The Italian law regulating assisted reproductive technologies that came into force in 2004 restricts the number of fertilized oocytes per cycle to three, obliges the subsequent transfer of all resulting embryos and prohibits the freezing of surplus embryos. This study evaluates the impact of the law on severe oligozoospermic, cryptozoospermic, obstructive azoospermic and non-obstructive azoospermic patients. Intracytoplasmic sperm injection outcomes of 1066 cycles performed in the 4years before the passing of the law were compared with 804 cycles performed in the 4years after the law came to pass. Globally, analysis of clinical and obstetric outcomes showed a significant decrease in terms of pregnancy and delivery rates per cycle (17.8% versus 10.9% and 14.2% versus 8.5%, respectively) and per embryo transfer (18.8% versus 13.8% and 15.0% versus 10.7%, respectively), and a significant drop in multiple deliveries (35.1% versus 17.6%) in the post-law period. Cryptozoospermic and azoospermic couples were affected by the Italian law more than severe oligozoospermic couples. The results showed that the Italian law limits the efficiency of assisted reproduction treatment in couples with severe male factor. It is hoped that the Italian assisted reproductive technologies law is altered as soon as possible, allowing the insemination of more than three oocytes.

  16. Association between serum folate and vitamin B-12 and outcomes of assisted reproductive technologies1

    PubMed Central

    Gaskins, Audrey J; Chiu, Yu-Han; Williams, Paige L; Ford, Jennifer B; Toth, Thomas L; Hauser, Russ; Chavarro, Jorge E

    2015-01-01

    Background: Preconceptional folate and vitamin B-12 have been linked to beneficial reproductive outcomes in both natural pregnancies and those after assisted reproductive technology (ART) treatment. Objective: The objective of the study was to evaluate the associations of serum folate and vitamin B-12 with ART outcomes. Design: This analysis included a random sample of 100 women (154 ART cycles) participating in a prospective cohort study [Environment and Reproductive Health (EARTH)] at the Massachusetts General Hospital Fertility Center (2007–2013). Serum folate and vitamin B-12 were measured in blood samples collected between days 3 and 9 of treatment. Generalized estimating equations with adjustment for age, BMI, and race were used to evaluate the association of serum folate and vitamin B-12 with ART outcomes. Results: Women in the highest quartile of serum folate (>26.3 ng/mL) had 1.62 (95% CI: 0.99, 2.65) times the probability of live birth compared with women in the lowest quartile (<16.6 ng/mL). Women in the highest quartile of serum vitamin B-12 (>701 pg/mL) had 2.04 (95% CI: 1.14, 3.62) times the probability of live birth compared with women in the lowest quartile (<439 pg/mL). Suggestive evidence of an interaction was observed; women with serum folate and vitamin B-12 concentrations greater than the median had 1.92 (95% CI: 1.12, 3.29) times the probability of live birth compared with women with folate and vitamin B-12 concentrations less than or equal to the median. This translated into an adjusted difference in live birth rates of 26% (95% CI: 10%, 48%; P = 0.02). Conclusion: Higher serum concentrations of folate and vitamin B-12 before ART treatment were associated with higher live birth rates among a population exposed to folic acid fortification. This trial was registered at clinicaltrials.gov as NCT00011713. PMID:26354529

  17. Oncofertility Program Implementation Increases Access to Fertility Preservation Options and Assisted Reproductive Procedures for Breast Cancer Patients

    PubMed Central

    VU, JOCELINE V.; LLARENA, NATALIA C.; ESTEVEZ, SAMANTHA L.; MORAVEK, MOLLY B.; JERUSS, JACQUELINE S.

    2017-01-01

    Background and Objectives Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. Methods An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007–2012, after program initiation. The study included women <45, stages 0–III, diagnosed before (n =278) and after (n =515) program initiation. Results Demographics for the cohorts were similar. Fertility discussions (P <0.0001), patients interested in maintaining fertility at diagnosis (P =0.0041), referrals to reproductive endocrinologists (P <0.0001), appointments (P <0.0001), and fertility preservation procedures (P <0.0183) increased significantly after programmatic implementation. Conclusions An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. PMID:27966219

  18. Examining Differences in Psychological Adjustment Problems among Children Conceived by Assisted Reproductive Technologies

    ERIC Educational Resources Information Center

    Shelton, Katherine H.; Boivin, Jacky; Hay, Dale; van den Bree, Marianne B. M.; Rice, Frances J.; Harold, Gordon T.; Thapar, Anita

    2009-01-01

    The aim of this study was to examine whether there was variation in levels of psychological adjustment among children conceived through Assisted Reproductive Technologies using the parents' gametes (homologous), sperm donation, egg donation, embryo donation and surrogacy. Information was provided by parents about the psychological functioning of…

  19. The Doctor's Dilemma: Paternalisms in the Medicolegal History of Assisted Reproduction and Abortion.

    PubMed

    Swanson, Kara W

    2015-01-01

    This article analyzes the comparative history of the law and practice of abortion and assisted reproduction in the United States to consider the interplay between medical paternalism and legal paternalism. It supplements existing critiques of paternalism as harmful to women's equality with the medical perspective, as revealed through the writings of Alan F. Guttmacher, to consider when legal regulation might be warranted.

  20. Families Created by Assisted Reproduction: Parent-Child Relationships in Late Adolescence

    ERIC Educational Resources Information Center

    Owen, Lucy; Golombok, Susan

    2009-01-01

    This paper presents the findings of the third phase of a longitudinal study of families created by assisted reproduction. The quality of parent-child relationships was examined close to the adolescent's 18th birthday in 26 "in vitro" fertilization (IVF) families and 26 donor insemination (DI) families in comparison with 38 adoptive families and 63…

  1. Joint reproductive autonomy: does Evans v Amicus Healthcare Ltd provide for a gender-neutral approach to assisted reproductive rights?

    PubMed

    Allin, Michael J

    2015-06-01

    Assisted reproductive technology encompasses methods of achieving pregnancy by artificial or partially artificial means. Whilst these methods are more commonly used by couples suffering from problems of infertility, some forms of assistance are employed by fertile couples, for example pre-implantation genetic diagnosis. The overall regulatory framework in the UK is predominantly found in the Human Fertilisation and Embryology Act 1990. The usual rules relating to consent and autonomy apply and were discussed in depth in Evans v Amicus Healthcare Ltd and later in Evans v United Kingdom. This paper considers whether the Evans litigation envisages the possibility of further encouraging joint autonomy in the use of zygotes and whether there is a continuing right to autonomy by the party not bearing the pregnancy.

  2. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy

    PubMed Central

    Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

    2013-01-01

    In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation – ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and

  3. Assisted reproduction causes placental maldevelopment and dysfunction linked to reduced fetal weight in mice

    PubMed Central

    Chen, Shuqiang; Sun, Fang-zhen; Huang, Xiuying; Wang, Xiaohong; Tang, Na; Zhu, Baoyi; Li, Bo

    2015-01-01

    Compelling evidence indicates that stress in utero, as manifested by low birth weight (LBW), increases the risk of metabolic syndrome in adulthood. Singletons conceived by assisted reproductive technology (ART) display a significant increase in LBW risk and ART offspring have a different metabolic profile starting at birth. Here, used mouse as a model, we found that ART resulted in reduced fetal weight and placental overgrowth at embryonic day 18.5 (E18.5). The ART placentae exhibited histomorphological alterations with defects in placental layer segregation and glycogen cells migration at E18.5. Further, ART treatments resulted in downregulation of a majority of placental nutrient transporters and reduction in placental efficiency. Moreover, the ART placentae were associated with increased methylation levels at imprinting control regions of H19, KvDMR1 and disrupted expression of a majority of imprinted genes important for placental development and function at E18.5. Our results from the mouse model show the first piece of evidence that ART treatment could affect fetal growth by disrupting placental development and function, suggests that perturbation of genomic imprinting resulted from embryo manipulation may contribute to these problems. PMID:26085229

  4. Assisted reproduction in Indonesia: policy reform in an Islamic culture and developing nation.

    PubMed

    Purvis, Taylor E

    2015-11-01

    This article considers how religious and economic factors shape assisted reproductive technology (ART) policy in Indonesia, the world's most populous Muslim country. Infertility clinic policies are grounded on both the views of the country's powerful Islamic coalition and those of the worldwide Islamic community. Indonesian government officials, physicians, and Islamic scholars have expressed concern over who can use ART and which procedures can be performed. Indonesia has also faced economic challenges related to ART, including inadequate health insurance coverage, inequitable access to ART, and maintenance of expensive ART infrastructure. The prohibitive price of infertility treatment and regional differences in the provision of health care prohibit most Indonesians from obtaining ART. In the absence of a shift in religious mores and a rapid reduction in poverty and inequality, Indonesia will need to adopt creative means to make ART both more available and less necessary as a solution to infertility. This paper suggests policy reforms to promote more affordable treatment methods and support preventative health programmes to reduce infertility rates. This country-specific analysis of the laws and customs surrounding ART in Indonesia reveals that strategies to reduce infertility must be tailored to a country's unique religious and economic climate.

  5. How old is too old? A contribution to the discussion on age limits for assisted reproduction technique access.

    PubMed

    Kocourková, Jiřina; Konečná, Hana; Burcin, Boris; Kučera, Tomáš

    2015-05-01

    In 2012, the Czech Republic established the women's age limit for access to assisted reproduction techniques at age 49 years. In this paper, the acceptability of this age limit from the children's perspective in the Czech Republic is assessed. Although the necessity of balancing the interests of parents and children is acknowledged, little research has taken children's interests into account. We have attempted to map out 'children's interests', asking older children and adolescents (aged 11-25 years) how old they would prefer their parents to be: Czech respondents would prefer to have younger parents. This finding is consistent with the optimal biological childbearing age rather than with the current postponement to a later age. So far, assisted reproduction techniques have been largely regarded as a medical treatment justifying the current women's age limit of 49 years. Had the children's perspective been taken into account, this age limit might have been lower than 49 years. We propose that reproductive health policy should adequately reflect multiple perspectives as an integral part of a multi-layered support system of a society.

  6. Effect of Antioxidants (β-mercaptoethanol and Cysteamine) on Assisted Reproductive Technology In vitro

    PubMed Central

    Nikseresht, Mohsen; Toori, Mehdi Akbartabar; Rahimi, Hamid Reza; Fallahzadeh, Ali Reza; Kahshani, Iraj Ragerdi; Hashemi, Seyedeh Fatemeh; Bahrami, Solmaz

    2017-01-01

    Introduction Oocyte Culture of Germinal Vesicle (GV) and its growth improves Assisted Reproductive Technology (ART) invitro and infertility. Inappropriate culture medium environment, low quality of oocytes, increase in Oxidative Stress (OS) events, Reactive Oxygen Species (ROS) and free radicals production are the main factors that result in unsuccessful Invitro Maturation (IVM) and decrease in reproduction. Aim The present study was conducted with the aim to evaluate the effect of β-mercaptoethanol (BME) and Cysteamine (CYS) on IVM improvement, embryo fertilization and development of blastocyst of mouse immature oocyte. Materials and Methods Oocytes were obtained from 4-6 weeks old Naval Medical Research Institute (NMRI) female mice, 48 hours after stimulation with Intraperitoneal (IP) injection of 10 IU Pregnant Mare Serum Gonadotropin (PMSG). GV oocyte with and without cumulus cells were isolated from ovaries and cultured in Tissue Culture Medium (TCM) 199 with availability of 100 μM of antioxidants (BME and CYS). After 24 hours, mature oocyte in metaphase II (MII) were fertilized with sperm in In vitro Fertilization (IVF) medium (T6) and evaluated for fetal development into blastocyst. Results BME and CYS could significantly (p<0.05) increase the rate of IVM and oocyte evolution, and embryo formation in medium culture. Furthermore, it is demonstrated that existence of Cumulus Oocyte Complexes (COC) significantly showed better IVM, fertilization and evolution trend as compared to oocytes without cumulus cover or Denuded Oocytes (DO), especially in TCM199 plus BME and CYS. So that the change in GV stage oocytes to MII (maturation rate), fertilization rates or 2PN formation, and two cell embryos formation or blastocyst development rate in the treatment group with addition of BME & CYS and COC was statistically significant as compared to the DO group (p-value < 0.0001). Conclusion Both cellular and environmental factors could be important and involved in ART

  7. The future potential of cryopreservation for assisted reproduction.

    PubMed

    Song, Ying; Sharp, Randy; Lu, Fenghua; Hassan, Maliha

    2010-07-01

    Cryopreservation of human gonadal tissue and oocytes has brought about new and exciting research in reproductive medicine, as well as new cryopreservation techniques that are dramatically improving post-thaw viability and freezing damage. The work done on gonadal tissues is aimed at improving the quality of life for infertile patients and for prepubertal patients undergoing gonadotoxic chemotherapy, patients for whom hormonal stimulation/IVF is not an option, and women without partners. Cryopreservation of mature oocytes is the best model for timing IVF. Vitrification is likely to benefit the field, and since 2005, implantation and pregnancy rates from vitrified oocytes have matched or eclipsed results from conventional methods, due to new cell-specific methods and formulas. Cryopreservation of immature oocytes leads to a new direction of egg banking in future. Preserving ovarian tissue for autografting is still promising and has resulted in folliculogenesis, resumed hormone production and live births in limited cases. The use of small cortical blocks, or mechanical/chemical digestion of ovarian tissue for isolation of follicles is a new direction for ovary preservation for reasons of cryoprotectant permeation and graft revascularization. Maturation of follicles in vitro has become more feasible with the use of alginate microencapsulation. Testicular tissue preservation has taken a sharp turn towards preservation of gonadal stem cells. Research into the mechanism for spermatogenesis points to the ability for male germ cells to resume spermatogenesis. The cryopreservation of minced testicular tissue for isolation of germ cells via chemical digestion has produced viable cells, however, structural damage that may be avoided by vitrification has been noted to the surrounding cell junctions and supporting cells.

  8. Severe Maternal Morbidity and the Use of Assisted Reproductive Technology in Massachusetts

    PubMed Central

    Belanoff, Candice; Declercq, Eugene R.; Diop, Hafsatou; Gopal, Daksha; Kotelchuck, Milton; Luke, Barbara; Nguyen, Thien; Stern, Judy E.

    2016-01-01

    Objectives To assess whether risk of severe maternal morbidity at delivery differed for women who conceived using assisted reproductive technology (ART), those with indicators of subfertility but no ART (“subfertile”), and those who had neither ART nor subfertility (“fertile”). Methods This retrospective cohort study was part of the larger Massachusetts Outcomes Study of Assisted Reproductive Technology (MOSART). To construct the MOSART database and identify ART deliveries, we linked ART treatment records to birth certificates and maternal and infant hospitalization records occurring in Massachusetts between 2004 and 2010. An algorithm of ICD-9-CM diagnosis and procedure codes identified severe maternal morbidity. We used Logistic Generalized Estimating Equations to estimate odds of severe maternal morbidity associated with fertility status, adjusting for maternal demographic and health factors and gestational age, stratifying on plurality and method of delivery. Results The prevalence of severe maternal morbidity among this population (n = 458,918) was 1.16%. The overall, crude prevalences of severe maternal morbidity among fertile, subfertile and ART deliveries were 1.09%, 1.44% and 3.14%, respectively. The most common indicator of severe maternal morbidity was blood transfusion. In multivariable analyses, among singletons, ART was associated with increased odds of severe maternal morbidity compared to both fertile (Vaginal: aOR 2.27, 95% CI: 1.78 – 2.88; cesarean: aOR 1.67, 95% CI: 1.40 – 1.98, respectively) and subfertile (vaginal: aOR 1.97, 95% CI: 1.30 – 3.00; cesarean: aOR 1.75, 95% CI: 1.30 – 2.35, respectively) deliveries. Among twins, only cesarean ART deliveries had significantly greater severe maternal morbidity compared to cesarean fertile deliveries (aOR 1.48, 95% CI: 1.14, 1.93). Conclusions Women who conceive through ART may have elevated risk severe maternal morbidity at delivery, largely indicated by blood transfusion, even when

  9. Outcome of Assisted Reproductive Technology (ART) and Subsequent Self-Reported Life Satisfaction

    PubMed Central

    Kuivasaari-Pirinen, Paula; Koivumaa-Honkanen, Heli; Hippeläinen, Maritta; Raatikainen, Kaisa; Heinonen, Seppo

    2014-01-01

    Objective To compare life satisfaction between women with successful or unsuccessful outcome after assisted reproductive treatment (ART) by taking into account the time since the last ART. Design Cohort study. Setting Tertiary hospital. Patients A total of 987 consecutive women who had undergone ART during 1996–2007 were invited and altogether 505 women participated in the study. Interventions A postal enquiry with a life satisfaction scale. Main Outcome Measure Self-reported life satisfaction in respect to the time since the last ART. Results In general, women who achieved a live birth after ART had a significantly higher life satisfaction than those who had unsuccessful ART, especially when compared in the first three years. The difference disappeared in the time period of 6–9 years after ART. The unsuccessfully treated women who had a child by some other means before or after the unsuccessful ART had comparable life satisfaction with successfully treated women even earlier. Conclusions Even if unsuccessful ART outcome is associated with subsequent lower level of life satisfaction, it does not seem to threaten the long-term wellbeing. PMID:25393846

  10. Increased Length of Awareness of Assisted Reproductive Technologies Fosters Positive Attitudes and Acceptance among Women

    PubMed Central

    Fortin, Chelsea; Abele, Susanne

    2016-01-01

    Background The field of infertility medicine has witnessed a surge of scientific developments in recent years, but research on public attitudes towards infertility treatments has remained minimal. This study examined the social and demographic factors that affect women’s attitudes towards assisted reproductive technology (ART) in general, as well as their opinions of specific issues related to ART. Materials and Methods This cross-sectional study was conducted from March 2011 to April 2011 by means of an online survey administered to a sample of 287 women. Results Women with a longer length of awareness of ART had significantly greater attitudinal favorability towards ART. Political affiliation was also significantly related to general attitudes, as well as several specific aspects of ART issues. Conclusion The results of this study suggest that several factors influence attitudes that women hold in regards to ART. Identifying some of these factors serves as a crucial starting point for devising strategies to increase public acceptance of ART. PMID:27110326

  11. Assisted Reproductive Technology in Iran: The First National Report on Centers, 2011

    PubMed Central

    Abedini, Mehrandokht; Ghaheri, Azadeh; Omani Samani, Reza

    2016-01-01

    Background: Due to the worldwide increase in infertility, it is both necessary and important to have assisted reproductive technology (ART) registries. In Iran, donation and surrogacy programs are approved by decrees from religious scholars. ART has been used since 1984 in Iran and the first Iranian infant conceived by gamete intra-fallopian transfer (GIFT) was born in 1989. This report, however, is the first national report on Iranian ART centers. Materials and Methods: This cross-sectional study, conducted under the supervision of the Iranian Ministry of Health, presented a summary of the numbers and percentages of centers that provided infertility services in Iran, as well as the status of ART in Iran during 2011. Results: A total of 52 centers reported treatment cycles and performed approximately 29000 intrauterine insemination (IUI), in addition to 35000 in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) cycles. Conclusion: Iran has considerable potential to provide IVF services for both Iranians as well as other nationalities throughout the region. This proves the need for a national center that will implement a registry system. PMID:27695610

  12. Risk of Chromosomal Abnormalities in Early Spontaneous Abortion after Assisted Reproductive Technology: A Meta-Analysis

    PubMed Central

    Qin, Jun-Zhen; Pang, Li-Hong; Li, Min-Qing; Xu, Jing; Zhou, Xing

    2013-01-01

    Background Studies on the risk of chromosomal abnormalities in early spontaneous abortion after assisted reproductive technology (ART) are relatively controversial and insufficient. Thus, to obtain a more precise evaluation of the risk of embryonic chromosomal abnormalities in first-trimester miscarriage after ART, we performed a meta-analysis of all available case–control studies relating to the cytogenetic analysis of chromosomal abnormalities in first-trimester miscarriage after ART. Methods Literature search in the electronic databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) based on the established strategy. Meta-regression, subgroup analysis, and Galbraith plots were conducted to explore the sources of heterogeneity. Results A total of 15 studies with 1,896 cases and 1,186 controls relevant to the risk of chromosomal abnormalities in first- trimester miscarriage after ART, and 8 studies with 601 cases and 602 controls evaluating frequency of chromosome anomaly for maternal age≥35 versus <35 were eligible for the meta-analysis. No statistical difference was found in risk of chromosomally abnormal miscarriage compared to natural conception and the different types of ART utilized, whereas the risk of fetal aneuploidy significantly increased with maternal age≥35 (OR 2.88, 95% CI: 1.74–4.77). Conclusions ART treatment does not present an increased risk for chromosomal abnormalities occurring in a first trimester miscarriage, but incidence of fetal aneuploidy could increase significantly with advancing maternal age. PMID:24130752

  13. States Monitoring Assisted Reproductive Technology (SMART) Collaborative: data collection, linkage, dissemination, and use.

    PubMed

    Mneimneh, Allison S; Boulet, Sheree L; Sunderam, Saswati; Zhang, Yujia; Jamieson, Denise J; Crawford, Sara; McKane, Patricia; Copeland, Glenn; Mersol-Barg, Michael; Grigorescu, Violanda; Cohen, Bruce; Steele, JoAnn; Sappenfield, William; Diop, Hafsatou; Kirby, Russell S; Kissin, Dmitry M

    2013-07-01

    Assisted reproductive technology (ART) refers to fertility treatments in which both eggs and sperm are handled outside the body. The Centers for Disease Control and Prevention (CDC) oversees the National ART Surveillance System (NASS), which collects data on all ART procedures performed in the United States. The NASS, while a comprehensive source of data on ART patient demographics and clinical procedures, includes limited information on outcomes related to women's and children's health. To examine ART-related health outcomes, CDC and three states (Massachusetts, Florida, and Michigan) established the States Monitoring ART (SMART) Collaborative to evaluate maternal and perinatal outcomes of ART and improve state-based ART surveillance. To date, NASS data have been linked with states' vital records, disease registries, and hospital discharge data with a linkage rate of 90.2%. The probabilistic linkage methodology used in the SMART Collaborative has been validated and found to be both accurate and efficient. A wide breadth of applied research within the Collaborative is planned or ongoing, including examinations of the impact of insurance mandates on ART use as well as the relationships between ART and birth defects and cancer, among others. The SMART Collaborative is working to improve state-based ART surveillance by developing state surveillance plans, establishing partnerships, and conducting data analyses. The SMART Collaborative has been instrumental in creating linked datasets and strengthening epidemiologic and research capacity for improving maternal and infant health programs and evaluating the public health impact of ART.

  14. Obstetric outcomes of monochorionic pregnancies conceived following assisted reproductive technology: A retrospective study

    PubMed Central

    Mascarenhas, Mariano; Kamath, Mohan S.; Muthukumar, K; Mangalaraj, Ann M.; Chandy, Achamma; Aleyamma, TK

    2014-01-01

    OBJECTIVES: The overwhelming numbers of twins following assisted reproductive technology (ART) are dichorionic twins, but monochorionic twins account for around 0.9% of post ART pregnancies. The data for post ART-monochorionic pregnancy outcomes are scarce due to the rarity of this condition. Hence, we evaluated the obstetric outcomes of monochorionic and dichorionic pregnancies conceived on ART. SETTINGS: University teaching hospital. STUDY DESIGN: A case–control study of monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) pregnancies conceived following ART treatment. Charts of all women who conceived following ART from 2008 to 2013 were screened. Among them, the monochorionic twins diagnosed in the first trimester were included and their obstetric outcome was followed-up. For comparison, an equal number of dichorionic twin pregnancies from age and body mass index matched mothers was selected. RESULTS: The baseline clinical characteristics were similar between the two groups. MCDA group had a higher miscarriage rate (50%) than the DCDA group (10%), with three seconds trimester miscarriages in the MCDA group. The live birth rates were lower in the MCDA versus DCDA group (40% vs. 90%). Among triplet pregnancies with a monochorionic component, the live birth rate was only 25%. CONCLUSIONS: Monochorionic pregnancies following ART have poorer obstetric outcomes when compared to dichorionic pregnancies. For monochorionic pregnancies following ART, intensive antenatal surveillance at a tertiary level obstetric and neonatal center may help optimize the outcome. PMID:25191025

  15. Short and long term outcomes of children conceived with assisted reproductive technology.

    PubMed

    Turkgeldi, Engin; Yagmur, Hande; Seyhan, Ayse; Urman, Bulent; Ata, Baris

    2016-12-01

    Despite their wide and global use, possible short and long-term effects of fertility treatments on children is not well-established. In this review, birth defects and perinatal complications and their relationship with assisted reproductive technology (ART), along with long-term effects of ART on cardiovascular system, metabolism, behavior, cognitive skills, and childhood cancers are discussed. Children conceived through ART are at increased risk for birth defects and perinatal complications such as preterm delivery, low birth weight and small for gestational age. Parental characteristics, underlying infertility etiology and ART procedures themselves may contribute to this. The long-term effects of ART are difficult to establish. Studies so far report that ART children have normal social, emotional, cognitive, and motor functions. Likewise, despite some minor inconsistencies in some studies, they do not seem to be at increased risk for childhood cancers. However, there are a number of studies that imply vascular system may be adversely affected by ART and its possible consequences should be further investigated with follow up studies. Large scale studies with long-term follow up periods are required to determine the effects of ART on conceived children.

  16. Committee Opinion No 671 Summary: Perinatal Risks Associated With Assisted Reproductive Technology.

    PubMed

    2016-09-01

    Over the past decades, the use of assisted reproductive technology (ART) has increased dramatically worldwide and has made pregnancy possible for many infertile couples. Although the perinatal risks that may be associated with ART and ovulation induction are much higher in multifetal gestations, even singletons achieved with ART and ovulation induction may be at higher risk than singletons from naturally occurring pregnancies. However, it remains unclear to what extent these associations might be related to the underlying cause(s) of infertility. Before initiating ART or ovulation induction procedures, obstetrician-gynecologists and other health care providers should complete a thorough medical evaluation to ensure that patients are in good health and should counsel these women about the risks associated with treatment. Any maternal health problems or inherited conditions should be addressed. Couples at risk of passing genetic conditions on to their offspring, including those due to infertility-associated conditions, should be counseled appropriately. When a higher-order (triplet or more) multifetal pregnancy is encountered, the option of multifetal reduction should be discussed. In the case of a continuing higher-order multifetal pregnancy, ongoing obstetric care should be with an obstetrician-gynecologist or other obstetric care provider and at a facility capable of managing anticipated risks and outcomes.

  17. Committee Opinion No 671: Perinatal Risks Associated With Assisted Reproductive Technology.

    PubMed

    2016-09-01

    Over the past decades, the use of assisted reproductive technology (ART) has increased dramatically worldwide and has made pregnancy possible for many infertile couples. Although the perinatal risks that may be associated with ART and ovulation induction are much higher in multifetal gestations, even singletons achieved with ART and ovulation induction may be at higher risk than singletons from naturally occurring pregnancies. However, it remains unclear to what extent these associations might be related to the underlying cause(s) of infertility. Before initiating ART or ovulation induction procedures, obstetrician-gynecologists and other health care providers should complete a thorough medical evaluation to ensure that patients are in good health and should counsel these women about the risks associated with treatment. Any maternal health problems or inherited conditions should be addressed. Couples at risk of passing genetic conditions on to their offspring, including those due to infertility-associated conditions, should be counseled appropriately. When a higher-order (triplet or more) multifetal pregnancy is encountered, the option of multifetal reduction should be discussed. In the case of a continuing higher-order multifetal pregnancy, ongoing obstetric care should be with an obstetrician-gynecologist or other obstetric care provider and at a facility capable of managing anticipated risks and outcomes.

  18. Endometriosis-Related Infertility: The Role of the Assisted Reproductive Technologies

    PubMed Central

    Surrey, Eric S.

    2015-01-01

    The assisted reproductive technologies, particularly in vitro fertilization (IVF), represent the most efficient and successful means of overcoming infertility associated with endometriosis. Although older studies suggest that IVF outcomes are compromised in endometriosis patients, more contemporary reports show no differences compared to controls. The exception may be evidence of poorer outcomes and diminished ovarian response in women with advanced disease, particularly those with significant ovarian involvement or prior ovarian surgery. Prolonged pre-IVF cycle suppressive medical therapy, particularly gonadotropin releasing hormone agonists, appears to improve success rates in a subset of endometriosis patients. However, as of yet, there is no diagnostic marker to specifically identify those who would most benefit from this approach. Pre-IVF cycle surgical resection of nonovarian disease has not been consistently shown to improve outcomes with the possible exception of resection of deeply invasive disease, although the data is limited. Precycle resection of ovarian endometriomas does not have benefit and should only be performed for gynecologic indications. Indeed, there is a large body of evidence to suggest that this procedure may have a deleterious impact on ovarian reserve and response. A dearth of appropriately designed trials makes development of definitive treatment paradigms challenging. PMID:26240824

  19. Investigation of Personality Traits between Infertile Women Submitted to Assisted Reproductive Technology or Surrogacy

    PubMed Central

    Asgari, Najmeh; Yazdkhasti, Fariba; Nasr Esfahani, Mohammad Hossein

    2016-01-01

    Background Personality traits affect human relationships, social interactions, treatment procedures, and essentially all human activities. The purpose of this study is to investigate the personality traitsincluding sensation seeking, flexibility, and happiness among a variety of infertile women who were apt to choose assisted reproductive technology (ART) or surrogacy. Materials and Methods This is a cross-sectional study that was performed on 251 infertile women who visited Isfahan and Tehran Reproductive Medicine Center. These fertility clinics are located in Isfahan and Tehran, Iran. In this study, 201 infertile women who underwent treatment using ART and 50 infertile women who tended to have surrogacy were chosen by convenience sampling. Zuckerman’s Sensation Seeking Scale Form V (SSS-V), Psychological Flexibility Questionnaire (adapted from NEO Personality Inventory-Revised) and Oxford Happiness Questionnaire (OHQ) were used as research instruments. All participants had to complete the research instruments in order to be included in this study. Data were analyzed by descriptive-analytical statistics and statistical tests including multivariate analysis of variance (MANOVA) and Z Fisher. Statistically significant effects were accepted for P<0.05. Results In the sensation-seeking variable, there was a meaningful difference between under-study groups. However, the flexibility and happiness variables did not have a significant difference between under-study groups (P<0.001). Interaction between education, employment, and financial status was effective in happiness of infertile women underwent ART (P<0.05), while age, education and financial status were also effective in happiness of infertile women sought surrogacy (P<0.05). A positive meaningful relationship was seen between sensation seeking and flexibility variables in both groups (P<0.05). And a negative meaningful relationship was seen between sensation seeking and happiness in infertile women who sought

  20. Funding fertility: issues in the allocation and distribution of resources to assisted reproduction technologies.

    PubMed

    Devlin, Nancy; Parkin, David

    2003-05-01

    The appropriate level and source of funds for assisted reproduction technologies (ARTs), in particular IVF, have been controversial in most developed economies. Funding of fertility services internationally is characterized by low public (or other third party) funding, a greater reliance on user-pays than in most other health services, and variations in funding and provision. This article describes the characteristics of infertility as a condition and its treatment that have been used as a rationale for its exclusion from an otherwise comprehensive coverage of health services. The challenges these characteristics pose for the use of economic evaluation to inform resource allocation are discussed. Most economic evaluations have focused on the cost effectiveness of alternative infertility treatments. These evaluations provide important information, but do not inform the real issue at stake: what is the appropriate allocation of funds to ARTs, given that it involves sacrificing improvements in health in other areas? Cost utility analysis - the method of economic appraisal preferred by most agencies charged with making such decisions (including the National Institute of Clinical Excellence in the UK) - is ill-equipped to deal with the benefits produced by ARTs. Alternative methods are available, but require decision makers to weigh up very different sorts of evidence. Demonstration of the willingness to pay for the benefits of ARTs can be used to support public decisions but, conversely, also implies that those who can pay will pay in a private market. Ultimately, decisions about the inclusion or otherwise of ARTs in collectively funded health systems probably rest as much on judgments about equity in access as value for money. Given that this is the case, public funding of IVF should be accompanied by the development of agreed criteria for the prioritization of potential recipients, to ensure treatment is targeted at those for whom it is most effective and that access

  1. Early embryonic development, assisted reproductive technologies, and pluripotent stem cell biology in domestic mammals.

    PubMed

    Hall, V; Hinrichs, K; Lazzari, G; Betts, D H; Hyttel, P

    2013-08-01

    Over many decades assisted reproductive technologies, including artificial insemination, embryo transfer, in vitro production (IVP) of embryos, cloning by somatic cell nuclear transfer (SCNT), and stem cell culture, have been developed with the aim of refining breeding strategies for improved production and health in animal husbandry. More recently, biomedical applications of these technologies, in particular, SCNT and stem cell culture, have been pursued in domestic mammals in order to create models for human disease and therapy. The following review focuses on presenting important aspects of pre-implantation development in cattle, pigs, horses, and dogs. Biological aspects and impact of assisted reproductive technologies including IVP, SCNT, and culture of pluripotent stem cells are also addressed.

  2. Potential Influence of the Microbiome on Infertility and Assisted Reproductive Technology

    PubMed Central

    Sirota, Ido; Zarek, Shvetha M.; Segars, James H.

    2014-01-01

    Although an altered vaginal microbiota has been demonstrated to affect parturition, its role in assisted reproductive technologies is uncertain. Nevertheless, the effect of known pathogens such as Mycoplasma tuberculosis, Chlamydia trachomatis, and Neisseria gonorrhoeae is clear, causing subclinical changes thought to be risk factors in subfertility. The Human Microbiome Project (HMP) has allowed for metagenomic studies to aid in characterizing normal vaginal flora. Recent findings from the HMP demonstrate that many different species of Lactobacillus are present in the vaginal tract, with a few that predominate. Studies that characterize the vaginal microbiome in assisted reproductive technology support the hypothesis that colonizing the transfer-catheter tip with Lactobacillus crispatus at the time of embryo transfer may increase the rates of implantation and live birth rate while decreasing the rate of infection. In addition, there is some evidence that a progesterone-resistant endometrium might increase the risk of an abnormal vaginal microbiome. PMID:24390919

  3. Zika virus infection and biological treatment for reproductive medicine.

    PubMed

    Kwak-Kim, Joanne; Song, Jeehey; Kim, Michael Woo-Il; Gilman-Sachs, Alice

    2017-02-01

    The recent Zika virus (ZIKV) epidemic is particularly challenging in the field of reproductive medicine as various biological tissues and byproducts, such as intravenous immunoglobulin G or cells are utilized during reproductive cycles, and an infected mother has an increased risk of having babies with fetal microcephaly and other congenital brain anomalies. In this review, current guidelines for prevention of sexual transmission of ZIKV, ZIKV testing, and tissue and blood product usages are summarized for physicians caring for those planning pregnancy or going through infertility treatment.

  4. Intrapartum interventions for singleton pregnancies arising from assisted reproductive technologies.

    PubMed

    Sun, Lu-Ming; Lanes, Andrea; Kingdom, John C P; Cao, Huiling; Kramer, Michael; Wen, Shi Wu; Wu, Junqing; Chen, Yue; Walker, Mark C

    2014-09-01

    Objectif : Déterminer si les grossesses monofœtales attribuables aux techniques de procréation assistée (TPA) sont associées à une hausse du recours à des interventions intrapartum, par comparaison avec les grossesses monofœtales spontanées. Méthodes : Au total, 1 327 grossesses attribuables aux TPA et 5 222 grossesses spontanées s’étant déroulées au cours de la période 2004-2008 ont été extraites du système informatique BORN (Better Outcomes Registry and Network ou, en français, « bons résultats dès la naissance ») de l’Ontario. L’incidence des interventions intrapartum courantes a été comparée et divers systèmes de classification des césariennes ont été utilisés pour en comparer les indications dans le cadre des grossesses monofœtales attribuables aux TPA (avec ou sans injection intracytoplasmique d’un spermatozoïde) et dans le cadre des grossesses monofœtales spontanées. Résultats : Par comparaison avec le groupe « spontanée », le groupe « TPA » présentait une hausse de l’incidence du monitorage fœtal électronique interne (RC, 1,60; IC à 95 %, 1,37 - 1,87), de la rupture artificielle des membranes (RC, 1,39; IC à 95 %, 1,17 - 1,66), de l’accélération du travail au moyen d’oxytocine (RC, 1,51; IC à 95 %, 1,28 - 1,77), du déclenchement du travail (RC, 1,31; IC à 95 %, 1,14 - 1,50) et de la césarienne (RC, 1,40; IC à 95 %, 1,24 - 1,60). Conclusion : Les grossesses monofœtales attribuables aux TPA ont été associées à une utilisation plus fréquente de plusieurs interventions intrapartum, dont la césarienne.

  5. Gasotransmitters in Gametogenesis and Early Development: Holy Trinity for Assisted Reproductive Technology—A Review

    PubMed Central

    Bodart, Jean-Francois; Petr, Jaroslav

    2016-01-01

    Creation of both gametes, sperm and oocyte, and their fusion during fertilization are essential step for beginning of life. Although molecular mechanisms regulating gametogenesis, fertilization, and early embryonic development are still subjected to intensive study, a lot of phenomena remain unclear. Based on our best knowledge and own results, we consider gasotransmitters to be essential for various signalisation in oocytes and embryos. In accordance with nitric oxide (NO) and hydrogen sulfide (H2S) physiological necessity, their involvement during oocyte maturation and regulative role in fertilization followed by embryonic development have been described. During these processes, NO- and H2S-derived posttranslational modifications represent the main mode of their regulative effect. While NO represent the most understood gasotransmitter and H2S is still intensively studied gasotransmitter, appreciation of carbon monoxide (CO) role in reproduction is still missing. Overall understanding of gasotransmitters including their interaction is promising for reproductive medicine and assisted reproductive technologies (ART), because these approaches contend with failure of in vitro assisted reproduction. PMID:27579148

  6. [Genetic engineering and assisted reproduction techniques in man: a framework for sociologic analysis].

    PubMed

    Sánchez Morales, M R

    1999-01-01

    The possibilities opened up by genetic engineering and assisted reproduction techniques require reflection by sociologists and extensive public debate. In view of their potential as factors of social change, evaluation and control are warranted. They can be viable only if transparent and through public co-responsibility, for which an exchange of views is needed between all those who play a part in the development of said techniques. This dialogue must be wholly interdisciplinary and democratic.

  7. Risk and safety management in infertility and assisted reproductive technology (ART): from the doctor's office to the ART procedure.

    PubMed

    de Ziegler, Dominique; Gambone, Joseph C; Meldrum, David R; Chapron, Charles

    2013-12-01

    Risk and safety management (RSM) is receiving increasing attention in medicine, with the goals of reducing medical error and increasing quality of care. The principles and tools of RSM can and should be applied to assisted reproductive technology (ART), a field that has already made significant progress in reducing the undesirable and sometimes dangerous consequences of treatment. ART is a prime area of medicine to contribute and help to lead the application of RSM and patient safety because it has been ahead of many other fields of medicine in standardizing treatment, certifying and auditing practitioners, and reporting standardized outcomes, and because treatments are applied to otherwise healthy individuals where exposure to risk may be less acceptable.

  8. Soy Intake Modifies the Relation Between Urinary Bisphenol A Concentrations and Pregnancy Outcomes Among Women Undergoing Assisted Reproduction

    PubMed Central

    Mínguez-Alarcón, Lidia; Chiu, Yu-Han; Gaskins, Audrey J.; Souter, Irene; Williams, Paige L.; Calafat, Antonia M.; Hauser, Russ

    2016-01-01

    Context: Experimental data in rodents suggest that the adverse reproductive health effects of bisphenol A (BPA) can be modified by intake of soy phytoestrogens. Whether the same is true in humans is not known. Objective: The purpose of this study was to evaluate whether soy consumption modifies the relation between urinary BPA levels and infertility treatment outcomes among women undergoing assisted reproduction. Setting: The study was conducted in a fertility center in a teaching hospital. Design: We evaluated 239 women enrolled between 2007 and 2012 in the Environment and Reproductive Health (EARTH) Study, a prospective cohort study, who underwent 347 in vitro fertilization (IVF) cycles. Participants completed a baseline questionnaire and provided up to 2 urine samples in each treatment cycle before oocyte retrieval. IVF outcomes were abstracted from electronic medical records. We used generalized linear mixed models with interaction terms to evaluate whether the association between urinary BPA concentrations and IVF outcomes was modified by soy intake. Main Outcome Measure: Live birth rates per initiated treatment cycle were measured. Results: Soy food consumption modified the association of urinary BPA concentration with live birth rates (P for interaction = .01). Among women who did not consume soy foods, the adjusted live birth rates per initiated cycle in increasing quartiles of cycle-specific urinary BPA concentrations were 54%, 35%, 31%, and 17% (P for trend = .03). The corresponding live birth rates among women reporting pretreatment consumption of soy foods were 38%, 42%, 47%, and 49% (P for trend = 0.35). A similar pattern was found for implantation (P for interaction = .02) and clinical pregnancy rates (P for interaction = .03) per initiated cycle, where urinary BPA was inversely related to these outcomes among women not consuming soy foods but unrelated to them among soy consumers. Conclusion: Soy food intake may protect against the adverse

  9. DNA methylation and gene expression changes derived from assisted reproductive technologies can be decreased by reproductive fluids

    PubMed Central

    Canovas, Sebastian; Ivanova, Elena; Romar, Raquel; García-Martínez, Soledad; Soriano-Úbeda, Cristina; García-Vázquez, Francisco A; Saadeh, Heba; Andrews, Simon; Kelsey, Gavin; Coy, Pilar

    2017-01-01

    The number of children born since the origin of Assisted Reproductive Technologies (ART) exceeds 5 million. The majority seem healthy, but a higher frequency of defects has been reported among ART-conceived infants, suggesting an epigenetic cost. We report the first whole-genome DNA methylation datasets from single pig blastocysts showing differences between in vivo and in vitro produced embryos. Blastocysts were produced in vitro either without (C-IVF) or in the presence of natural reproductive fluids (Natur-IVF). Natur-IVF embryos were of higher quality than C-IVF in terms of cell number and hatching ability. RNA-Seq and DNA methylation analyses showed that Natur-IVF embryos have expression and methylation patterns closer to in vivo blastocysts. Genes involved in reprogramming, imprinting and development were affected by culture, with fewer aberrations in Natur-IVF embryos. Methylation analysis detected methylated changes in C-IVF, but not in Natur-IVF, at genes whose methylation could be critical, such as IGF2R and NNAT. DOI: http://dx.doi.org/10.7554/eLife.23670.001 PMID:28134613

  10. DNA methylation and gene expression changes derived from assisted reproductive technologies can be decreased by reproductive fluids.

    PubMed

    Canovas, Sebastian; Ivanova, Elena; Romar, Raquel; García-Martínez, Soledad; Soriano-Úbeda, Cristina; García-Vázquez, Francisco A; Saadeh, Heba; Andrews, Simon; Kelsey, Gavin; Coy, Pilar

    2017-02-01

    The number of children born since the origin of Assisted Reproductive Technologies (ART) exceeds 5 million. The majority seem healthy, but a higher frequency of defects has been reported among ART-conceived infants, suggesting an epigenetic cost. We report the first whole-genome DNA methylation datasets from single pig blastocysts showing differences between in vivo and in vitro produced embryos. Blastocysts were produced in vitro either without (C-IVF) or in the presence of natural reproductive fluids (Natur-IVF). Natur-IVF embryos were of higher quality than C-IVF in terms of cell number and hatching ability. RNA-Seq and DNA methylation analyses showed that Natur-IVF embryos have expression and methylation patterns closer to in vivo blastocysts. Genes involved in reprogramming, imprinting and development were affected by culture, with fewer aberrations in Natur-IVF embryos. Methylation analysis detected methylated changes in C-IVF, but not in Natur-IVF, at genes whose methylation could be critical, such as IGF2R and NNAT.

  11. Assisted reproductive technology in Europe, 2007: results generated from European registers by ESHRE

    PubMed Central

    de Mouzon, J.; Goossens, V.; Bhattacharya, S.; Castilla, J.A.; Ferraretti, A.P.; Korsak, V.; Kupka, M.; Nygren, K.G.; Andersen, A. Nyboe

    2012-01-01

    BACKGROUND This 11th European IVF-monitoring report presents the results of assisted reproductive technology (ART) treatments initiated in Europe during 2007. METHODS From 33 countries, 1029 clinics reported 493 184 treatment cycles: IVF (120 761), ICSI (256 642), frozen embryo replacement (91 145), egg donation (15 731), preimplantation genetic diagnosis/preimplantation genetic screening (4638), in vitro maturation (660) and frozen oocytes replacements (3607). Overall, this represents a 7.6% increase since 2006, mostly related to an increase in all registers. IUI using husband/partner's (IUI-H) and donor (IUI-D) semen was reported from 23 countries: 142 609 IUI-H (+6.2%) and 26 088 IUI-D (+7.2%). RESULTS In 18 countries where all clinics reported, 376 971 ART cycles were performed in a population of 425.6million (886 cycles per million). The clinical pregnancy rates per aspiration and per transfer were 29.1 and 32.8% for IVF, and 28.6 and 33.0% for ICSI. Delivery rate after IUI-H was 10.2% in women aged < 40 years. In IVF/ICSI cycles, 1, 2, 3 and ≥4 embryos were transferred in 21.4, 53.4, 22.7 and 2.5% of cycles, with no decline in the number of embryos per transfer since 2006. The proportion of multiple deliveries (22.3: 21.3% twin and 1.0% triplet), did not decrease compared with 2006 (20.8%) and 2005 (21.8%). In women < 40 years undergoing IUI-H, twin deliveries occurred in 11.7% and triplets in 0.5%. CONCLUSIONS In comparison with previous years, the reported number of ART cycles in Europe increased in 2007; pregnancy rates increased marginally, but the earlier decline in the number of embryos transferred and multiple births did not continue. PMID:22343707

  12. Medical devices; obstetrical and gynecological devices; classification of the assisted reproduction embryo image assessment system. Final order.

    PubMed

    2015-02-26

    The Food and Drug Administration (FDA) is classifying the Assisted Reproduction Embryo Image Assessment System into class II (special controls). The special controls that will apply to the device are identified in this order, and will be part of the codified language for the Assisted Reproduction Embryo Image Assessment System classification. The Agency is classifying the device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device.

  13. Clinical and molecular analyses of Beckwith-Wiedemann syndrome: Comparison between spontaneous conception and assisted reproduction techniques.

    PubMed

    Tenorio, Jair; Romanelli, Valeria; Martin-Trujillo, Alex; Fernández, García-Moya; Segovia, Mabel; Perandones, Claudia; Pérez Jurado, Luis A; Esteller, Manel; Fraga, Mario; Arias, Pedro; Gordo, Gema; Dapía, Irene; Mena, Rocío; Palomares, María; Pérez de Nanclares, Guiomar; Nevado, Julián; García-Miñaur, Sixto; Santos-Simarro, Fernando; Martinez-Glez, Víctor; Vallespín, Elena; Monk, David; Lapunzina, Pablo

    2016-10-01

    Beckwith-Wiedemann syndrome (BWS) is an overgrowth syndrome characterized by an excessive prenatal and postnatal growth, macrosomia, macroglossia, and hemihyperplasia. The molecular basis of this syndrome is complex and heterogeneous, involving genes located at 11p15.5. BWS is correlated with assisted reproductive techniques. BWS in individuals born following assisted reproductive techniques has been found to occur four to nine times higher compared to children with to BWS born after spontaneous conception. Here, we report a series of 187 patients with to BWS born either after assisted reproductive techniques or conceived naturally. Eighty-eight percent of BWS patients born via assisted reproductive techniques had hypomethylation of KCNQ1OT1:TSS-DMR in comparison with 49% for patients with BWS conceived naturally. None of the patients with BWS born via assisted reproductive techniques had hypermethylation of H19/IGF2:IG-DMR, neither CDKN1 C mutations nor patUPD11. We did not find differences in the frequency of multi-locus imprinting disturbances between groups. Patients with BWS born via assisted reproductive techniques had an increased frequency of advanced bone age, congenital heart disease, and decreased frequency of earlobe anomalies but these differences may be explained by the different molecular background compared to those with BWS and spontaneous fertilization. We conclude there is a correlation of the molecular etiology of BWS with the type of conception. © 2016 Wiley Periodicals, Inc.

  14. Reproductive Outcome Following Hysteroscopic Treatment of Uterine Septum

    PubMed Central

    Esmaeilzadeh, Seddigheh; Delavar, Mouloud Agajani; Andarieh, Maryam Ghanbari

    2014-01-01

    Background: Septate uterus is the most common uterine anomaly and a cause for miscarriage and infertility. Existing data suggested a better reproductive outcome of uterine septum following hysteroscopic septum resection. Objective: Current study was administered to share our experience in hystroscopic septum resection for reproductive outcome following hysteroscopic treatment of uterine septum and specifically focusing on different treatment protocols after hysteroscopic septum resection. Methods& materials: This study was a cross-sectional study based on secondary data that was obtained from medical records of infertile women who had undergone transvaginal hysteroscopy and used different treatment protocols after hysteroscopic correction of uterine septum in Infertility and Reproductive Health Research Center between April 2005 and February 2014. Results: The total number of infertile women underwent hysteroscopy uterine septoplasty was 106. The hysteroscopy septoplasty resulted in an overall pregnancy rate of 67% and a live birth 57.5%. Pregnancy rate for patients who had not male infertility was 92.1%. The chi-square test did not reveal any statistically significant difference in side affect, pregnancy, live birth, abortion, preterm deliveries, and term deliveries rate between these patients either with consistent hormone therapy plus IUD insertion or with alternate hormone therapy plus IUD after hysteroscopic metroplasty. Conclusion: The findings of the present study indicated hysteroscopic septum resection to remove a uterine septum in women with infertility is safe and may be an efficacious procedure. Treatment following hysteroscopic septum resection, either the consistent or the alternate protocol is both beneficial to improve pregnancy rate. PMID:25685079

  15. Canada's Assisted Human Reproductive Act: is it scientific censorship, or a reasoned approach to the regulation of rapidly emerging reproductive technologies?

    PubMed

    Rasmussen, Colin

    2004-01-01

    After more than a decade of study, discussion and debate, the Canadian House of Commons and Senate have approved the Assisted Human Reproduction Act. Building on the earlier Bill C-47, which died on the order paper in 1997, the Act bans human cloning for reproductive or therapeutic purposes, payment for surrogacy arrangements, and trading in human reproductive materials or their use without informed consent. In addition, the Act significantly restricts research using human reproductive materials. This article compares the Act to legislative regimes in other nations with advanced human reproductive science. It concludes that while the Act has many laudable goals, it is flawed in that it tries to cover too much legislative ground. As a result it unreasonable impairs the ability of Canadian scientists to compete in areas such as stem cell research, and area that is expected to yield significant new approaches to treating human disease.

  16. Cord Blood Karyotyping: A Safe and Non-Invasive Method for Postnatal Testing of Assisted Reproductive Technology Children

    PubMed Central

    Moradi, Shabnam Zarei; Masoudi, Najmehsadat; Mohseni Meybodi, Anahita; Anisi Hemaseh, Khadijeh; Mozafari Kermani, Ramin; Shahzadeh Fazeli, Abolhasan; Gourabi, Hamid

    2016-01-01

    Background: To verify the hypothesis that the incidence of chromosomal abnormalities increases in babies conceived by different assisted reproduction procedures. The availability of the umbilical cord blood encouraged us to study this hypothesis via this method. Materials and Methods: This is a descriptive study, umbilical cord blood samples of assisted reproductive technology (ART) children were analyzed with standard cytogenetic techniques (G banding). Karyotyping was possible in 109 cases. Results: The number of abnormal cases was four (3.7%), among which, three cases (2.8%) were inherited and only 1 case (0.9%) was a de novo translocation. In total, the incidence of de novo chromosomal abnormalities was in the range observed in all live births in the general population (0.7-1%). Conclusion: No significant difference in the incidence of chromosomal abnormality was found between ART and naturally conceived babies. To date, several studies have examined the medical and developmental outcome of ART children and still have not reached a definite conclusion. Genetic counseling is recommended as an integral part of planning of treatment strategies for couples wishing to undergo ART. PMID:27695612

  17. Computer-Assisted Exposure Treatment for Flight Phobia

    ERIC Educational Resources Information Center

    Tortella-Feliu, Miguel; Bornas, Xavier; Llabres, Jordi

    2008-01-01

    This review introduces the state of the art in computer-assisted treatment for behavioural disorders. The core of the paper is devoted to describe one of these interventions providing computer-assisted exposure for flight phobia treatment, the Computer-Assisted Fear of Flying Treatment (CAFFT). The rationale, contents and structure of the CAFFT…

  18. [Oocyte vitrification and its impact on the clinical practice of assisted reproduction].

    PubMed

    Boyer, P; Tourame, P; Gervoise-Boyer, M

    2012-11-01

    Oocyte vitrification is a new technique in cryobiology that will lead to a number of improvements in assisted reproduction practices, oocyte donation and the preservation of female fertility. Professionals already versed in the techniques of micromanipulation will be able to master the new procedures, which should not be delegated to unqualified staff. When adopted by clinical units, oocyte vitrification will require changes in laboratory and administrative organization. The technique will also modify the ethical outlines of reproductive biology. France today is running behind in the application of this major development in cryobiology. The reasons are many and have to do with a long waiting period for authorization from national health authorities, a lack of material and human resources and a foreseeable shake-up in the nationally established egg donation program. However, recently a new law of bioethics has recognized the breakthrough that this new technique represents by allowing couples covered by the French national health care program for Assisted Reproductive Technologies (ART) to choose oocyte vitrification as an option.

  19. The impact of male overweight on semen quality and outcome of assisted reproduction

    PubMed Central

    Thomsen, Lise; Humaidan, Peter; Bungum, Leif; Bungum, Mona

    2014-01-01

    It is well-documented that male overweight and obesity causes endocrine disorders that might diminish the male reproductive capacity; however, reports have been conflicting regarding the influence of male body mass index (BMI) on semen quality and the outcome of assisted reproductive technology (ART). The aim of this study was to investigate whether increased male BMI affects sperm quality and the outcome of assisted reproduction in couples with an overweight or obese man and a non-obese partner. Data was prospectively collected from 612 infertile couples undergoing ART at a Danish fertility center. Self-reported information on paternal height and weight were recorded and BMI was calculated. The men were divided into four BMI categories: underweight BMI < 20 kg m−2, normal BMI 20–24.9 kg m−2, overweight BMI 25–29.9 kg m−2 and obese BMI > 30 kg m−2. Conventional semen analysis was performed according to the World Health Organization guideline and sperm DNA integrity was analyzed by the Sperm Chromatin Structure Assay (SCSA). No statistically significant effect of male BMI was seen on conventional semen parameters (sperm concentration, total sperm count, seminal volume and motility) or on SCSA-results. Furthermore, the outcome of ART regarding fertilization rate, number of good quality embryos (GQE), implantation and pregnancy outcome was not influenced by the increasing male BMI. PMID:24759576

  20. Can Male Fertility Be Improved Prior to Assisted Reproduction through The Control of Uncommonly Considered Factors?

    PubMed Central

    Campagne, Daniel M.

    2013-01-01

    Male factor infertility or subfertility is responsible for up to 50% of infertility cases. A considerable body of recent studies indicates that lifestyle as well as environmental and psychological factors can negatively affect male fertility, more than previously thought. These negative effects have been shown in many cases to be reversible. This review aims to provide a rationale for early clinical attention to these factors and presents a non-exhaustive evidence-based collection of primary relevant conditions and recommendations, specifically with a view to making first line diagnostics and recommendations. The presently available evidence suggests that considering the high cost, success rates, and possible side effects of assisted reproduction techniques (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), early efforts to improve male fertility appear to be an attainable and worthwhile primary goal. A series of searches was conducted of Medline, Cochrane and related databases from November 14th, 2010 to January 26th, 2012 with the following keywords: male, fertility, infertility, sperm defects, IVF, ICSI, healthy habits, and lifestyle. Subsequent follow-up searches were performed for upcoming links. The total number of studies contemplated were 1265; of these, 296 studies were reviewed with criteria of relevance; the date of study or review; study sample size and study type; and publishing journal impact status. Data were abstracted based upon probable general clinical relevancy and use. Only a selection of the references has been reflected here because of space limitations. The main results obtained were evidence-supported indications as to the other causes of male infertility, their early detection, and treatment. PMID:24520443

  1. Lab-on-a-chip biophotonics: its application to assisted reproductive technologies.

    PubMed

    Lai, David; Smith, Gary D; Takayama, Shuichi

    2012-08-01

    With the benefits of automation, sensitivity and precision, microfluidics has enabled complex and otherwise tedious experiments. Lately, lab-on-a-chip (LOC) has proven to be a useful tool for enhancing non-invasive assisted reproductive technology (ART). Non-invasive gamete and embryo assessment has largely been through periodic morpohological assessment using optical microscopy and early LOC ART was the same. As we realize that morphological assessment is a poor indication of gamete or embryo health, more advanced biophotonics has emerged in LOC ART to assay for metabolites or gamete separation via optoelectrical tweezers. Off-chip, even more advanced biophotonics with broad spectrum analysis of metabolites and secretomes has been developed that show even higher accuracy to predicting reproductive potential. The integration of broad spectrum metabolite analysis into LOC ART is an exciting future that merges automation and sensitivity with the already highly accurate and strong predictive power of biophotonics.

  2. Biodynamic imaging of live porcine oocytes, zygotes and blastocysts for viability assessment in assisted reproductive technologies

    PubMed Central

    An, Ran; Wang, Chunmin; Turek, John; Machaty, Zoltan; Nolte, David D.

    2015-01-01

    The success of assisted reproductive technologies relies on accurate assessment of reproductive viability at successive stages of development for oocytes and embryos. The current scoring system used to select good-quality oocytes relies on morphologically observable traits and hence is indirect and subjective. Biodynamic imaging may provide an objective approach to oocyte and embryo assessment by measuring physiologically-relevant dynamics. Biodynamic imaging is a coherence-gated approach to 3D tissue imaging that uses digital holography to perform low-coherence speckle interferometry to capture dynamic light scattering from intracellular motions. The changes in intracellular activity during cumulus oocyte complex maturation, before and after in vitro fertilization, and the subsequent development of the zygote and blastocyst provide a new approach to the assessment of preimplant candidates. PMID:25798318

  3. Globalisation of birth markets: a case study of assisted reproductive technologies in India

    PubMed Central

    2011-01-01

    The escalation of Assisted Reproductive Technologies (ARTs) in India into a veritable fertility industry is the result of a multitude of reasons. This paper places the bio-genetic industry within the larger political economy framework of globalisation and privatisation, thus employing a framework that is often omitted from discussions on ARTs, but has direct and significant bearings on the ART industry in India. As markets for human organs, tissues and reproductive body parts experience unprecedented growth, the limits of what can or should be bought and sold continue to be pushed. As such, bodies have emerged as sale-worthy economic capital. Commercial flows of reproductive material create and deploy the division of the body into parts over which ownership is claimed, in the process following 'modern routes of capital' and raising issues of structural inequality. This paper presents a brief picture of India's fertility industry with specific focus on its ground-level operation, nature and growth. It aims to explore the industry dimensions of ARTs, by highlighting the macro picture of health care markets and medical tourism in India, the proliferation of the ART industry, market features such as the social imperative to mother, costs, promotion and marketing, unverified claims, inflated success rates, deals and offers, actors and collaborations in the field, and finally, the absence of standards. This paper presents findings from the research 'Constructing Conceptions: The Mapping of Assisted Reproductive Technologies in India', by Sama, a Delhi-based resource group working on gender, health and rights. This research was conducted from 2008 to 2010 in the three states of Uttar Pradesh, Orissa and Tamil Nadu in India, and is one of the first of its kind, highlighting unethical medical practices and making a case for the regulation of the ART industry. As such, it forms a significant part of Sama's ongoing work on women and technologies, particularly policy

  4. Globalisation of birth markets: a case study of assisted reproductive technologies in India.

    PubMed

    Sarojini, Nadimpally; Marwah, Vrinda; Shenoi, Anjali

    2011-08-12

    The escalation of Assisted Reproductive Technologies (ARTs) in India into a veritable fertility industry is the result of a multitude of reasons. This paper places the bio-genetic industry within the larger political economy framework of globalisation and privatisation, thus employing a framework that is often omitted from discussions on ARTs, but has direct and significant bearings on the ART industry in India. As markets for human organs, tissues and reproductive body parts experience unprecedented growth, the limits of what can or should be bought and sold continue to be pushed. As such, bodies have emerged as sale-worthy economic capital. Commercial flows of reproductive material create and deploy the division of the body into parts over which ownership is claimed, in the process following 'modern routes of capital' and raising issues of structural inequality.This paper presents a brief picture of India's fertility industry with specific focus on its ground-level operation, nature and growth. It aims to explore the industry dimensions of ARTs, by highlighting the macro picture of health care markets and medical tourism in India, the proliferation of the ART industry, market features such as the social imperative to mother, costs, promotion and marketing, unverified claims, inflated success rates, deals and offers, actors and collaborations in the field, and finally, the absence of standards. This paper presents findings from the research 'Constructing Conceptions: The Mapping of Assisted Reproductive Technologies in India', by Sama, a Delhi-based resource group working on gender, health and rights. This research was conducted from 2008 to 2010 in the three states of Uttar Pradesh, Orissa and Tamil Nadu in India, and is one of the first of its kind, highlighting unethical medical practices and making a case for the regulation of the ART industry. As such, it forms a significant part of Sama's ongoing work on women and technologies, particularly policy

  5. [Arthroscopically assisted treatment of ankle fractures].

    PubMed

    Braunstein, M; Baumbach, S F; Böcker, W; Mutschler, W; Polzer, H

    2016-02-01

    Acute ankle fractures are one of the most common fractures in adults with an incidence of 0.1-0.2 % per year. Operative treatment by open reduction and internal fixation (ORIF) is the standard method of treatment for unstable or dislocated fractures. The main goal of the operation is the anatomical realignment of the joint and restoration of ankle stability; nevertheless, anatomical reduction does not automatically lead to favorable clinical results. According to several studies the mid-term and in particular the long-term outcome following operative treatment is often poor with residual symptoms including chronic pain, stiffness, recurrent swelling and ankle instability. There is growing evidence that this poor outcome might be related to occult intra-articular injuries involving cartilage and soft tissues. In recent studies the frequency of fracture-related osteochondral lesions was reported to be approximately 64 %. By physical examination, standard radiography or even computed tomography (CT), these intra-articular pathologies cannot be reliably diagnosed; therefore, many authors emphasize the value of ankle arthroscopy in acute fracture treatment as it has become a safe and effective diagnostic and therapeutic procedure. Arthroscopically assisted open reduction and internal fixation (AORIF) allows control of the reduction as well examination of all intra-articular structures. If necessary, intra-articular pathologies can be addressed by removing ruptured ligaments and loose bodies, performing chondroplasty or microfracturing. So far there is no evidence that supplementary ankle arthroscopy increases the complication rate. On the other hand, the positive effect of AORIF has also not been clearly documented; nevertheless, there are clear indications that arthroscopically assisted fracture treatment is beneficial, especially in complex fractures.

  6. Continuous quality improvement and assisted reproductive technology multiple gestations: some progress, some answers, more questions.

    PubMed

    Gibbons, William; Grainger, David; Cedars, Marcelle; Jain, Tarun; Klein, Nancy; Stern, Judy

    2007-08-01

    The past decade has seen a fall in the number of embryos transferred accompanied by a reduction in the rate of higher order multiple pregnancies occurring from U.S. assisted reproductive technology (ART) cycles, which is temporally related to voluntary adherence to embryo transfer guidelines. The twin rate has remained relatively constant. The ability to continue the reduction in multiple pregnancies while maintaining advocacy positions for both patient couples and offspring will best occur with attention to scientific, sociologic, economic, and provider issues.

  7. Assisted reproductive technology and congenital overgrowth: some speculations on a case of Pallister-Killian syndrome.

    PubMed

    Chiurazzi, P; Bajer, J; Tabolacci, E; Pomponi, M G; Lecce, R; Zollino, M; Neri, G

    2004-10-15

    We report on a boy with Pallister-Killian syndrome (PKS) who was conceived by assisted reproductive technology (ART), specifically in vitro fertilization (IVF) with parents' gametes. A prenatal diagnosis performed elsewhere by CVS failed to detect the presence of the isochromosome 12p that was demonstrated postnatally in approximately 50% of cultured skin fibroblasts. Given that the patient did not show the congenital overgrowth typical of PKS, we speculate that ART might have restricted overgrowth in this particular case. More broadly, we hypothesize that overgrowth might protect from early demise fetuses conceived by ART, a technology known to cause low and very low birth weight.

  8. [Spontaneous and assisted reproduction-associated heterotopic pregnancy. The clinical characteristics].

    PubMed

    Barrón Vallejo, J; Góngora Rodríguez, A; Kuttothara, A; Kably Ambe, A

    1999-07-01

    Heterotopic pregnancy is an uncommon obstetric entity with variegated symptomatology. The objective of this report is to describe the clinical findings of the two varieties of heterotopic pregnancy, spontaneous an related with Assisted Reproduction Techniques (ART). Three cases of heterotopic pregnancy are described, two spontaneous and one occurred after in vitro fertilization and embryo transfer (IVF-ET). The two former culminated in miscarriage of intrauterine pregnancy and tubal rupture; and the late obscured for the ovarian hyperstimulation syndrome which prevented accurate ultrasonographic diagnosis. The clinical presentation and key differences are discussed.

  9. Risk disparities in the globalisation of assisted reproductive technology: the case of Asia.

    PubMed

    Ha, Jung-Ok

    2013-01-01

    This paper analyses the disparities in risks associated with biomedical technology focusing on the results of assisted reproductive technology (ART). ART among biomedical technologies transferred to Asia is a representative case that reveals in its clinical use and related scientific research the global politics of technology. This study notes the global politics at work in the recognition of and reaction to such risks. While many Asian countries aggressively pursue technological development, weak legislative and administrative regulations have created various problems and controversial cases. This study asserts that risks associated with technology are characterised as social facts not natural ones or mere 'side effects', since technological development and risk are closely intertwined.

  10. Considerations for clinics and practitioners treating foreign patients with assisted reproductive technology: lessons from experiences at Ghent University Hospital, Belgium.

    PubMed

    De Sutter, Petra

    2011-11-01

    Cross-border reproductive care (CBRC) is not a new concept, having been around since the beginning of assisted reproductive technology. Countries having taken the lead in developing new technologies have seen an influx of patients from other countries, because of legal limitations or the unavailability of good-quality care in their home country. This paper describes the experience of the Ghent University Hospital fertility centre with Dutch and French patients and tries to set out standards of care for CBRC patients. Dutch patients usually have longer histories, more complex pathology and are better informed, more outspoken and more financially secure. Thus, the care for these patients is challenging. The standards of care should be the same for local patients and CBRC patients; however, the nature of the complexity of the problems they come with will necessitate more time investment. Experience shows that many patients who have no access to treatment in their own country obtain reasonably good results. Some of them, however, are beyond possible help and these patients need a high standard of psychological care. All should be done to avoid that cross-border patients compromise the local care system. Special arrangements should be taken to manage possible complications following treatment.

  11. The European study of assisted reproduction families: a comparison of family functioning and child development between Eastern and Western Europe.

    PubMed

    Cook, R; Vatev, I; Michova, Z; Golombok, S

    1997-09-01

    Developments in reproductive technology over the past 20 years have given infertile couples new opportunities to have children. Although assisted reproduction does not appear to lead to negative consequences with respect to parent-child relationships or the socioemotional development of the child, the outcome for children and their parents may well differ according to the social and cultural environment. The aim of the present study was to compare family functioning and the social and emotional development of children in families created as a result of assisted reproductive techniques in Western Europe with assisted reproduction families in an Eastern European country (Bulgaria) where there is a history of specific pronatalist interventions. The findings indicate greater difficulties in parental adjustment and child behavior in assisted conception families in Eastern Europe. In addition, Eastern European parents were more uncertain than Western European parents about whether they would tell the child, and Eastern European parents were much more secretive with respect to telling others. Thus the outcomes of assisted reproduction for family functioning and child development appear to be independent, to some extent at least, on the social context in which these techniques are carried out.

  12. Epigenetic disorders and altered gene expression after use of Assisted Reproductive Technologies in domestic cattle.

    PubMed

    Urrego, Rodrigo; Rodriguez-Osorio, Nélida; Niemann, Heiner

    2014-06-01

    The use of Assisted Reproductive Technologies (ARTs) in modern cattle breeding is an important tool for improving the production of dairy and beef cattle. A frequently employed ART in the cattle industry is in vitro production of embryos. However, bovine in vitro produced embryos differ greatly from their in vivo produced counterparts in many facets, including developmental competence. The lower developmental capacity of these embryos could be due to the stress to which the gametes and/or embryos are exposed during in vitro embryo production, specifically ovarian hormonal stimulation, follicular aspiration, oocyte in vitro maturation in hormone supplemented medium, sperm handling, gamete cryopreservation, and culture of embryos. The negative effects of some ARTs on embryo development could, at least partially, be explained by disruption of the physiological epigenetic profile of the gametes and/or embryos. Here, we review the current literature with regard to the putative link between ARTs used in bovine reproduction and epigenetic disorders and changes in the expression profile of embryonic genes. Information on the relationship between reproductive biotechnologies and epigenetic disorders and aberrant gene expression in bovine embryos is limited and novel approaches are needed to explore ways in which ARTs can be improved to avoid epigenetic disorders.

  13. Epigenetic disorders and altered gene expression after use of Assisted Reproductive Technologies in domestic cattle

    PubMed Central

    Urrego, Rodrigo; Rodriguez-Osorio, Nélida; Niemann, Heiner

    2014-01-01

    The use of Assisted Reproductive Technologies (ARTs) in modern cattle breeding is an important tool for improving the production of dairy and beef cattle. A frequently employed ART in the cattle industry is in vitro production of embryos. However, bovine in vitro produced embryos differ greatly from their in vivo produced counterparts in many facets, including developmental competence. The lower developmental capacity of these embryos could be due to the stress to which the gametes and/or embryos are exposed during in vitro embryo production, specifically ovarian hormonal stimulation, follicular aspiration, oocyte in vitro maturation in hormone supplemented medium, sperm handling, gamete cryopreservation, and culture of embryos. The negative effects of some ARTs on embryo development could, at least partially, be explained by disruption of the physiological epigenetic profile of the gametes and/or embryos. Here, we review the current literature with regard to the putative link between ARTs used in bovine reproduction and epigenetic disorders and changes in the expression profile of embryonic genes. Information on the relationship between reproductive biotechnologies and epigenetic disorders and aberrant gene expression in bovine embryos is limited and novel approaches are needed to explore ways in which ARTs can be improved to avoid epigenetic disorders. PMID:24709985

  14. Application of failure mode and effect analysis in an assisted reproduction technology laboratory.

    PubMed

    Intra, Giulia; Alteri, Alessandra; Corti, Laura; Rabellotti, Elisa; Papaleo, Enrico; Restelli, Liliana; Biondo, Stefania; Garancini, Maria Paola; Candiani, Massimo; Viganò, Paola

    2016-08-01

    Assisted reproduction technology laboratories have a very high degree of complexity. Mismatches of gametes or embryos can occur, with catastrophic consequences for patients. To minimize the risk of error, a multi-institutional working group applied failure mode and effects analysis (FMEA) to each critical activity/step as a method of risk assessment. This analysis led to the identification of the potential failure modes, together with their causes and effects, using the risk priority number (RPN) scoring system. In total, 11 individual steps and 68 different potential failure modes were identified. The highest ranked failure modes, with an RPN score of 25, encompassed 17 failures and pertained to "patient mismatch" and "biological sample mismatch". The maximum reduction in risk, with RPN reduced from 25 to 5, was mostly related to the introduction of witnessing. The critical failure modes in sample processing were improved by 50% in the RPN by focusing on staff training. Three indicators of FMEA success, based on technical skill, competence and traceability, have been evaluated after FMEA implementation. Witnessing by a second human operator should be introduced in the laboratory to avoid sample mix-ups. These findings confirm that FMEA can effectively reduce errors in assisted reproduction technology laboratories.

  15. Fake it till you make it: Policymaking and assisted human reproduction in Canada.

    PubMed

    Baylis, Françoise; Downie, Jocelyn; Snow, Dave

    2014-06-01

    The Assisted Human Reproduction Act (AHR Act) came into effect in 2004. The AHR Act stipulates in s.12 that no reimbursement of expenditures incurred in the course of donating gametes, maintaining or transporting in vitro embryos, or providing surrogacy services is permitted, except in accordance with the regulations and with receipts. Ten years later, Health Canada still has not drafted the regulations governing reimbursement. Section 12 is therefore still not in force. Health Canada and others have asserted that there is a Health Canada policy on reimbursement and that reimbursement with receipts is legally permissible. We dispute the existence of such a policy and its legitimacy (if it exists). We also challenge the decision by Health Canada not to produce regulations and thereby make it possible for Parliament to bring s.12 into force. This intentional lack of action is worrisome on at least two fronts. First, it sidesteps the processes required for regulations and thereby ducks the Parliamentary oversight very deliberately built into the AHR Act. Second, it leaves Canadians who provide and who access assisted human reproduction uncertain about what is and is not permitted, and therefore fearful of, or at risk of, prosecution. We conclude that Health Canada should take the steps necessary to put regulations in front of Parliament so that Parliament will then be able to pass regulations and bring s.12 into force. Canadians should demand no less.

  16. Are there optimal numbers of oocytes, spermatozoa and embryos in assisted reproduction?

    PubMed Central

    Milachich, Tanya; Shterev, Atanas

    2016-01-01

    The aim of this overview is to discuss the current information about the search for the optimum yield of gametes in assisted reproduction, as one of the major pillars of IVF success. The first topic is focused on the number of male gametes and the possible impact of some genetic traits on these parameters. The number of spermatozoa did not seem to be crucial when there is no severe male factor of infertility. Genetic testing prior to using those sperm cells is very important. Different methods were applied in order to elect the "best" spermatozoa according to specific indications. The next problem discussed is the importance of the number of oocytes collected. Several studies have agreed that "15 oocytes is the perfect number," as the number of mature oocytes is more important. However, if elective single embryo transfer is performed, the optimal number of oocytes will enable a proper embryo selection. The third problem discussed concerns fertility preservation. Many educational programs promote and encourage procreation at maternal ages between 20-35 years, since assisted reproduction is unable to fully overcome the effects of female aging and fertility loss after that age. It is also strongly recommended to ensure a reasonable number of cryopreserved mature oocytes, preferably in younger ages (<35), for which an average of two stimulation cycles are likely required. For embryo cryopreservation, the "freeze all" strategy suggests the vitrification of good embryos, therefore quality is prior to number and patient recruitment for this strategy should be performed cautiously. PMID:27584608

  17. The construction of meaning by experts and would-be parents in assisted reproductive technology.

    PubMed

    Silva, Susana; Machado, Helena

    2011-09-01

    This article explores the construction of meaning regarding assisted reproductive technology by legal framers, medical practitioners and would-be parents, through the concept of ecology of knowledge. It is argued that these inter-relationships between experts and lay people can be understood in terms of the formation of a social structure of ecology of knowledge, which depends on local and emotional knowledge co-produced by medical doctors, jurists and lay people in dynamic ways without compromising the autonomy of medical, legal and lay knowledge and skills. The assessment of the benefits and risks of assisted reproductive technology partially represents negotiations of knowledge between these social and professional groups, aiming to reproduce existing relations and practices, particularly the social power of medicine and technology, the dominant perceptions about women's and men's bodies and the geneticisation of genealogy. These negotiations of knowledge generate new rights, new social actors, new scientific fields and new ways of thinking and talking about individual and institutional responsibilities. Ecology of knowledge comes imbued with hope, trust, power, credibility of institutions and moralisation whereby some citizens' rights may be weakened.

  18. Impact of assisted reproductive technologies: a mitochondrial perspective of cytoplasmic transplantation.

    PubMed

    Harvey, A J; Gibson, T C; Quebedeaux, T M; Brenner, C A

    2007-01-01

    Many of the assisted reproductive techniques associated with maternal aging, disease states, or implantation failure aim to correct poor developmental capacity. These techniques are highly invasive and require the exchange of nuclear or cytoplasmic material from a donor oocyte to compensate for deficiencies inherent in the affected individual. These techniques are based on the assumption that the cytoplasm of the donor oocyte can effectively substitute the necessary component(s) to enable development to proceed. Several studies have attempted to inject cytoplasm from "normal" (young) donors, into aged eggs, again assuming that beneficial components of the cytoplasm are transferred to restore developmental capacity. These invasive assisted reproduction technology (ART) procedures aim to eliminate chromosomal abnormalities, improve the quality of oocytes deficient in some important cytoplasmic factors necessary for maturation and/or subsequent development, and eliminate maternally inherited diseases (particularly mitochondrial myopathies). However, in order to develop such ART, understanding the processes involving mitochondrial DNA replication and transcription is imperative, as asynchrony between mitochondrial and nuclear genomes may cause problems in mitochondrial function, localization, and biogenesis.

  19. [Literature review and state of the art of the Italian law on medically assisted reproduction].

    PubMed

    Ricci, G; Delbon, P; Conti, A; Sirignano, A

    2015-01-01

    This article analyzes the current situation of medically assisted reproduction in Italy after the promulgation of Law 40 in 2004. This law is actually completely different from the origin version. The controversial points like reproduction for couples who bear genetic diseases, prohibition of heterologous fertilization, cryoconservation of the embryos, obligation to perform just one and contemporaneous implant of all the embryos produced, are today definitively erased. This new situation is due to the jurisprudence of the Italian Courts but especially to the changes introduced by the European Court of Human Rights and by the questions of constitutionality raised by some Italian Courts. After analysis of the legislation, the views of various authors are compared, and the weaknesses and strong points of the law are considered from the point of view of legal medicine, science and bioethics. After ten years of operation of this law Italy has returned to a situation that existed before the law. In fact the old law was only full of prohibitions. Now is possible to do heterologous fertilization and this article photographs the current situation of hospitals for assisted procreation in Italy. The work also comments on procreative tourism, a direct consequence of this law, and on the status of women, who must be the subject and not the object of the legislation.

  20. Female reproductive potential after treatment for Hodgkin's disease

    SciTech Connect

    Horning, S.J.; Hoppe, R.T.; Kaplan, H.S.; Rosenberg, S.A.

    1981-06-01

    The probability of maintaining ovarian function, becoming pregnant, and delivering a normal child is important to young women anticipating successful therapy for Hodgkin's disease. In this study, reproductive function was retrospectively examined in 103 women 40 years old or younger who had undergone treatment for Hodgkin's disease with total-lymphoid irradiation (TLI) alone, combination chemotherapy, or combined TLI and chemotherapy. Infertility was directly related to gonadal exposure to therapy and to age at treatment. Twenty women became pregnant after receiving total-nodal irradiation or combination chemotherapy or both. No fetal wastage occurred, and no birth defects were seen in the 24 infants born to these women. Even after intensive treatment programs, women successfully treated for Hodgkin's disease have become pregnant and delivered phenotypically normal children.

  1. New frontiers in human assisted reproduction ‑ from research to clinical practice: Several considerations (Review).

    PubMed

    Gizzo, Salvatore; Noventa, Marco; Quaranta, Michela; Venturella, Roberta; Vitagliano, Amerigo; Gangemi, Michele; D'Antona, Donato

    2016-11-01

    In the era of very late, or advanced, motherhood, in which 'egg banks', 'social' egg‑freezing, egg donation and surrogacy represent a potential solution to a number of obstacles to human reproduction, what is the role of scientists and clinicians involved in assisted reproduction? In light of the apprehension that, in the future, through fertility treatment infertility may be passed on to the offspring, boundaries of medical vs. 'social' infertility are being created. Scientists and clinicians are joining forces in a synergistic effort to improve the effectiveness of infertility care by introducing novel therapeutic protocols with the intent of customising care and improving cost‑effectiveness, testing novel drugs and formulations, and searching for novel markers (for estimating biological age) and nomograms (to optimise the yield of a controlled ovarian hyperstimulation cycle). On the other hand, political, social and health institutions are doing little to educate young women with respect to disinformation and to increase their awareness regarding age as the predominant factor that contributes towards the decline in fertility. Nevertheless, despite the great advances that have been made, 38 years after the birth of the first baby via in vitro fertilisation, the intricate road leading from the antral follicle to the fully developed baby continues to be designated as being too 'expensive', 'empirical', 'mysterious' or 'bound by ethics', with few significant improvements in terms of real cost‑effectiveness.

  2. Society for assisted reproductive technology position statement on donor suitability of recipients of smallpox vaccine (vaccinia virus).

    PubMed

    2004-09-01

    Although there is presently no definitive evidence linking vaccinia virus transmission through reproductive cells, SART/ASRM accordingly recommends that assisted reproductive technology (ART) practitioners consider deferring donors who have recently received smallpox vaccine or contracted symptomatic vaccinia virus infection through close contact with a vaccine recipient (until after the vaccine or infectious scab has spontaneously separated). Good donor practice further suggests that donors who are not in good health, including those with recent complications from smallpox vaccine, should be similarly deferred.

  3. Society for assisted reproductive technology position statement on donor suitability of recipients of smallpox vaccine (vaccinia virus).

    PubMed

    2004-04-01

    Although there is presently no definitive evidence linking vaccinia virus transmission through reproductive cells, SART/ASRM accordingly recommends that assisted reproductive technology (ART) practitioners consider deferring donors who have recently received smallpox vaccine or contracted symptomatic vaccinia virus infection through close contact with a vaccine recipient (until after the vaccine or infectious scab has spontaneously separated). Good donor practice further suggests that donors who are not in good health, including those with recent complications from smallpox vaccine, should be similarly deferred.

  4. GnRH agonist versus GnRH antagonist in assisted reproduction cycles: oocyte morphology

    PubMed Central

    2012-01-01

    Background The selection of developmentally competent human gametes may increase the efficiency of assisted reproduction. Spermatozoa and oocytes are usually assessed according to morphological criteria. Oocyte morphology can be affected by the age, genetic characteristics, and factors related to controlled ovarian stimulation. However, there is a lack of evidence in the literature concerning the effect of gonadotropin-releasing hormone (GnRH) analogues, either agonists or antagonists, on oocyte morphology. The aim of this randomized study was to investigate whether the prevalence of oocyte dysmorphism is influenced by the type of pituitary suppression used in ovarian stimulation. Methods A total of 64 patients in the first intracytoplasmic sperm injection (ICSI) cycle were prospectively randomized to receive treatment with either a GnRH agonist with a long-term protocol (n: 32) or a GnRH antagonist with a multi-dose protocol (n: 32). Before being subjected to ICSI, the oocytes at metaphase II from both groups were morphologically analyzed under an inverted light microscope at 400x magnification. The oocytes were classified as follows: normal or with cytoplasmic dysmorphism, extracytoplasmic dysmorphism, or both. The number of dysmorphic oocytes per total number of oocytes was analyzed. Results Out of a total of 681 oocytes, 189 (27.8 %) were morphologically normal, 220 (32.3 %) showed cytoplasmic dysmorphism, 124 (18.2%) showed extracytoplasmic alterations, and 148 (21.7%) exhibited both types of dysmorphism. No significant difference in oocyte dysmorphism was observed between the agonist- and antagonist-treated groups (P ≫ 0.05). Analysis for each dysmorphism revealed that the most common conditions were alterations in polar body shape (31.3%) and the presence of diffuse cytoplasmic granulations (22.8%), refractile bodies (18.5%) and central cytoplasmic granulations (13.6%). There was no significant difference among individual oocyte dysmorphisms in the

  5. Current issues in medically assisted reproduction and genetics in Europe: research, clinical practice, ethics, legal issues and policy. European Society of Human Genetics and European Society of Human Reproduction and Embryology.

    PubMed

    Harper, Joyce C; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo; Gianaroli, Luca; Harton, Gary; Milachich, Tanya; Kääriäinen, Helena; Liebaers, Inge; Morris, Michael; Sequeiros, Jorge; Sermon, Karen; Shenfield, Françoise; Skirton, Heather; Soini, Sirpa; Spits, Claudia; Veiga, Anna; Vermeesch, Joris Robert; Viville, Stéphane; de Wert, Guido; Macek, Milan

    2013-11-01

    In March 2005, a group of experts from the European Society of Human Genetics and European Society of Human Reproduction and Embryology met to discuss the interface between genetics and assisted reproductive technology (ART), and published an extended background paper, recommendations and two Editorials. Seven years later, in March 2012, a follow-up interdisciplinary workshop was held, involving representatives of both professional societies, including experts from the European Union Eurogentest2 Coordination Action Project. The main goal of this meeting was to discuss developments at the interface between clinical genetics and ARTs. As more genetic causes of reproductive failure are now recognised and an increasing number of patients undergo testing of their genome before conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and preimplantation genetic diagnosis (PGD) may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from randomised clinical trials to substantiate that the technique is both effective and efficient. Whole-genome sequencing may create greater challenges both in the technological and interpretational domains, and requires further reflection about the ethics of genetic testing in ART and PGD/PGS. Diagnostic laboratories should be reporting their results according to internationally accepted accreditation standards (International Standards Organisation - ISO 15189). Further studies are needed in order to address issues related to the impact of ART on epigenetic reprogramming of the early embryo. The legal landscape regarding assisted reproduction is evolving but still remains very heterogeneous and often contradictory. The lack of legal harmonisation and uneven access to infertility treatment and PGD/PGS fosters considerable cross-border reproductive care in Europe and beyond. The aim of this paper is to complement previous publications and provide

  6. Biomedical research with human embryos: changes in the legislation on assisted reproduction in Spain.

    PubMed

    Vidal Martínez, Jaime

    2006-01-01

    This study deals with issues of research with human embryos obtained through in vitro fertilization in the context of the Spanish Law. The paper focuses on Act 14/2006 on techniques of human assisted reproduction, which replaces the previous Act from 1988. The author claims that the main goals of Act 14/2006 are, on the one hand, to eliminate the restrictions affecting research with human embryos put in place by Act 45/2003 and, on the other, to pave the way for a future legislation on biomedical research. This paper argues for the need of an effective and adequate juridical protection of human embryos obtained in vitro according to responsibility and precautionary principles.

  7. The impact of stress and psychosocial interventions on assisted reproductive technology outcome.

    PubMed

    Morreale, Mary; Balon, Richard; Tancer, Manuel; Diamond, Michael

    2011-01-01

    In natural cycles of attempted conception, stress has been shown to predict lower conception rates. The objective of this article is to determine whether stress affects the outcome of assisted reproductive technology (ART) as well. In addition, this article analyzes the effect that psychosocial interventions targeting the reduction of stress have on ART outcomes. This review examined available PubMed articles published in the past 15 years, and 28 articles were included. Looking specifically at numbers of women studied, stress appears to negatively affect ART outcome; interventions targeting stress reduction appear beneficial. Because stress appears to negatively affect ART outcome, and psychosocial interventions do not have detrimental effects, screening for stress should occur and some type of intervention considered during the ART process.

  8. The Italian Constitutional Court modifies Italian legislation on assisted reproduction technology.

    PubMed

    Benagiano, Giuseppe; Gianaroli, Luca

    2010-03-01

    On 8 May 2009, the Italian Constitutional Court declared, at least in part, that the law regulating assisted reproduction technology in Italy (Law 40/04) is unconstitutional. The most important theoretical point made by the Court is that the law does not provide unlimited protection to embryos, since it admits that some of them may not produce a viable fetus. Embryo protection is therefore limited by the imperative to ensure a concrete possibility to achieve a successful pregnancy. The Court also reaffirmed the need to empower the attending physician with the means to carry out a full evaluation. At present, the situation is not clear and, theoretically, requires a new intervention by Parliament. This, however, is unlikely.

  9. Assisted reproduction with gametes and embryos: what research is needed and fundable?

    PubMed

    Seidel, George E

    2016-01-01

    Principles for selecting future research projects include interests of investigators, fundability, potential applications, ethical considerations, being able to formulate testable hypotheses and choosing the best models, including selection of the most appropriate species. The following 10 areas of assisted reproduction seem especially appropriate for further research: efficacious capacitation of bovine spermatozoa in vitro; improved in vitro bovine oocyte maturation; decreasing variability and increasing efficacy of bovine superovulation; improved fertility of sexed semen; improving equine IVF; improving cryopreservation of rooster spermatozoa; understanding differences between males in success of sperm cryopreservation and reasons for success in competitive fertilisation; mechanisms of reprogramming somatic cell nuclei after nuclear transfer; regulation of differentiation of ovarian primordial follicles; and means by which spermatozoa maintain fertility during storage in the epididymis. Issues are species specific for several of these topics, in most cases because the biology is species specific.

  10. Long-term follow-up of children conceived through assisted reproductive technology.

    PubMed

    Lu, Yue-hong; Wang, Ning; Jin, Fan

    2013-05-01

    Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced.

  11. The paternal genome and the health of the assisted reproductive technology child.

    PubMed

    Lewis, Sheena E M; Kumar, Kishlay

    2015-01-01

    As a number of children born by assisted reproductive technology (ART) are increasing each year across the developed world, the health of such offspring is a matter of public concern. Does the integrity of the paternal genome impact on offspring health? In societal terms, as birth rates fall, and the Western population become unsustainable, do the benefits outweigh the costs of creating and providing for this ART conceived subpopulation? There are little data to date to answer these questions. The long-term health of such children has largely been ignored, and success measured only by early (prebirth) outcomes such as embryo quality or pregnancy. However, there are powerful paradigms such as ageing and smoking that give vital clues as to the potential impact of unhealthy spermatozoa on disease risk, mental and physical health, fertility and mortality of these offspring.

  12. The paternal genome and the health of the assisted reproductive technology child

    PubMed Central

    Lewis, Sheena EM; Kumar, Kishlay

    2015-01-01

    As a number of children born by assisted reproductive technology (ART) are increasing each year across the developed world, the health of such offspring is a matter of public concern. Does the integrity of the paternal genome impact on offspring health? In societal terms, as birth rates fall, and the Western population become unsustainable, do the benefits outweigh the costs of creating and providing for this ART conceived subpopulation? There are little data to date to answer these questions. The long-term health of such children has largely been ignored, and success measured only by early (prebirth) outcomes such as embryo quality or pregnancy. However, there are powerful paradigms such as ageing and smoking that give vital clues as to the potential impact of unhealthy spermatozoa on disease risk, mental and physical health, fertility and mortality of these offspring. PMID:25926606

  13. Impact of HIV treatment scale-up on women's reproductive health care and reproductive rights in Southern Africa.

    PubMed

    Myer, Landon; Akugizibwe, Paula

    2009-11-01

    The HIV epidemic has changed the face of women's reproductive health across southern Africa. In some circles, there have been calls for restrictions on women's reproductive rights, focusing particularly on the spread of HIV between sexual partners and from mother to child. However, during the past decade, public health attention and resources for the clinical care of HIV-infected individuals living in Africa have led to advances in women's reproductive health services. As many programs have recognized that effective HIV care and treatment services must link to other areas of primary care, key reproductive health services such as those providing contraception and barrier methods are commonly integrated into antiretroviral therapy services. In much of the region, this programmatic focus has helped increase attention on the ground to women's reproductive rights. However, in many settings, policies explicitly supporting the reproductive rights of HIV-infected women have lagged. Important gaps remain both in policy development and in the design, evaluation, and implementation of interventions promoting women's reproductive health and rights at the service delivery level.

  14. Epigenetic deregulation of genomic imprinting in human disorders and following assisted reproduction.

    PubMed

    Arnaud, Philippe; Feil, Robert

    2005-06-01

    Imprinted genes play important roles in the regulation of growth and development, and several have been shown to influence behavior. Their allele-specific expression depends on inheritance from either the mother or the father, and is regulated by "imprinting control regions" (ICRs). ICRs are controlled by DNA methylation, which is present on one of the two parental alleles only. These allelic methylation marks are established in either the female or the male germline, following the erasure of preexisting DNA methylation in the primordial germ cells. After fertilization, the allelic DNA methylation at ICRs is maintained in all somatic cells of the developing embryo. This epigenetic "life cycle" of imprinting (germline erasure, germline establishment, and somatic maintenance) can be disrupted in several human diseases, including Beckwith-Wiedemann syndrome (BWS), Prader-Willi syndrome (PWS), Angelman syndrome and Hydatidiform mole. In the neurodevelopmental Rett syndrome, the way the ICR mediates imprinted expression is perturbed. Recent studies indicate that assisted reproduction technologies (ART) can sometimes affect the epigenetic cycle of imprinting as well, and that this gives rise to imprinting disease syndromes. This finding warrants careful monitoring of the epigenetic effects, and absolute risks, of currently used and novel reproduction technologies.

  15. [Planned children--supporting and inhibiting influences on the development of personality and relationships after technology-assisted reproduction].

    PubMed

    Lebersorger, Karin J

    2016-03-01

    In the western industrial countries more and more couples with an unfulfilled desire for a child use assisted reproductive technology (ART). This focusses on physical processes and doesn't sufficiently provide necessary supportive psychological/psychotherapeutic guidance.Neglecting the psychological dimension causes ART to enhance the risk for negative processes of emotional development of a child.After a brief overview of prevalence and summarizing the legal situation three areas will be discussed which involve a high risk potential and their influences on relationship- and personality development will be described: • The psychological burden for potential parents during the treatment. • Wishes of perfection and high expectations concerning the child which can turn normative crises into severe problems. • The frequent handling of the treatment as a taboo which can become a destructive family secret between parents and child.The paper will conclude with thoughts concerning prevention and treatment.Every person working in the field of childhood and adolescence can contribute to a healthy psychological development of these children. This means acknowledging and working through the emotional burden and the wishes and explaining about the dangers of taboos like in foster care and adoption.

  16. The use of semen evaluation and assisted reproduction in Spix's macaws in terms of species conservation.

    PubMed

    Fischer, Dominik; Neumann, Daniel; Purchase, Cromwell; Bouts, Tim; Meinecke-Tillmann, Sabine; Wehrend, Axel; Lierz, Michael

    2014-01-01

    The Spix's macaw (Cyanopsitta spixii) is the rarest parrot on earth. The remaining captive population consists of 79 individuals. Captive propagation is ongoing to increase the number of individuals for future reintroduction back into the wild. Unfortunately, from 2004 to 2012, only 33 chicks hatched from 331 eggs. Semen evaluation and assisted reproduction might help to overcome this problem. Therefore, a recently developed electro-stimulated semen collection technique was used in Spix's macaws. Semen collection was successful in 39 of 78 attempts in 10 out of 17 males. Examination of the semen included evaluation of volume, color, consistency, contaminations and pH, as well as determination of motility, viability, morphology, concentration, and total count of spermatozoa. The median volume of semen samples was 5.6 µl. On average, 34.7 ± 21.9% (median 30%) of the sperm were motile and 23.1 ± 22.1% (median 16.5%) were progressively motile. In addition to spermatozoa, round cells were detected in the samples. Median sperm concentration was 15,500/µl (range 500-97,500/µl) and median viability was 50% (range 5-87%). Morphological examination revealed in 26.5% normal spermatozoa, high numbers of malformations of the head (50.2%) and tail region (20.5%), with 29% of all sperm showing multiple abnormalities. Artificial insemination was performed in three females; two eggs laid after artificial insemination had spermatozoa present on the perivitelline layer, suggesting the possible success of the insemination technique. Although no fertilization could be demonstrated, these preliminary results are promising, as they indicate that assisted reproduction might be a tool for species conservation in the Spix's macaw.

  17. Cryopreservation and delayed embryo transfer-assisted reproductive technology registry and reporting implications.

    PubMed

    Doody, Kevin J

    2014-07-01

    Clinics performing assisted reproductive technology (ART) procedures have collected data via registry and publicly reported pregnancy outcomes for more than 25 years. During this time, the practice of ART has changed considerably with frozen embryo transfer (FET) procedures contributing an increasing proportion of live births. Cycles initiated with the intent of embryo banking for the purpose of fertility preservation have been excluded from these public reports, because pregnancy outcomes are not immediately available. An unintended consequence of the common sense handling of fertility preservation has been that cycles performed with intentional short-term cryopreservation of all embryos for other indications have also been excluded from the report. Over the last few years, cryopreservation with short-term delayed transfer increasingly has been performed for reasons other than fertility preservation. The pregnancy outcomes of these cycles are expected within a reasonable time frame and should be transparently reported. The Society for Assisted Reproductive Technology has collaborated with the Centers for Disease Control and Prevention to "recapture" these cycles for the public reports. This recapture is done by linking the FET cycles to the stimulation cycles from which the embryos were derived and by changing the labels of the outcome success metrics. Stimulations using ART, initiated for the purpose of transferring embryos within 1 year will be included in the report despite any prospective intent to freeze all eggs or embryos. A positive outcome will be reported when a live birth results from the first embryo transfer following stimulation ("primary transfer"). Linkage of ovarian stimulation and egg-retrieval procedures to FET will also allow development of other success metrics to further benefit fertility patients.

  18. Effect of Embryo Banking on U.S. National Assisted Reproductive Technology Live Birth Rates

    PubMed Central

    Kushnir, Vitaly A.; Barad, David H.; Albertini, David F.; Darmon, Sarah K.; Gleicher, Norbert

    2016-01-01

    Background Assisted Reproductive Technology (ART) reports generated by the Centers for Disease Control and Prevention (CDC) exclude embryo banking cycles from outcome calculations. Methods We examined data reported to the CDC in 2013 for the impact of embryo banking exclusion on national ART outcomes by recalculating autologous oocyte ART live birth rates. Inflation of reported fresh ART cycle live birth rates was assessed for all age groups of infertile women as the difference between fresh cycle live births with reference to number of initiated fresh cycles (excluding embryo banking cycles), as typically reported by the CDC, and fresh cycle live births with reference to total initiated fresh ART cycles (including embryo banking cycles). Results During 2013, out of 121,351 fresh non-donor ART cycles 27,564 (22.7%) involved embryo banking. The proportion of banking cycles increased with female age from 15.5% in women <35 years to 56.5% in women >44 years. Concomitantly, the proportion of thawed cycles decreased with advancing female age (P <0.0001). Exclusion of embryo banking cycles led to inflation of live birth rates in fresh ART cycles, increasing in size in parallel to advancing female age and utilization of embryo banking, reaching 56.3% in women age >44. The inflation of live birth rates in thawed cycles could not be calculated from the publically available CDC data but appears to be even greater. Conclusions Utilization of embryo banking increased during 2013 with advancing female age, suggesting a potential age selection bias. Exclusion of embryo banking cycles from national ART outcome reports significantly inflated national ART success rates, especially among older women. Précis Exclusion of embryo banking cycles from US National Assisted Reproductive Technology outcome reports significantly inflates reported success rates especially in older women. PMID:27159215

  19. Assisted reproductive techniques for cattle breeding in developing countries: a critical appraisal of their value and limitations.

    PubMed

    Rodriguez-Martinez, H

    2012-01-01

    Commercialization of animal biotechnologies, including those related to reproduction [also known as assisted reproductive techniques (ARTS)], is an increasing reality in developing countries, following the enormous flow of information around us and the increasing global commercial interests in areas where cattle production has its major assets. The present review discusses the achievements of various biotechnological tools for reproduction in cattle including semen handling for artificial insemination (AI), superovulation and embryo transfer (MOET), in vitro handling of oocytes and production of embryos, reproductive cloning and emerging technologies (sex selection, gene targeting and nuclear transfer for livestock transgenesis, genomics for marker-assisted selection, etc.). The application of these technologies for cattle breeding is critically discussed in relation to their impact in the improvement of the efficiency of dairy and beef production in developed and - particularly - in developing countries, which ultimately rule the possibilities of a competitive and sound production of food for human consumption. Despite the remarkable progress made and the punctual importance of some of the above-mentioned technologies, AI remains the most important assisted reproductive technology (ART) in developing countries. Any attempt to gain widespread of any other ART under the predominant economical conditions in developing countries ought to match the simplicity and the success of AI as a breeding tool.

  20. American Society for Reproductive Medicine/Society for Assisted Reproductive Technology position statement on West Nile virus.

    PubMed

    2006-11-01

    Although there is currently no definitive evidence linking West Nile virus (WNV) transmission with reproductive cells, it is recommended that practitioners defer gamete donors who have confirmed or suspected WNV infections.

  1. Results and unsolved problems following the amendment to the Italian Law on assisted reproduction brought about by the Constitutional Court.

    PubMed

    Molinelli, Andrea; Bonsignore, Alessandro; Darretta, Valeria; Anserini, Paola

    2012-07-01

    Since the approval of Law N° 40/2004, Italian specialists have been applying assisted reproductive techniques in compliance with a number of restrictions. Several attempts were made to find a solution to the practical and ethical issues brought about by this restrictive legislation. Finally, in May 2009, the Italian Constitutional Court banned most of the limitations. In the last year the authors worked together to study the impact of the Italian Constitutional Court modifications on assisted reproduction from both a gynecological and medico-legal point of view. Despite the clinically positive impact of the ruling, a lot of technical and legal unsolved issues still exist. Analyzing these problems, the authors stress the importance of a multidisciplinary approach to achieve adequate legislation in order to improve patients' outcome and avoid "reproductive migration" from Italy to other European Countries. New regulation could also be important for practitioners by keeping the risk of legal troubles to the minimum.

  2. Costs of achieving live birth from assisted reproductive technology: a comparison of sequential single and double embryo transfer approaches

    PubMed Central

    Crawford, Sara; Boulet, Sheree L.; Mneimneh, Allison S.; Perkins, Kiran M.; Jamieson, Denise J.; Zhang, Yujia; Kissin, Dmitry M.

    2016-01-01

    Objective To assess treatment and pregnancy/infant-associated medical costs and birth outcomes for assisted reproductive technology (ART) cycles in a subset of patients using elective double embryo (ET) and to project the difference in costs and outcomes had the cycles instead been sequential single ETs (fresh followed by frozen if the fresh ET did not result in live birth). Design Retrospective cohort study using 2012 and 2013 data from the National ART Surveillance System. Setting Infertility treatment centers. Patient(s) Fresh, autologous double ETs performed in 2012 among ART patients younger than 35 years of age with no prior ART use who cryopreserved at least one embryo. Intervention(s) Sequential single and double ETs. Main Outcome Measure(s) Actual live birth rates and estimated ART treatment and pregnancy/infant-associated medical costs for double ET cycles started in 2012 and projected ART treatment and pregnancy/infant-associated medical costs if the double ET cycles had been performed as sequential single ETs. Result(s) The estimated total ART treatment and pregnancy/infant-associated medical costs were $580.9 million for 10,001 double ETs started in 2012. If performed as sequential single ETs, estimated costs would have decreased by $195.0 million to $386.0 million, and live birth rates would have increased from 57.7%–68.0%. Conclusion(s) Sequential single ETs, when clinically appropriate, can reduce total ART treatment and pregnancy/infant-associated medical costs by reducing multiple births without lowering live birth rates. PMID:26604068

  3. [Extension of assisted reproductive technologies with donor sperm (ARTD) to non-medical indications].

    PubMed

    Jouannet, Pierre

    2014-01-01

    In France as in other countries, more and more single women and lesbian couples wish to become mothers. To carry through their parenting project they may consult a physician in France and often go abroad in order to get Assisted Reproductive Technologies with donor sperm (ARTD). Should ARTD be available to those women in France? The physician has not to take the decision. In such situations ARTD has no medical indication or contraindication. This assisted procreation raises many questions on children development and well-being. The results of studies made in other countries are often reassuring but their methodologies do not allow any conclusion to be drawn and grey areas persist. Therefore it should be necessary to develop a research effort in the field as it recently started in France. Would ARTD access to women without a male partner be legalized, the law should respect the ethical principles of non-payment and anonymity associated with donation of all body components. In any case, it should also allow an efficient medical care to be performed to ensure under the best conditions the well-being of the children and their mothers.

  4. Preimplantation and postimplantation therapy for the treatment of reproductive failure

    PubMed Central

    Kumar, Pratap; Mahajan, Siddharth

    2013-01-01

    Treatment of patients with recurrent pregnancy losses and recurrent implantation failure can be instituted only when the underlying etiology is determined. Embryo-secreted preimplantation factor (PIF) is essential for implantation and adequate trophoblastic invasion. Deficiency of PIF affects the outcome of the pregnancy leading to recurrent pregnancy losses. Synthetic PIF modulates the outcome of the pregnancy decreasing the incidence of recurrent implantation failure and recurrent pregnancy losses. In this article a thorough search is done regarding the data published for diagnoses of reproductive failure and its treatment. The effect of immunoglobulin (Ig), intralipid, heparin, aspirin, progesterone, estrogen, and granulocyte colony stimulating factor (G-CSF) is taken into consideration. Heparin, aspirin, and progesterone have successfully shown to decrease the incidence of recurrent pregnancy loses; whereas G-CSF, intralipids, estrogen, and Igs have shown success in the treatment of the recurrent implantation failure and recurrent pregnancy failure. The pregnancies treated with Igs and intralipids showed equal outcome when evaluated and compared. The place of intralipid in reducing natural killer (NK) cells has been discussed. PMID:24082648

  5. The novel POSEIDON stratification of 'Low prognosis patients in Assisted Reproductive Technology' and its proposed marker of successful outcome.

    PubMed

    Humaidan, Peter; Alviggi, Carlo; Fischer, Robert; Esteves, Sandro C

    2016-01-01

    In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to optimize the definition of this subgroup of patients, the existing POR criteria unfortunately comprise a heterogeneous population and, importantly, do not offer any recommendations for clinical handling. Recently, the POSEIDON group ( Patient- Oriented Strategies Encompassing Individualize D Oocyte Number) proposed a new stratification of assisted reproductive technology (ART) in patients with a reduced ovarian reserve or unexpected inappropriate ovarian response to exogenous gonadotropins. In brief, four subgroups have been suggested based on quantitative and qualitative parameters, namely, i. Age and the expected aneuploidy rate; ii. Ovarian biomarkers (i.e. antral follicle count [AFC] and anti-Müllerian hormone [AMH]), and iii. Ovarian response - provided a previous stimulation cycle was performed. The new classification introduces a more nuanced picture of the "low prognosis patient" in ART, using clinically relevant criteria to guide the physician to most optimally manage this group of patients. The POSEIDON group also introduced a new measure for successful ART treatment, namely, the ability to retrieve the number of oocytes needed for the specific patient to obtain at least one euploid embryo for transfer. This feature represents a pragmatic endpoint to clinicians and enables the development of prediction models aiming to reduce the time-to-pregnancy (TTP). Consequently, the POSEIDON stratification should not be applied for retrospective analyses having live birth rate (LBR) as endpoint. Such an approach would fail as the attribution of patients to each Poseidon group is related to specific requirements and could only be made prospectively. On the other hand, any

  6. The need for interaction between assisted reproduction technology and genetics: recommendations of the European Societies of Human Genetics and Human Reproduction and Embryology.

    PubMed

    2006-08-01

    Infertility and reproductive genetic risk are both increasing in our societies because of lifestyle changes and possibly environmental factors. Owing to the magnitude of the problem, they have implications not only at the individual and family levels but also at the community level. This leads to an increasing demand for access to assisted reproduction technology (ART) and genetic services, especially when the cause of infertility may be genetic in origin. The increasing application of genetics in reproductive medicine and vice versa requires closer collaboration between the two disciplines. ART and genetics are rapidly evolving fields where new technologies are currently introduced without sufficient knowledge of their potential long-term effects. As for any medical procedures, there are possible unexpected effects which need to be envisaged to make sure that the balance between benefits and risks is clearly on the benefit side. The development of ART and genetics as scientific activities is creating an opportunity to understand the early stages of human development, which is leading to new and challenging findings/knowledge. However, there are opinions against investigating the early stages of development in humans who deserve respect and attention. For all these reasons, these two societies, European Society of Human Genetics (ESHG) and European Society of Human Reproduction and Embryology (ESHRE), have joined efforts to explore the issues at stake and to set up recommendations to maximize the benefit for the couples in need and for the community.

  7. Just Molly and me, and donor makes three: lesbian motherhood in the age of assisted reproductive technology.

    PubMed

    Ehrensaft, Diane

    2008-01-01

    The psychological experiences of lesbian mothers, both coupled and single, are compared and contrasted with heterosexual and gay parents who use assisted reproductive technology, focusing on issues of parental desire, fertility, babies conceived from science rather than sex, presence of an outside party in conception, genetic asymmetry, social anxieties, legal protections, disclosure, and gender. The psychological meaning of the donor or surrogate as "extra" and "missing" piece of the family, along with the interactive effects of homophobia and "reproductive technophobia" are considered. Lesbian families are recognized to be constructing a new narrative of a bio-social family as they define and live their experience.

  8. Assisted reproductive technology and pregnancy-related hypertensive complications: a systematic review.

    PubMed

    Thomopoulos, C; Tsioufis, C; Michalopoulou, H; Makris, T; Papademetriou, V; Stefanadis, C

    2013-03-01

    Hypertensive complications in pregnancy are the leading cause of maternal morbidity, at least in the developed countries. In recent years, infertility issues are managed with ever growing therapeutic options namely assisted reproductive technologies (ART), which improve the ratio of successful induction of pregnancy. It is still debated whether various ART modalities are associated with adverse pregnancy outcomes, including hypertensive complications, particularly with higher incidence of preeclampsia. The main source of controversy stems from the diversity of effect modifiers modulating the association between ART-oriented pregnancy and hypertensive disorders. Indeed, women undergoing an ART procedure are affected by diverse causes of infertility, are frequently characterized by different genetic patterns with respect to their artificially conceived embryo and experienced multiple gestations. In order to investigate whether ART modalities are associated with increased incidence of hypertensive complications in pregnancy, we reviewed all published studies carried out before the end of 2010 and identified in the PubMed database. Among the 47 studies finally selected and by acknowledging the potential of shortcomings related to the different study design and populations, the overall evidence suggests that ART-oriented pregnancies-especially the in-vitro fertilization techniques-are accompanied by increased risk for gestational hypertension and preeclampsia as compared with non-ART pregnancies, even after adjustment for confounders. Multiple gestations, advanced age and underlying polycystic ovary syndrome resulted in constant confounders of the questioned association. Reducing multiple gestations by implementing single embryo techniques might be the therapeutic limiting step to lower the rate of hypertensive complications in assisted pregnancies.

  9. Outcomes and Recommendations of an Indian Expert Panel for Improved Practice in Controlled Ovarian Stimulation for Assisted Reproductive Technology

    PubMed Central

    Ahemmed, Baiju; Sundarapandian, Vani; Gutgutia, Rohit; Balasubramanyam, Sathya; Jagtap, Richa; Biliangady, Reeta; Gupta, Priti; Jadhav, Sachin; Satwik, Ruma; Thakor, Priti

    2017-01-01

    Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should “freeze-all” policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10–15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt “freeze-all” policy. Further research is needed due to lack of data availability on progesterone threshold or index. PMID:28246628

  10. Effect of male body mass index on clinical outcomes following assisted reproductive technology: a meta-analysis.

    PubMed

    Le, W; Su, S-H; Shi, L-H; Zhang, J-F; Wu, D-L

    2016-05-01

    Overweight and obese males might exhibit a great risk of infertility. However, according to the current studies, the association between elevated male body mass index (BMI) and the clinical adverse results after assisted reproductive technology (ART) remains controversial. Hence, we conducted a meta-analysis to evaluate the effects of raised male BMI on clinical outcomes following ART. PubMed, EMBASE and three Chinese databases were used to identify relevant studies. The primary outcome was clinical pregnancy rate. Secondary outcomes included live birth rate and sperm parameters. A total of 5262 male participants from 10 cohort studies were subjected to meta-analysis. Results indicated that overweight or obese had no significant impact on clinical pregnancy rate [in vitro fertilisation (IVF): odds ratio (OR), 0.73; 95% confidence interval (CI), 0.39-1.39; intracytoplasmic sperm injection (ICSI): OR, 1.03; 95% CI, 0.92-1.15], live birth rate (IVF: OR, 0.91; 95% CI, 0.78-1.06; ICSI: OR, 1.00; 95% CI, 0.50-1.99) and sperm concentration (SMD, -0.28; 95% CI, -0.65 to 0.08) compared with normal weight following IVF/ICSI treatments. Exclusion of any single study and almost all the sensitivity analyses showed that our results were reliable. At present, the role of male BMI in the process of ART is only partly understood and should be further investigated.

  11. The attitudes of infertile couples towards assisted reproductive techniques in Yazd, Iran: A cross sectional study in 2014

    PubMed Central

    Afshani, Seyed Alireza; Abdoli, Ali Mohammad; Hashempour, Mehrieh; Baghbeheshti, Maryam; Zolfaghari, Mohammad

    2016-01-01

    Background: Knowledge about assisted reproductive techniques (ART) and its procedures affect the attitude of infertile people. Making decisions about the use of ART is affected by one's perception and attitude. Objective: The aim of this cross-sectional study was to determine the attitude of infertile couples toward applying ART, and to investigate its related factors. Materials and Methods: A randomized cross-sectional study was conducted on 184 infertile couples who had referred to the Research and Clinical Center of Infertility, Yazd, Iran for diagnosis and treatment in June 2014. The data was collected using a two-part questionnaire containing demographic and attitudinal statements. For data analysis, SPSS statistical software and statistical tests of mean differences (t-test), Pearson correlation and analysis of variance were used. Results: A significant relationship between spouse's attitude (p<0.01), relative's attitude (p<0.01), the applied knowledge of ART (p<0.01), and attitude of infertile couples toward applying the ART was observed; however, there was not any significant relationship between gender and socioeconomic status toward applying ART (p>0.05). Conclusion: In conclusion, making a decision and accepting ART can be influenced by couple's attitude, their family's attitude and applied knowledge of ART. PMID:28066835

  12. The European Court legitimates access of Italian couples to assisted reproductive techniques and to pre-implantation genetic diagnosis.

    PubMed

    Turillazzi, Emanuela; Frati, Paola; Busardò, Francesco Paolo; Gulino, Matteo; Fineschi, Vittorio

    2015-07-01

    On 28 August 2012, the European Court of Human Rights (ECHR) issued a judgment regarding the requirements for the legitimate access of couples to assisted reproductive techniques (ART) and to pre-implantation genetic diagnosis (PGD). This judgment concerns the case of an Italian couple who found out after their first child was born with cystic fibrosis that they were healthy carriers of the disease. When the woman became pregnant again in 2010 and underwent fetal screening, it was found that the unborn child also had cystic fibrosis, whereupon she had the pregnancy terminated on medical grounds. In order to have the embryo genetically screened prior to implantation under the procedure of PGD, the couple sought to use in vitro fertilisation to have another child. Since article 1 of the Italian law strictly limits access to ART to sterile/infertile couples or those in which the man has a sexually transmissible disease, the couple appealed to the European court, raising the question of the violation of articles 8 and 14 of the European Convention on Human Rights. The applicants lodged a complaint that they were not allowed legitimate access to ART and to PGD to select an embryo not affected by the disease. The European Court affirmed that the prohibition imposed by Italian law violated article 8 of the European Convention on Human Rights. Focusing on important regulatory and legal differences among EU Nations in providing ART treatments and PGD, we derived some important similarities and differences.

  13. Assisted reproduction technique outcomes for fresh versus deferred cryopreserved day-2 embryo transfer: a retrospective matched cohort study.

    PubMed

    Bourdon, Mathilde; Santulli, Pietro; Gayet, Vanessa; Maignien, Chloé; Marcellin, Louis; Pocate-Cheriet, Khaled; Chapron, Charles

    2017-03-01

    Ovarian stimulation could adversely affect endometrial receptivity and consequently embryo implantation. One emerging strategy is the 'freeze-all' approach. Most studies have focused on blastocyst transfers, with limited research on day-2 deferred cryopreserved embryo transfers. In this large retrospective cohort study, outcomes were compared between day-2 fresh versus deferred cryopreserved embryo transfers. After matching by age and number of previous cycles, 325 cycles were included in the fresh group and 325 in the deferred cryopreserved embryo transfers group: no significant differences were found between groups in implantation (0.20 ± 0.33 versus 0.17 ± 0.31, respectively) and ongoing pregnancy rates (21.85% versus 18.46%). Independent predictors for ongoing pregnancy after a multiple logistic regression analysis were the women's age (OR = 0.92; 95% CI 0.88 to 0.97), body mass index (OR = 0.94; 95% CI 0.89 to 0.99), the number of two pronuclei embryos (OR = 1.19; 95% CI 1.04 to 1.40) and at least one grade 1 embryo transferred (OR = 1.97; 95% CI 1.26 to 3.05). In the case of a day-2 embryo transfer, outcomes after treatment with assisted reproduction techniques are similar for fresh versus deferred cryopreserved embryo transfers when pre-transfer progesterone exposures are similar in the two groups.

  14. Barriers to access to infertility care and assisted reproductive technology within the public health sector in Brazil

    PubMed Central

    Makuch, M.Y.; Bahamondes, L.

    2012-01-01

    Background: In Brazil, access to infertility care, including assisted reproductive technologies (ARTs), is restricted. This is the third report of a study on access to infertility care and ARTs within the public sector, focusing on the barriers to these services. Methods: The study was anchored on quantitative and qualitative methods. For the quantitative study interviews were conducted with health authorities in each of the 26 states, the Federal District, the state capitals and 16 cities with ≥ 500,000 inhabitants and directors of infertility referral centres within the public sector. Qualitative case studies were conducted in five ART centres. Results: Overall, 63.5% of the authorities reported that complex infertility treatments were unavailable. Barriers identified consisted of “lack of political decision to implement them”, and “lack of financial resources”. In addition, 75% reported to have “no plans to implement them over the next 12 months”. At the facilities offering ART, the barriers to these procedures were the high costs, long waiting times, complex scheduling processes and lack of initiative to implement low cost ARTs. Conclusions: Infertile couples’ access to ART procedures is restricted due to the insufficient services and lack of political commitment to support existing and new services.. PMID:24753912

  15. Direct-to-consumer advertising of success rates for medically assisted reproduction: a review of national clinic websites

    PubMed Central

    Vail, Andy; Roberts, Stephen A

    2017-01-01

    Objectives To establish how medically assisted reproduction (MAR) clinics report success rates on their websites. Setting Websites of private and NHS clinics offering in vitro fertilisation (IVF) in the UK. Participants We identified clinics offering IVF using the Choose a Fertility Clinic facility on the website of the Human Fertilisation and Embryology Authority (HFEA). Of 81 clinics identified, a website could not be found for 2, leaving 79 for inclusion in the analysis. Primary and secondary outcome measures Outcome measures reported by clinic websites. The numerator and denominator included in the outcome measure were of interest. Results 53 (67%) websites reported their performance using 51 different outcome measures. It was most common to report pregnancy (83% of these clinics) or live birth rates (51%). 31 different ways of reporting pregnancy and 9 different ways of reporting live birth were identified. 11 (21%) reported multiple birth or pregnancy rates. 1 clinic provided information on adverse events. It was usual for clinics to present results without relevant contextual information such as sample size, reporting period, the characteristics of patients and particular details of treatments. Conclusions Many combinations of numerator and denominator are available for the purpose of reporting success rates for MAR. The range of reporting options available to clinics is further increased by the possibility of presenting results for subgroups of patients and for different time periods. Given the status of these websites as advertisements to patients, the risk of selective reporting is considerable. Binding guidance is required to ensure consistent, informative reporting. PMID:28082363

  16. Homocysteine in embryo culture media as a predictor of pregnancy outcome in assisted reproductive technology.

    PubMed

    Boyama, Burcu Aydin; Cepni, Ismail; Imamoglu, Metehan; Oncul, Mahmut; Tuten, Abdullah; Yuksel, Mehmet Aytac; Kervancioglu, Mehmet Ertan; Kaleli, Semih; Ocal, Pelin

    2016-01-01

    The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 μmol/l in the non-pregnant group and 3.37 ± 0.92 μmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65-0.94; p < 0.05). A cut-off value of 3.53 μmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

  17. Clinical outcomes after assisted reproductive technology in twin pregnancies: chorionicity-based comparison

    PubMed Central

    Sun, Luming; Zou, Gang; Wei, Xing; Chen, Yan; Zhang, Jun; Okun, Nanette; Duan, Tao

    2016-01-01

    The chorionicity–based evaluation of the perinatal risk in twin pregnancies after assisted reproductive technology (ART) is lacking. A retrospective review was performed of all twin pregnancies monitored prenatally and delivered at our hospital between 2010 and 2014. Chorionicity was diagnosed by ultrasound examination at first trimester and confirmed by postnatal pathology. Pregnancy and perinatal outcomes were prospectively recorded. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated in a logistic regression model. A total of 1153 twin pregnancies were analyzed. The occurrence of preterm premature rupture of membranes (PPROM) was 3 times as frequent in monochorionic diamniotic (MCDA) twin pregnancies after ART as in those spontaneous counterparts (aOR 3.0; 95%CI 1.1–3.2). The prevalence of intrahepatic cholestasis of pregnancies (ICP) was significantly higher in dichorionic diamniotic (DCDA) twin pregnancies following ART compared to spontaneous DCDA pregnancies (aOR 3.3; 95%CI 1.3–5.6). Perinatal outcomes did not differ between two conception methods, either in MCDA or DCDA twin pregnancies. Based on differentiation of chorionicity, ART is associated with the increased risk of PPROM in MCDA twin pregnancies and with a higher rate of ICP in DCDA twin gestations. ART does not increase adversity of perinatal outcomes in twin pregnancies. PMID:27243373

  18. Conflicts of Interest and Effective Oversight of Assisted Reproduction Using Donated Oocytes.

    PubMed

    Blake, Valarie K; McGowan, Michelle L; Levine, Aaron D

    2015-01-01

    Oocyte donation raises conflicts of interest and commitment for physicians but little attention has been paid to how to reduce these conflicts in practice. Yet the growing popularity of assisted reproduction has increased the stakes of maintaining an adequate oocyte supply and (where appropriate) minimizing conflicts. A growing body of professional guidelines, legal challenges to professional self-regulation, and empirical research on the practice of oocyte donation all call for renewed attention to the issue. As empirical findings better inform existing conflicts and their potential harms, we can better attempt to reduce these conflicts. To that end, the article first describes the nature of conflicts in oocyte donation and relevant regulations and professional guidelines. We then describe studies on conflicts at four phases of oocyte donation: recruitment, screening, stimulation, and post-stimulation monitoring. Next we consider three models for conflict reduction in medicine generally: improved professional self-regulation, outright restriction like Stark anti-referral laws, or the use of conflict mediators, like in living organ donation. We ultimately conclude that improved professional self-regulation is a reasonable starting place for oocyte donation.

  19. Stability of genomic imprinting in embryonic stem cells: lessons from assisted reproductive technology.

    PubMed

    Huntriss, John; Picton, Helen M

    2008-05-01

    Imprinted genes are expressed predominantly or exclusively from one allele only. This mode of gene expression makes the regulation of imprinted genes susceptible to epigenetic insults, which may in turn lead to disease. There is compelling experimental evidence that certain aspects of assisted reproductive technology (ART) such as in vitro cell culture may have adverse effects on the regulation of epigenetic information in mammalian embryos, including the disruption of imprinted genes and epigenetic regulators. Moreover, in humans, disorders of genomic imprinting have been reported in children conceived by ART. The derivation and in vitro culture of embryonic stem (ES) cells are potential points of origin for epigenetic abnormalities. There is evidence that defects of genomic imprinting occur in mouse embryonic stem cells, with similar data now emerging in related studies in non-human primate and human ES cells. It is therefore pertinent to rigorously assess the epigenetic status of all stem cells and their derivatives prior to their therapeutic use in humans. Focusing on the stability of genomic imprinting, this review discusses the current evidence for epigenetic disruption in mammalian embryonic stem cells in light of the epigenetic disruption observed in ART-derived mammalian embryos.

  20. A review of known imprinting syndromes and their association with assisted reproduction technologies.

    PubMed

    Amor, David J; Halliday, Jane

    2008-12-01

    An association between assisted reproduction technologies (ART) and abnormal genomic imprinting in humans has been recognized for several years; however, the magnitude of this risk and the spectrum of imprinting syndromes to which the risk applies remains unknown. Nine human imprinting syndromes have been identified but current evidence links ART with only three: Beckwith-Wiedemann syndrome, Angelman syndrome and the newly described maternal hypomethylation syndrome. There is currently a lack of evidence linking ART with the remaining six imprinting syndromes: Prader-Willi syndrome, Russell-Silver syndrome, maternal and paternal uniparental disomy of chromosome 14, pseudohypoparathyroidism type 1b and transient neonatal diabetes. Evidence from clinical reports suggests that the association between imprinting syndromes and ART may be restricted to syndromes where the imprinting change takes the form of hypomethylation on the maternal allele. In contrast, studies of gametes and early embryos suggest that ART can be associated with hypermethylation as well as hypomethylation, with imprinting changes occurring on paternal as well as maternal alleles. The health effects of ART-associated imprinting changes may also extend beyond the nine recognized imprinting syndromes.

  1. The Chromosomal Constitution of Embryos Arising from Monopronuclear Oocytes in Programmes of Assisted Reproduction

    PubMed Central

    2014-01-01

    The assessment of oocytes showing only one pronucleus during assisted reproduction is associated with uncertainty. A compilation of data on the genetic constitution of different developmental stages shows that affected oocytes are able to develop into haploid, diploid, and mosaic embryos with more or less complex chromosomal compositions. In the majority of cases (~80%), haploidy appears to be caused by gynogenesis, whereas parthenogenesis or androgenesis is less common. Most of the diploid embryos result from a fertilization event involving asynchronous formation of the two pronuclei or pronuclear fusion at a very early stage. Uniparental diploidy may sometimes occur if one pronucleus fails to develop and the other pronucleus already contains a diploid genome or alternatively a haploid genome undergoes endoreduplication. In general, the chance of obtaining a biparental diploid embryo appears higher after conventional in vitro fertilization than after intracytoplasmic sperm injection. If a transfer of embryos obtained from monopronuclear oocytes is envisaged, it should be tried to culture them up to the blastocyst since most haploid embryos are not able to reach this stage. Comprehensive counselling of patients on potential risks is advisable before transfer and a preimplantation genetic diagnosis could be offered if available. PMID:25763399

  2. Processes involved in assisted reproduction technologies significantly increase sperm DNA fragmentation and phosphatidylserine translocation.

    PubMed

    Balasuriya, A; Serhal, P; Doshi, A; Harper, J C

    2014-03-01

    Sperm preparation techniques in assisted reproduction technologies (ART) are potential generators of exogenous stresses that cause additional DNA damage. DNA fragmentation tests, such as the sperm chromatin structure assay, involve freezing sperm samples in the absence of cryoprotectant. Thermal, oxidative stress (OS) and freezing are detrimental to sperm DNA fragmentation and phosphatidylserine (PS) translocation. The primary aim of this study was to subject mature sperm to environmental insults that normally occur during ART. We tested the hypotheses that OS, thermal stress and freeze-thawing caused sperm nuclear and membrane damage and that a positive correlation exists between PS translocation and DNA fragmentation. Sperm DNA integrity deteriorates in semen samples from men with advancing age and a sperm concentration of <15 m ml(-1) . The significant increase in sperm DNA fragmentation at 37 °C after merely 1 h is important clinically as semen liquefaction and short-term sperm storage in an ART cycle involve incubating samples at this temperature. Freezing without a cryoprotectant significantly increases the level of sperm nuclear damage, so it is important not to freeze neat semen prior to DNA fragmentation testing. This study highlights the importance of minimising the production of exogenous stresses during sperm preparation in ART.

  3. Homoaffective parentage--specifically, a matter of medically assisted reproduction: a parallel between Brazil and Portugal.

    PubMed

    Chaves, Marianna

    2011-09-01

    In the field of homosexuality an issue still excessively polemical is the one concerning the possibility of paternity or maternity (biological or adoptive) as a right to be exercised by homosexuals. An even more controversial issue is that of homosexuals' access to assisted reproductive techniques. Carrying out an analysis of two countries, Brazil and Portugal face this with opposite approaches in legislation and legal doctrine. In Brazil, the issue is not legislatively regulated. In Portugal, there is regulatory law. The question that arises is: what is better an extremely reductive and discriminatory law or a true legal vacuum? Several questions may be raised in this context. The first one is: is there indeed a right to parenthood? What to say about surrogacy? In these cases is the commandment of the child's best interest being heeded, which is the vector for any decision relating to an infant or teenager? Differences of understanding will always exist, especially in such a sensitive field as Family Law. But one fact must be accepted: any resolution and legislation in this context must be based on the principle of the best interests of the - born or unborn - child and other constitutional principles as equality, freedom, non-discrimination and human dignity, forgetting the prejudice rooted in society and the unfounded conjectures of homophobic judgments.

  4. Efficient production of cynomolgus monkeys with a toolbox of enhanced assisted reproductive technologies

    PubMed Central

    Ma, Yunhan; Li, Jiayu; Wang, Ge; Ke, Qiong; Qiu, Sien; Gao, Liang; Wan, Haifeng; Zhou, Yang; Xiang, Andy Peng; Huang, Qunshan; Feng, Guoping; Zhou, Qi; Yang, Shihua

    2016-01-01

    The efficiency of assisted reproductive technologies (ARTs) in nonhuman primates is low due to no screening criterions for selecting sperm, oocyte, and embryo as well as its surrogate mothers. Here we analyzed 15 pairs of pregnant and non-pregnant cynomolgus monkeys, each pair of which received embryos from one batch of fertilized oocytes, and found ratio of endometrial to myometrial thicknesses in abdominal ultrasonic transverse section of uterus is a reliable indicator for selection of recipients for embryo transfer. We performed 305 ovarian stimulations in 128 female cynomolgus monkeys and found that ovarian stimulation can be performed in a whole year and repeated up to six times in the same monkey without deteriorating fertilization potential of eggs until a poor response to stimulation happened. Fertilization can be efficiently achieved with both conventional and piezo-driven intracytoplasmic sperm injection procedures. In semen collection, semen quality is higher with the penile robe electrical stimulus method compared with the rectal probe method. Moreover, caesarean section is an effective strategy for increasing baby survival rates of multiple pregnancies. These findings provide a practical guidance for the efficient use of ARTs, facilitating their use in genetic engineering of macaque monkeys for basic and translational neuroscience research. PMID:27173128

  5. Maternal and Live-birth Outcomes of Pregnancies following Assisted Reproductive Technology: A Retrospective Cohort Study

    PubMed Central

    Zhu, Linling; Zhang, Yu; Liu, Yifeng; Zhang, Runjv; Wu, Yiqing; Huang, Yun; Liu, Feng; Li, Meigen; Sun, Saijun; Xing, Lanfeng; Zhu, Yimin; Chen, Yiyi; Xu, Li; Zhou, Liangbi; Huang, Hefeng; Zhang, Dan

    2016-01-01

    This study was carried out to explore associations between assisted reproductive technology (ART) and maternal and neonatal outcomes compared with similar outcomes following spontaneously conceived births. We conducted a retrospective cohort study of pregnancies conceived by ART (N = 2641) during 2006–2014 compared to naturally conceived pregnancies (N = 5282) after matching for maternal age and birth year. Pregnancy complications, perinatal complications and neonatal outcomes of enrolled subjects were investigated and analysed by multivariate logistic regression. We found that pregnancies conceived by in vitro fertilization (IVF) were associated with a significantly increased incidence of gestational diabetes mellitus, gestational hypertension, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, placental abruption, preterm premature rupture of membranes, placental adherence, postpartum haemorrhage, polyhydramnios, preterm labour, low birth weight, and small-for-date infant compared with spontaneously conceived births. Pregnancies conceived by intracytoplasmic sperm injection (ICSI) showed similar elevated complications, except some of the difference narrowed or disappeared. Singleton pregnancies or nulliparous pregnancies following ART still exhibited increased maternal and neonatal complications. Therefore, we conclude that pregnancies conceived following ART are at increased risks of antenatal complications, perinatal complications and poor neonatal outcomes, which may result from not only a higher incidence of multiple pregnancy, but also the manipulation involved in ART processes. PMID:27762324

  6. A descriptive study of culture media in Brazilian assisted reproduction clinics

    PubMed Central

    Bartmann, Ana; do Amaral, Amanda Turato Barbosa; Gonçalves, Letícia

    2016-01-01

    Objective The present study aimed to draw a profile of the most commonly used media and protocol characteristics from assisted reproduction technology (ART) facilities in Brazil. Methods To obtain an overview of ART methods and culture media, a questionnaire was given to embryologists from ART clinics in Brazil. Further research in scientific papers and journals was carried out for describing the processes around Brazil, USA and Europe. Results From the questionnaire, we found that the embryo medium mostly used is CSCMTM from Irvine Scientific, represented 37.04% in Brazilian ART clinics; interestingly, 70.37% of clinics exchange the embryo media bath; however, 70.37% do not change the media type. Transfers in Brazilian clinics were variable, but day 3 transfer was a procedure seen in 37.04%. The remaining embryos are habitually maintained in prolonged cultivation in 51.85% of the clinics interviewed. Conclusion Although there are numerous studies trying to better understand embryo culture media influences, there is a lack of evidence for choosing one as the most appropriate. In short, it is a random decision for such an essential stage of In Vitro Fertilization. PMID:27584601

  7. Corpus luteal contribution to maternal pregnancy physiology and outcomes in assisted reproductive technologies.

    PubMed

    Conrad, Kirk P; Baker, Valerie L

    2013-01-15

    Investigations in the rat model of pregnancy indicate an important role for the corpus luteal (CL) hormone relaxin in the maternal circulatory and osmoregulatory changes in pregnancy, which are epitomized by profound vasodilation and modest hypoosmolality, respectively. In a pilot study of infertile women who became pregnant through donor eggs, in vitro fertilization, and embryo transfer, the gestational rise in glomerular filtration and fall in plasma osmolality were markedly subdued. Because these women were infertile, they lacked a CL and circulating relaxin (and possibly other vasoactive CL hormones). Based on these findings in pregnant rats and women, we hypothesize that infertile women conceiving through donor eggs will have overall subdued circulatory changes (e.g., attenuated reduction in systemic vascular resistance and subdued increase in cardiac output) particularly during early pregnancy when CL hormones predominate before the full development and maturation of the placenta. In contrast, infertile women conceiving by autologous eggs retrieved after ovarian stimulation and fresh embryo transfer may have a relatively hyperdynamic circulation due to the presence of many CL (up to 20 or more) and higher circulating levels of vasodilatory ovarian hormones such as relaxin. Emerging evidence suggests that women undergoing Assisted Reproductive Technologies (ART) have increased risk for adverse pregnancy outcomes such as preeclampsia and small for gestational-age babies. This increased risk may be partly caused by the maternal milieu, which is not physiological in ART pregnancies due to the abnormal status of the CL.

  8. Effect of contaminated preprocessed semen on fertilization rate and embryo quality in assisted reproductive techniques.

    PubMed

    Krissi, H; Orvieto, R; Ashkenazi, J; Gilboa, Y; Shalev, J; Moscovitch, I; Bar-Hava, I

    2004-02-01

    We aimed to identify the sources and prevalence of semen contamination from mastrubation and determine the effect of bacterospermia on fertilization rate and embryo quality in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This was a prospective controlled study, in an IVF unit of a university teaching hospital, of 93 consecutive couples undergoing IVF-embryo transfer cycles. We evaluated handwashing; semen collection and processing; and assisted reproductive technology using semen provided by masturbation. The main outcome measures were presence and type of micro-organisms in the semen samples and embryo culture medium; the effect of hand washing on rate of contamination; and the effect of semen contamination on fertilization rate and embryo quality. The first consecutive 52 men of the 93 couples were not instructed to wash their hands before masturbation, and the remainder were so instructed. Forty-nine semen cultures (94.2%) in the first group were contaminated compared to only 16 (39%) in the second (p < 0.016); 27 of the 65 positive cultures (41.5%) were contaminated by more than one organism. The most common contaminators were bacteria usually found on the skin. All but four embryo medium cultures were negative. There was no significant difference in fertilization rate and embryo quality by culture findings in either the IVF or the ICSI procedures. We found that a high percentage of manually obtained semen for standard IVF or ICSI procedures was contaminated, but this had no effect on fertilization rate and embryo quality.

  9. Incidence of abnormal offspring from cloning and other assisted reproductive technologies.

    PubMed

    Hill, Jonathan R

    2014-02-01

    In animals produced by assisted reproductive technologies, two abnormal phenotypes have been characterized. Large offspring syndrome (LOS) occurs in offspring derived from in vitro cultured embryos, and the abnormal clone phenotype includes placental and fetal changes. LOS is readily apparent in ruminants, where a large calf or lamb derived from in vitro embryo production or cloning may weigh up to twice the expected body weight. The incidence of LOS varies widely between species. When similar embryo culture conditions are applied to nonruminant species, LOS either is not as dramatic or may even be unapparent. Coculture with serum and somatic cells was identified in the 1990s as a risk factor for abnormal development of ruminant pregnancies. Animals cloned from somatic cells may display a combination of fetal and placental abnormalities that are manifested at different stages of pregnancy and postnatally. In highly interventional technologies, such as nuclear transfer (cloning), the incidence of abnormal offspring continues to be a limiting factor to broader application of the technique. This review details the breadth of phenotypes found in nonviable pregnancies, together with the phenotypes of animals that survive the transition to extrauterine life. The focus is on animals produced using in vitro embryo culture and nuclear transfer in comparison to naturally occurring phenotypes.

  10. Association Between Assisted Reproductive Technology Conception and Autism in California, 1997–2007

    PubMed Central

    Fountain, Christine; Zhang, Yujia; Kissin, Dmitry M.; Schieve, Laura A.; Jamieson, Denise J.; Rice, Catherine

    2015-01-01

    Objectives. We assessed the association between assisted reproductive technology (ART) and diagnosed autistic disorder in a population-based sample of California births. Methods. We performed an observational cohort study using linked records from the California Birth Master Files for 1997 through 2007, the California Department of Developmental Services autism caseload for 1997 through 2011, and the Centers for Disease Control and Prevention’s National ART Surveillance System for live births in 1997 through 2007. Participants were all 5 926 251 live births, including 48 865 ART-originated infants and 32 922 cases of autism diagnosed by the Department of Developmental Services. We compared births originated using ART with births originated without ART for incidence of autism. Results. In the full population, the incidence of diagnosed autism was twice as high for ART as non-ART births. The association was diminished by excluding mothers unlikely to use ART; adjustment for demographic and adverse prenatal and perinatal outcomes reduced the association substantially, although statistical significance persisted for mothers aged 20 to 34 years. Conclusions. The association between ART and autism is primarily explained by adverse prenatal and perinatal outcomes and multiple births. PMID:25790396

  11. Boundaries and risk: Media framing of assisted reproductive technologies and older mothers.

    PubMed

    Campbell, Patricia

    2011-01-01

    Assisted reproductive technologies (ARTs) have historically been sites of heated public controversy. However, with widespread use, the boundary-challenging risks surrounding ARTs have become less newsworthy. One exception includes their use by "older mothers," particularly postmenopausal mothers. In this paper, I review the social science literature related to the risks of ARTs and the conceptualizations of "older mothers". Next, I move to analyze the specific case of 60-year-old Ranjit Hayer, who gave birth to twins in Calgary, Canada, through the context of the Canadian media coverage the week following the birth, using concepts from cultural approaches to risk perception, constructivist studies of technology, and risk communication theory. I argue that risk discourses emerge when technologies and users expose and challenge the contingent stability of the sociotechnical discourses surrounding them. This leads to a public re-opening of a "closed" technology and user and a reconstruction of the risks associated with them. This case demonstrates how an apparently "settled" sociotechnical network becomes reframed in terms of risk, and how the negotiation of this risk reveals, constructs, and interweaves various boundary discourses.

  12. ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people†.

    PubMed

    De Wert, G; Dondorp, W; Shenfield, F; Barri, P; Devroey, P; Diedrich, K; Tarlatzis, B; Provoost, V; Pennings, G

    2014-09-01

    This Task Force document discusses ethical issues arising with requests for medically assisted reproduction from people in what may be called 'non-standard' situations and relationships. The document stresses that categorically denying access to any of these groups cannot be reconciled with a human rights perspective. If there are concerns about the implications of assisted reproduction on the wellbeing of any of the persons involved, including the future child, a surrogate mother or the applicants themselves, these concerns have to be considered in the light of the available scientific evidence. When doing so it is important to avoid the use of double standards. More research is needed into the psychosocial implications of raising children in non-standard situations, especially with regard to single women, male homosexual couples and transsexual people.

  13. CO2 laser in treatment of condylomata acuminata of male reproductive organs

    NASA Astrophysics Data System (ADS)

    Wozniak, Jakub; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Wilczak, Maciej; Pisarski, Tadeusz

    1996-03-01

    The results of laser therapy in the treatment of condylomata acuminata of male reproductive organs are reported. Between November 1991 and February 1995 in the Department of Reproduction, Institute of Gynecology and Obstetrics, Karol Marcinkowski University School of Medical Sciences, Poznan in 28 patients with condylomatous changes of reproductive organs carbon-dioxide laser therapy under colposcopic control was done. In 24 of them the healing was achieved. In four patients second laser therapy was done. All patients are still under control in the Department of Reproduction and there was no recurrence diagnosed.

  14. Extended culture up to the blastocyst stage: a strategy to avoid multiple pregnancies in assisted reproductive technologies.

    PubMed

    Sepúlveda, Soledad J; Portella, Jimmy R; Noriega, Luis P; Escudero, Ernesto L; Noriega, Luis H

    2011-01-01

    The aim of this study was to review the experience and outcomes of assisted reproduction cycles with embryos grown up to day 5 of development, comparing different parameters according to the ages of the patients. We retrospectively studied 1,874 assisted reproduction cycles where embryo culture was extended up to the fifth or sixth day of development. All IVF and ICSI cycles were included, comparing, according to patient age, the following rates: blastocyst formation, pregnancy, implantation and abortion. As control, we analyzed cycles with donated oocytes from young donors (OD). The number of embryos reaching the blastocyst stage is similar in all groups of patients. Only the OD group was different in terms of blastocyst formation, pregnancy and implantation rates. Patients over 39 years of age had an abortion rate of 59.1 %, which is significantly higher than the other groups. Extended embryo culture up to the blastocyst stage can be implemented in programs of assisted reproduction in order to increase the pregnancy rate. The potential of blastocyst implantation is high, allowing us to transfer fewer embryos and reduce the probability of multiple pregnancies.

  15. Psychological adjustment in adolescents conceived by assisted reproduction techniques: a systematic review

    PubMed Central

    Ilioi, Elena Cristiana; Golombok, Susan

    2015-01-01

    BACKGROUND Adolescence is a transitional time for identity formation and relationships with parents. While people born through assisted reproduction techniques (ART) appear to be well adjusted in childhood, it is unclear whether these findings carry into adolescence, and whether diverse ART have different psychological outcomes. This review summarizes what is known about the psychological adjustment and family relationships of the growing number of children born through ART who are reaching adolescence. METHODS The Pubmed, Web of Knowledge, PsycINFO and Scopus databases were searched systematically for peer reviewed papers focusing on adolescent psychological adjustment and parent–adolescent relationships in families created by ART. Key search inclusion criteria included all papers published in English relating to adolescents aged between 11 and 18 years. RESULTS Seventeen publications with varied methodologies were identified by this review. Only papers relating to in vitro fertilization (IVF), egg donation and donor insemination were identified. Results were categorized according to ART that used the parents' own gametes (IVF) and those that involved reproductive donation (egg donation, and donor insemination). Compared with naturally conceived adolescents and standardized normative samples, adolescents born through all ARTs seemed to be equally well adjusted, and to have positive parent–adolescent relationships. Some differences were however identified based on the type of ART used. In particular, the sex of the parent and child, along with age and process of disclosure of the adolescent's conception were identified as key mediators of parent–adolescent relationships in families created by donor insemination. CONCLUSIONS The studies in this review indicate that children born through ART have positive parent–adolescent relationships and are well adjusted, with some slight differences based on different ART. The generalizability of findings may be limited

  16. [Computer-assisted optimization of dialysis treatment].

    PubMed

    Rieck, B; Reinschke, P

    1988-01-01

    In some dialysis centers of the GDR personal computers are introduced step by step. There are two main areas in the use of computers in dialysis centers: data management systems and computer-assisted individualization of dialysis. Type and size of data processing are the result of the specific information process in a dialysis center and the presence of a long-term constantly group of patients along with a stereotypical amount of data. In the mathematical modelling of dialysis it is possible to adapt the standard dialysis to each patient.

  17. A Review of The Society for Assisted Reproductive Technology Embryo Grading System and Proposed Modification

    PubMed Central

    Hossain, Amjad; Phelps, John; Agarwal, Ashok; Sanz, Eduardo; Mahadevan, Maha

    2016-01-01

    The Society for Assisted Reproductive Technology (SART) method of embryo grad- ing is unique, simple, and widely practiced, and its use has been mandatory for SART membership programs since 2010. Developed by SART in 2006, the current embryo grading system categories, “good, fair, and poor,” are limited because they do not describe the best 1-2 embryos in the interest of keeping pace with the shift in clinical practice to be more selective and to transfer fewer embryos. This inspired us to conduct a review on the SART embryo grading system. In this retrospective study, the literature on evaluation of human embryo quality in gen- eral, and the SART method of evaluation in particular, were reviewed for the period of 2000 to 2014. A multifaceted search pertaining to methods of embryo grading and trans- fer using a combination of relevant terms [embryo, mammalian, embryo transfer, grade, grading, morphology, biomarkers, SART, and in vitro fertilization (IVF)] was performed. The inclusion and exclusion in this review were dictated by the aim and scope of the study. Two investigators independently assessed the studies and extracted information. A total of 61 articles were reviewed. Very few studies have evaluated the efficacy of the SART embryo grading method. The present study suggests the necessity for revision of the current SART grading system. The system, as it is now, lacks criteria for describing the cohort specific best embryo and thus is of limited use in single embryo transfer. The study foresees heightened descriptive efficiency of the SART system by implementing the proposed changes. Strengths and weaknesses of the SART embryo grading were identified. Ideas for selecting the best cohort-specific embryo have been discussed, which may trigger methodological improvement in SART and other embryo grading systems. PMID:27441045

  18. Culture media influenced laboratory outcomes but not neonatal birth weight in assisted reproductive technology.

    PubMed

    Yin, Tai-lang; Zhang, Yi; Li, Sai-jiao; Zhao, Meng; Ding, Jin-li; Xu, Wang-ming; Yang, Jing

    2015-12-01

    Whether the type of culture media utilized in assisted reproductive technology has impacts on laboratory outcomes and birth weight of newborns in in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) was investigated. A total of 673 patients undergoing IVF/ICSI and giving birth to live singletons after fresh embryo transfer on day 3 from Jan. 1, 2010 to Dec. 31, 2012 were included. Three types of culture media were used during this period: Quinn's Advantage (QA), Single Step Medium (SSM), and Continuous Single Culture medium (CSC). Fertilization rate (FR), normal fertilization rate (NFR), cleavage rate (CR), normal cleavage rate (NCR), good-quality embryo rate (GQER) and neonatal birth weight were compared using one-way ANOVA and χ (2) tests. Multiple linear regression analysis was performed to determine the impact of culture media on laboratory outcomes and birth weight. In IVF cycles, GQER was significantly decreased in SSM medium group as compared with QA or CSC media groups (63.6% vs. 69.0% in QA; vs. 71.3% in CSC, P=0.011). In ICSI cycles, FR, NFR and CR were significantly lower in CSC medium group than in other two media groups. No significant difference was observed in neonatal birthweight among the three groups (P=0.759). Multiple linear regression analyses confirmed that the type of culture medium was correlated with FR, NFR, CR and GQER, but not with neonatal birth weight. The type of culture media had potential influences on laboratory outcomes but did not exhibit an impact on the birth weight of singletons in ART.

  19. Characterization of global loss of imprinting in fetal overgrowth syndrome induced by assisted reproduction.

    PubMed

    Chen, Zhiyuan; Hagen, Darren E; Elsik, Christine G; Ji, Tieming; Morris, Collin James; Moon, Laura Emily; Rivera, Rocío Melissa

    2015-04-14

    Embryos generated with the use of assisted reproductive technologies (ART) can develop overgrowth syndromes. In ruminants, the condition is referred to as large offspring syndrome (LOS) and exhibits variable phenotypic abnormalities including overgrowth, enlarged tongue, and abdominal wall defects. These characteristics recapitulate those observed in the human loss-of-imprinting (LOI) overgrowth syndrome Beckwith-Wiedemann (BWS). We have recently shown LOI at the KCNQ1 locus in LOS, the most common epimutation in BWS. Although the first case of ART-induced LOS was reported in 1995, studies have not yet determined the extent of LOI in this condition. Here, we determined allele-specific expression of imprinted genes previously identified in human and/or mouse in day ∼105 Bos taurus indicus × Bos taurus taurus F1 hybrid control and LOS fetuses using RNAseq. Our analysis allowed us to determine the monoallelic expression of 20 genes in tissues of control fetuses. LOS fetuses displayed variable LOI compared with controls. Biallelic expression of imprinted genes in LOS was associated with tissue-specific hypomethylation of the normally methylated parental allele. In addition, a positive correlation was observed between body weight and the number of biallelically expressed imprinted genes in LOS fetuses. Furthermore, not only was there loss of allele-specific expression of imprinted genes in LOS, but also differential transcript amounts of these genes between control and overgrown fetuses. In summary, we characterized previously unidentified imprinted genes in bovines and identified misregulation of imprinting at multiple loci in LOS. We concluded that LOS is a multilocus LOI syndrome, as is BWS.

  20. The impact of assisted reproductive technologies on the genome and epigenome of the newborn.

    PubMed

    Kochanski, A; Merritt, T A; Gadzinowski, J; Jopek, A

    2013-01-01

    The question of genetic alterations resulting from assisted reproductive technologies (ART) in humans is examined within the organization of the human genome. Increased rates of birth defects have been reported among children conceived using ART; however, questions remain and controversy exists regarding how "infertility" predisposes to birth defects. ART has been shown to be associated with an increased number of chromosomal alterations especially in the X chromosome. There is increased risk for embryonal tumors among ART conceived children, as well as, imprinting disorders (Beckwith-Wiedemann and Angelman Syndromes). Genetic studies of children conceived using ART reveal a larger (genome-wide) scale of methylation defects that encompass hundreds of genes. Genes involved in carcinogenesis and developmental pathways appear altered and may impact on later development of chronic illness, although these data are very preliminary. ART may create novel mutations by different chromosomal and molecular mechanisms; however, these techniques also enable propagation of pre-existing mutations that are associated with impaired fertility. While older maternal age is often associated with female infertility and chromosomal aneuploidy, sperm from older men have more new gene mutations. The prevalence of birth defects is increased when ART is used for conception. These data are summarized by large meta-analyses or from multi-year national registries. Whether the increased number of birth defects is due to ART procedures themselves or are a consequence of the impaired fertility of the parents is discussed. Long-term evaluation of children conceived using ART and/or ovarian hyper-stimulation is needed to determine whether alterations during embryonic development may increase the prevalence of chronic diseases in adulthood.

  1. Male age is not an independent factor to affect the outcome of assisted reproductive techniques.

    PubMed

    Kumtepe, Yakup; Yakin, Kayhan; Kahraman, Semra; Sertyel, Semra; Vanlioğlu, Faruk; Cengiz, Sami; Dönmez, Ersan

    2003-06-01

    Controversy exists whether advanced male age is associated with poor sperm quality and subsequent failure in the assisted reproductive techniques (ART). The purpose of this study was to evaluate the effect of male age on sperm quality and the outcome of ART as well as the association of male age with other relevant factors, particularly with the female age. A retrospective study was performed in order to evaluate the effect of male age on the sperm parameters in 880 routine seminal analyses. Additionally, sperm parameters were also compared among different age groups in 919 cases with male factor infertility who had been included in an ART programme. The laboratory and clinical results of ART (fertilization rate, number and quality of embryos transferred, as well as pregnancy rates) were compared according to different age groups. The results were also evaluated by one-way correlation and also step-wise logistic regression analysis to identify the interactions and correlations between different parameters. There were no statistically significant differences between male age groups in terms of sperm concentration, motility and morphology either in routine seminal analyses or in ART groups. In the ART group, a statistically significant linear correlation was present between male and female ages. Male age was increasing in parallel to female age. Female age was also correlated significantly with ART results. In one-way correlation analysis, male age was found to be correlated with the pregnancy rate, but not with fertilization rate and the quality of the transferred embryos. However, regression analysis revealed that correlation between male age and pregnancy results was simply dependent on the effect of the female age. Seminal parameters did not reveal a significant change with the increasing male age. The effect of male age on ART results in cases with male factor infertility is not a direct effect but a reflection of the negative impact of the parallel increase in

  2. Dynamic regulation of DNA methyltransferases in human oocytes and preimplantation embryos after assisted reproductive technologies.

    PubMed

    Petrussa, Laetitia; Van de Velde, Hilde; De Rycke, Martine

    2014-09-01

    DNA methylation is a key epigenetic modification which is essential for normal embryonic development. Major epigenetic reprogramming takes place during gametogenesis and in the early embryo; the complex DNA methylation patterns are established and maintained by DNA methyltransferases (DNMTs). However, the influence of assisted reproductive technologies (ART) on DNA methylation reprogramming enzymes has predominantly been studied in mice and less so in human oocytes and embryos. The expression and localization patterns of the four known DNMTs were analysed in human oocytes and IVF/ICSI embryos by immunocytochemistry and compared between a reference group of good quality fresh embryos and groups of abnormally developing embryos or embryo groups after cryopreservation. In humans, DNMT1o rather than DNMT1s seems to be the key player for maintaining methylation in early embryos. DNMT3b, rather than DNMT3a and DNMT3L, appears to ensure global DNA remethylation in the blastocysts before implantation. DNMT3L, an important regulator of maternal imprint methylation in mouse, was not detected in human oocytes (GV, MI and MII stage). Our study confirms the existence of species differences for mammalian DNA methylation enzymes. In poor quality fresh embryos, the switch towards nuclear DNMT3b expression was delayed and nuclear DNMT1, DNMT1s and DNMT3b expression was less common. Compared with the reference embryos, a smaller number of cryopreserved embryos showed nuclear DNMT1, while a delayed switch to nuclear DNMT3b and an extended DNMT1s temporal expression pattern were also observed. The spatial and temporal expression patterns of DNMTs seem to be disturbed in abnormally developing embryos and in embryos that have been cryopreserved. Further research must be performed in order to understand whether the potentially disturbed embryonic DNMT expression after cryopreservation has any long-term developmental consequences.

  3. Assisted reproductive technology and the risk of preterm birth among primiparas

    PubMed Central

    Dunietz, Galit Levi; Holzman, Claudia; McKane, Patricia; Li, Chenxi; Boulet, Sheree L.; Todem, David; Kissin, Dmitry M.; Copeland, Glenn; Bernson, Dana; Sappenfield, William M.; Diamond, Michael P.

    2015-01-01

    Objective To investigate the risk of preterm birth among liveborn singletons to primiparas who conceived with assisted reproductive technology (ART) using four mutually exclusive categories of infertility (female infertility only, male infertility only, female and male infertility, and unexplained infertility) and to examine preterm birth risk along the gestational age continuum. Design Retrospective cohort study. Setting Not applicable. Patient(s) Singletons born to primiparas who conceived with or without ART. Intervention(s) None. Main Outcome Measure(s) Preterm (<37 weeks’ gestation) and preterm/early term birth <39 weeks’ gestation). Result(s) For the male infertility only, female infertility only, combined male and female infertility, and unexplained infertility groups, ART-conceived singletons were significantly more likely than non-ART singletons to be born preterm: adjusted odds ratio (aOR) 1.24 (95% CI, 1.13, 1.37), aOR 1.60 (95% CI, 1.50, 1.70), aOR 1.49 (95% CI, 1.35, 1.64), and aOR 1.26 (1.12, 1.43) respectively. Among infants whose mothers were diagnosed with infertility, the odds of preterm birth were highest between 28–30 weeks [female infertility only, aOR 1.95 (95% CI, 1.59, 2.39); male and female infertility: 2.21 (95% CI, 1.62, 3.00)] compared with infants in the general population. Within the ART population, singletons of couples with female infertility only were more likely to be born preterm than singletons born to couples with other infertility diagnoses. Conclusion(s) Among singleton births to primiparas, those conceived with ART had an increased risk for preterm birth, even when only the male partner had been diagnosed with infertility. The risk of preterm birth for ART-conceived infants whose mothers were diagnosed with infertility included the earliest deliveries. PMID:25707336

  4. Screening of mutations in the CFTR gene in 1195 couples entering assisted reproduction technique programs.

    PubMed

    Stuppia, Liborio; Antonucci, Ivana; Binni, Francesco; Brandi, Alessandra; Grifone, Nicoletta; Colosimo, Alessia; De Santo, Mariella; Gatta, Valentina; Gelli, Gianfranco; Guida, Valentina; Majore, Silvia; Calabrese, Giuseppe; Palka, Chiara; Ravani, Anna; Rinaldi, Rosanna; Tiboni, Gian Mario; Ballone, Enzo; Venturoli, Anna; Ferlini, Alessandra; Torrente, Isabella; Grammatico, Paola; Calzolari, Elisa; Dallapiccola, Bruno

    2005-08-01

    Genetic testing of the cystic fibrosis transmembrane conductance (CFTR) gene is currently performed in couples undergoing assisted reproduction techniques (ART), because of the high prevalence of healthy carriers in the population and the pathogenic relationship with congenital bilateral absence of vas deferens (CBAVD). However, discordant data have been reported concerning the usefulness of this genetic test in couples with no family history of cystic fibrosis (CF). In this study, we report the results of CFTR molecular screening in 1195 couples entering ART. Genetic testing was initially carried out in a single partner of each couple. CFTR mutations were detected in 55 subjects (4.6%), a percentage that overlaps with the one reported in the general population. However, significantly higher frequencies of were found in CBAVD individuals (37.5%) and in males with nonobstructive azoospermia (6.6%). The 5T allele was found in 78 patients (6.5%). This figure was again significantly different in males with nonobstructive-azoospermia (9.9%) and in those with CBAVD (100%). All together, 139 subjects (11.6%) had either a CFTR mutation or the 5T allele. Subsequent molecular analysis of their partners disclosed a CFTR mutation or 5T allele in nine cases (6.5%). However, none of these couples had CFTR alterations in both members, a CFTR mutation being invariably present in one partner and the 5T allele in the other. In order to improve genetic counselling of these couples, the TG-M470V-5T association was analyzed, and a statistically significant relationship between 12TG-V470 and CBAVD was detected.

  5. Ficoll-400 density gradient method as an effective sperm preparation technique for assisted reproductive techniques

    PubMed Central

    Highland, Hyacinth N.; Rishika, A. Sharma; Almira, S. Shaikh; Kanthi, P. Bansal

    2016-01-01

    BACKGROUND: Infertility being a burning issue, the male itself contributes about 40% as a cause, as evident by statistical data. However, Assisted Reproductive Technology (ART) has emerged as a powerful tool in the management of infertility. Sperm preparation techniques govern the selection procedure to separate functional spermatozoa which can then be used in IUI, IVF, and ART and for cryopreservation. AIM: The present study was aimed at evaluation of sperm preparation techniques for reliability, performance and to determine the most effective, feasible and economical technique. MATERIALS AND METHODS: The subjects under study includes males with normal proven fertility (n=40) and the males with unexplained infertility (n=40). Four sperm separation techniques, viz., Swim-up, Swim-down, Sucrose and Ficoll-400 density gradient techniques were evaluated for their efficacy in separation of good quality fraction of spermatozoa. Sperm viability, morphology and maturation status of spermatozoa were taken as evaluation parameters following the standard methods (WHO 2010). STATISTICAL ANALYSIS: Data was analyzed using student's t-test and the four selected techniques were compared with the normal semen samples for scoring the efficiency of the techniques. RESULTS AND DISCUSSION: Out of the several techniques used, Ficoll-400 was found to be more efficient method for separation of spermatozoa. The percentage of change in each parameter was calculated and taken as the index for recovery of potent sperm from the original sperm. Ficoll-400 density gradient yielded higher percentage of live, mature, morphologically normal spermatozoa in an isolated fraction as compared to other three techniques. CONCLUSION: It was observed that a combination of Ficoll-400 gradient separation with Swim-up technique could give quality spermatozoa which in-turn would directly have an impact on the success of IVF and other ART techniques. PMID:27803588

  6. A Review of The Society for Assisted Reproductive Technology Embryo Grading System and Proposed Modification.

    PubMed

    Hossain, Amjad; Phelps, John; Agarwal, Ashok; Sanz, Eduardo; Mahadevan, Maha

    2016-01-01

    The Society for Assisted Reproductive Technology (SART) method of embryo grad- ing is unique, simple, and widely practiced, and its use has been mandatory for SART membership programs since 2010. Developed by SART in 2006, the current embryo grading system categories, "good, fair, and poor," are limited because they do not describe the best 1-2 embryos in the interest of keeping pace with the shift in clinical practice to be more selective and to transfer fewer embryos. This inspired us to conduct a review on the SART embryo grading system. In this retrospective study, the literature on evaluation of human embryo quality in gen- eral, and the SART method of evaluation in particular, were reviewed for the period of 2000 to 2014. A multifaceted search pertaining to methods of embryo grading and trans- fer using a combination of relevant terms [embryo, mammalian, embryo transfer, grade, grading, morphology, biomarkers, SART, and in vitro fertilization (IVF)] was performed. The inclusion and exclusion in this review were dictated by the aim and scope of the study. Two investigators independently assessed the studies and extracted information. A total of 61 articles were reviewed. Very few studies have evaluated the efficacy of the SART embryo grading method. The present study suggests the necessity for revision of the current SART grading system. The system, as it is now, lacks criteria for describing the cohort specific best embryo and thus is of limited use in single embryo transfer. The study foresees heightened descriptive efficiency of the SART system by implementing the proposed changes. Strengths and weaknesses of the SART embryo grading were identified. Ideas for selecting the best cohort-specific embryo have been discussed, which may trigger methodological improvement in SART and other embryo grading systems.

  7. Associations between maternal older age, family environment and parent and child wellbeing in families using assisted reproductive techniques to conceive.

    PubMed

    Boivin, J; Rice, Frances; Hay, Dale; Harold, Gordon; Lewis, Allyson; van den Bree, Marianne M B; Thapar, Anita

    2009-06-01

    Maternal age effects on parenting and family outcomes are of increasing interest because of the demographic shift toward older maternal age at first birth. Maternal age is also of interest because of the greater use of assisted reproductive techniques (ART) to bypass age-related infertility in couples trying to conceive late in the reproductive life cycle of the woman. The aim of the present study was to investigate maternal age effects associated with delayed parenting by comparing families of mothers who gave birth at a younger (<31 years) or older (>38 years) age and to ascertain whether associations were linear associations by comparing these groups to women who had conceived in between these ages (i.e., >31 and <38 years). All children (4-11 year olds) were first-born and conceived using ART. Participants were recruited from one of 20 fertility clinics and mothers (n=642) and fathers (n=439) completed a postal questionnaire about demographic and reproductive characteristics, family environment as well as parent and child wellbeing. Our results demonstrate that parenthood via assisted conception later in the reproductive life cycle is not associated with a negative impact on child wellbeing. Despite maternal age-group differences on demographic (education, income) and reproductive characteristics (bleeding during pregnancy, caesarean rate, breast feeding), and parental warmth and depressive symptoms, child wellbeing was similar across mother age groups. We conclude that the parenting context is different for older mother families (more depressive symptoms in mothers and fathers, less expressed warmth in the couple) but that this difference is not associated with child wellbeing in early and middle childhood.

  8. Evaluation of quantitative trait loci affecting intramuscular fat and reproductive traits in pigs using marker-assisted introgression.

    PubMed

    Sato, S; Ohnishi, C; Kikuchi, T; Kohira, K; Egawa, S; Terai, S; Nakamura, T; Arata, S; Komatsuda, A; Uemoto, Y

    2014-12-01

    We investigated the effects of previously identified quantitative trait loci (QTL) in an experimental backcross (BC) between Chinese Meishan pigs and commercial Duroc pigs. We performed marker-assisted introgression of two QTL for intramuscular fat (IMF) content (IMF population) and three QTL for reproductive traits (reproduction population) from a donor Meishan pig into a recipient Duroc pig. At the fourth BC generation of the IMF population and third BC generation of the reproduction population, carrier animals were selected for the production of animals homozygous for the QTL. Our previous studies have shown that the presence of a Meishan allele on the IMF QTL is associated with low IMF values, and the Meishan allele on the reproductive QTL is associated with large litters. In this study, the presence of a Duroc allele at the IMF QTL on SSC9 resulted in a 0.27% increase in IMF (additive effect = 0.27 ± 0.08), whereas the presence of a Meishan allele at the IMF QTL on SSC7 resulted in a 0.34% increase in IMF (additive effect = -0.34 ± 0.09). The presence of the Meishan allele at the IMF QTL on SSC7 thus had the opposite effect to our previous studies, that is, increased IMF. In the reproduction population, we observed no differences between the genotypes of the three QTL in regard to number of corpora lutea or litter size. Marker-assisted introgression at these QTL is thus unlikely to result in an associated increase in litter size. These results show that it is possible to introgress alleles from other breeds into a selection population using molecular markers; any unexpected results might be associated with the genetic background.

  9. Disinvestment policy and the public funding of assisted reproductive technologies: outcomes of deliberative engagements with three key stakeholder groups

    PubMed Central

    2014-01-01

    Background Measures to improve the quality and sustainability of healthcare practice and provision have become a policy concern. In addition, the involvement of stakeholders in health policy decision-making has been advocated, as complex questions arise around the structure of funding arrangements in a context of limited resources. Using a case study of assisted reproductive technologies (ART), deliberative engagements with a range of stakeholder groups were held on the topic of how best to structure the distribution of Australian public funding in this domain. Methods Deliberative engagements were carried out with groups of ART consumers, clinicians and community members. The forums were informed by a systematic review of ART treatment safety and effectiveness (focusing, in particular, on maternal age and number of treatment cycles), as well as by international policy comparisons, and ethical and cost analyses. Forum discussions were transcribed and subject to thematic analysis. Results Each forum demonstrated stakeholders’ capacity to understand concepts of choice under resource scarcity and disinvestment, and to countenance options for ART funding not always aligned with their interests. Deliberations in each engagement identified concerns around ‘equity’ and ‘patient responsibility’, culminating in a broad preference for (potential) ART subsidy restrictions to be based upon individual factors rather than maternal age or number of treatment cycles. Community participants were open to restrictions based upon measures of body mass index (BMI) and smoking status, while consumers and clinicians saw support to improve these factors as part of an ART treatment program, as distinct from a funding criterion. All groups advocated continued patient co-payments, with measures in place to provide treatment access to those unable to pay (namely, equity of access). Conclusions Deliberations yielded qualitative, socially-negotiated evidence required to inform ethical

  10. Corticosteroid therapy in assisted reproduction - immune suppression is a faulty premise.

    PubMed

    Robertson, Sarah A; Jin, Min; Yu, Danqing; Moldenhauer, Lachlan M; Davies, Michael J; Hull, M Louise; Norman, Robert J

    2016-10-01

    There is ongoing interest in immune-suppressant corticosteroid drugs such as prednisolone to treat infertility in women with repeated IVF failure and recurrent miscarriage. The rationale draws on the pervasive but flawed view that immune activation is inconsistent with normal pregnancy. This ignores clear evidence that controlled inflammation and activation of the immune response is essential for embryo implantation. Generally, the immune response actively promotes reproductive success - by facilitating endometrial receptivity and tolerance of the foreign embryo, and promoting vascular adaptation to support placental morphogenesis. The peri-conception immune response also establishes developmental trajectories that can impact on fetal growth and gestational age at birth. Here, we describe immune changes accompanying conception that could be impeded by inappropriate corticosteroid administration. While women with specific clinical conditions may benefit from the anti-inflammatory and immune-deviating actions of prednisolone and related drugs, it is incorrect to assume a 'one-size-fits-all' approach. Better diagnostics and more preclinical studies are essential to define patient groups, build evidence for efficacy and fine-tune treatments so as not to inhibit essential actions of immune cells. We argue that unless overt immune pathology is evident, utilization of corticosteroids is not warranted and may be harmful. In most women, perturbing immune adaptation at implantation is expected to adversely influence placental development and impair immune-mediated quality control mechanisms, potentially elevating risk of altered fetal growth and developmental programming, congenital anomalies and preterm birth.

  11. Assisted Reproductive Technology and Newborn Size in Singletons Resulting from Fresh and Cryopreserved Embryos Transfer

    PubMed Central

    Holzman, Claudia; Zhang, Yujia; Talge, Nicole M.; Li, Chenxi; Todem, David; Boulet, Sheree L.; McKane, Patricia; Kissin, Dmitry M.; Copeland, Glenn; Bernson, Dana; Diamond, Michael P.

    2017-01-01

    Objectives and Study Design The aim of this study was two-fold: to investigate the association of Assisted Reproductive Technology (ART) and small newborn size, using standardized measures; and to examine within strata of fresh and cryopreserved embryos transfer, whether this association is influenced by parental infertility diagnoses. We used a population-based retrospective cohort from Michigan (2000–2009), Florida and Massachusetts (2000–2010). Our sample included 28,946 ART singletons conceived with non-donor oocytes and 4,263,846 non-ART singletons. Methods Regression models were used to examine the association of ART and newborn size, measured as small for gestational age (SGA) and birth-weight-z-score, among four mutually exclusive infertility groups: female infertility only, male infertility only, combined female and male infertility, and unexplained infertility, stratified by fresh and cryopreserved embryos transfer. Results We found increased SGA odds among ART singletons from fresh embryos transfer compared with non-ART singletons, with little difference by infertility source [adjusted odds-ratio for SGA among female infertility only: 1.18 (95% CI 1.10, 1.26), male infertility only: 1.20 (95% CI 1.10, 1.32), male and female infertility: 1.18 (95% CI 1.06, 1.31) and unexplained infertility: 1.24 (95% CI 1.10, 1.38)]. Conversely, ART singletons, born following cryopreserved embryos transfer, had lower SGA odds compared with non-ART singletons, with mild variation by infertility source [adjusted odds-ratio for SGA among female infertility only: 0.56 (95% CI 0.45, 0.71), male infertility only: 0.64 (95% CI 0.47, 0.86), male and female infertility: 0.52 (95% CI 0.36, 0.77) and unexplained infertility: 0.71 (95% CI 0.47, 1.06)]. Birth-weight-z-score was significantly lower for ART singletons born following fresh embryos transfer than non-ART singletons, regardless of infertility diagnoses. PMID:28114395

  12. From biopolitics to bioethics: church, state, medicine and assisted reproductive technology in Ireland.

    PubMed

    McDonnell, Orla; Allison, Jill

    2006-09-01

    This paper examines the emerging bioethical debate on assisted reproductive technology (ART) in Ireland, which is shaped by the long-standing contentious issue of abortion and the constitutional protection afforded to the 'unborn'. The focus of the paper is on the way in which the terms of this debate are shaped and constrained by the historical relations of power between church, state and medicine. Since the representation of Ireland as a post-Catholic, plural republic is becoming increasingly mainstream to cultural and political discourse, we pay particular attention to how the Catholic Church embraces bioethics as a meta frame or code for refocusing questions of values, beliefs and meanings to sustain the ideal of Ireland as a 'pro-life' and essentially Catholic nation. The Catholic Church is not simply asserting its voice of dissent in the context of public debate as one voice amongst a plurality of other voices, but to shape the emerging debate as a powerful, institutional actor. The opportunity to do so is afforded by the lack of public debate on bioethical issues and the exceedingly slow pace at which bioethics is moving towards an institutionalised framework in Ireland. These events can be explained by the legacy of the social power of the Catholic Church in Ireland and the direct and indirect influence it has long exercised over public policy vis-à-vis the state and its institutions, including medicine. There are two interconnected threads to the contextual analysis presented in our case study: first, the legacy of the social power wielded by the Catholic Church, and its slow and incremental demise reflected in the pace of secularisation in Ireland and the privatisation of morality; second, the emergence of a bioethical regulatory debate on ART, which is mired in the abortion controversy. Our analysis focuses on a number of key contradictions and tensions in the way in which the key institutions of church, state and medicine navigate their own positions

  13. Use of antimicrobials in the treatment of reproductive diseases in cattle and horses.

    PubMed

    Pyörälä, S; Taponen, J; Katila, T

    2014-09-01

    Use of antimicrobials for veterinary indications related to reproduction in cattle and horses is reviewed. Antimicrobial compounds are widely used to treat and prevent infections of reproductive organs. Total amounts of antimicrobials for such purposes, estimated by weight, are low compared with major uses in food animals. The most common reproduction-related indication in cattle is mastitis. The number of intramammary products available for treatment of mastitis in the European Union is high. Metritis and endometritis also require antimicrobial treatment of cattle and specific products for intrauterine administration are available. The traditions and practices associated with the use of these products vary considerably among different countries. Parenteral antimicrobial treatment is used to treat acute clinical mastitis and puerperal metritis. Pharmacological characteristics of the antimicrobial administered parenterally are critical to achieve and maintain therapeutic concentrations in the target organs. In mares, the most common indications associated with reproduction are endometritis, retained placenta and placentitis. The number of authorized antimicrobial products for horses is limited. Horses are treated individually and off-label use of antimicrobials is very common. In veterinary indications related to reproduction, treatment practices exist that cannot be considered to be evidence-based or responsible use of antimicrobials. Not all products for local treatment have proven efficacy data. Examples of unnecessary uses are routine treatment of cows with retained placenta and use of post-breeding antibiotic treatments in mares.

  14. A prediction model for live birth and multiple births within the first three cycles of assisted reproductive technology

    PubMed Central

    Luke, Barbara; Brown, Morton B.; Wantman, Ethan; Stern, Judy E.; Baker, Valerie L.; Widra, Eric; Coddington, Charles C.; Gibbons, William E.; Ball, G. David

    2014-01-01

    Objective To develop a model predictive of live-birth rates (LBR) and multiple birth rates (MBR) for an individual considering assisted reproduction technology (ART) using linked cycles from Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) for 2004–2011. Design Longitudinal cohort. Setting Clinic-based data. Patient(s) 288,161 women with an initial autologous cycle, of whom 89,855 did not become pregnant and had a second autologous cycle and 39,334 did not become pregnant in the first and second cycles and had a third autologous cycle, with an additional 33,598 women who had a cycle using donor oocytes (first donor cycle). Intervention(s) None. Main Outcome Measure(s) LBRs and MBRs modeled by woman’s age, body mass index, gravidity, prior full-term births, infertility diagnoses by oocyte source, fresh embryos transferred, and cycle, using backward-stepping logistic regression with results presented as adjusted odds ratios (AORs) and 95% confidence intervals. Result(s) The LBRs increased in all models with prior full-term births, number of embryos transferred; in autologous cycles also with gravidity, diagnoses of male factor, and ovulation disorders; and in donor cycles also with the diagnosis of diminished ovarian reserve. The MBR increased in all models with number of embryos transferred and in donor cycles also with prior full-term births. For both autologous and donor cycles, transferring two versus one embryo greatly increased the probability of a multiple birth (AOR 27.25 and 38.90, respectively). Conclusion(s) This validated predictive model will be implemented on the Society for Assisted Reproductive Technology Web site (www.sart.org) so that patients considering initiating a course of ART can input their data on the Web site to generate their expected outcomes. PMID:24934487

  15. Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis.

    PubMed

    Campbell, Jared M; Lane, Michelle; Owens, Julie A; Bakos, Hassan W

    2015-11-01

    This systematic review investigated the effect of paternal obesity on reproductive potential. Databases searched were Pubmed, Ovid, Web of Science, Scopus, Cinahl and Embase. Papers were critically appraised by two reviewers, and data were extracted using a standardized tool. Outcomes were: likelihood of infertility, embryo development, clinical pregnancy, live birth, pregnancy viability, infant development, sperm; concentration, morphology, motility, volume, DNA fragmentation, chromatin condensation, mitochondrial membrane potential (MMP), and seminal plasma factors. Thirty papers were included, with a total participant number of 115,158. Obese men were more likely to experience infertility (OR = 1.66, 95% CI 1.53-1.79), their rate of live birth per cycle of assisted reproduction technology (ART) was reduced (OR = 0.65, 95% CI 0.44-0.97) and they had a 10% absolute risk increase of pregnancy non-viability. Additionally, obese men had an increased percentage of sperm with low MMP, DNA fragmentation, and abnormal morphology. Clinically significant differences were not found for conventional semen parameters. From these findings it can be concluded that male obesity is associated with reduced reproductive potential. Furthermore, it may be informative to incorporate DNA fragmentation analysis and MMP assessment into semen testing, especially for obese men whose results suggest they should have normal fertility.

  16. A comprehensive method for the conservation of mouse strains combining natural breeding, sperm cryopreservation and assisted reproductive technology.

    PubMed

    Li, Dun-Gao; Zhu, Yan; Li, He-Ping; Chen, Xue-Jin; Jiang, Man-Xi

    2014-05-01

    The maintenance and preservation of strains of mice used in biomedical research presents a unique challenge to individual investigators and research institutions. The goal of this study was to assess a comprehensive system for mouse strain conservation through a combination of natural mating, sperm cryopreservation and assisted reproductive technology. Our strategy was based on the collection and cryopreservation of fresh epididymal sperm from male mice by semi-vasectomy; these mice were then naturally mated for breeding purposes. If no satisfactory results were obtained from natural breeding, then the cryopreserved sperm were used for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI); resultant embryos were then transferred into pseudopregnant-recipient female mice. Our results show that some semi-vasectomized mouse strains can be conserved by natural breeding, and that sterile males can be compensated for through the use of IVF and ICSI technology. As such, we believe this system is suitable for the purpose of strain conservation, allowing the continuation of natural breeding with the safeguard of assisted reproduction available.

  17. Clones, controversy, and criminal law: a comment on the proposal for legislation governing assisted human reproduction.

    PubMed

    Caulfield, T

    2001-09-01

    In the past few years there has been a tremendous amount of regulatory conflict and social controversy in the area of reproductive genetics. The Canadian government has recently released a proposal for legislating in this complex arena. Although the proposed Bill contains many positive elements, it is argued that the use of the criminal law as a regulatory mechanism is neither warranted nor appropriate. The author suggests a more flexible and responsive system of moratoriums and licenses that would enable review and adjustment to the realities of emerging reproductive technologies is a better approach.

  18. Staff concerns in heroin-assisted treatment centres.

    PubMed

    Demaret, I; Lemaître, A; Ansseau, M

    2012-08-01

    Heroin-assisted treatment (HAT) is a solution for improving the condition of treatment-resistant heroin addicts. Since 1994, six randomized controlled trials have concluded that HAT is more efficacious than oral methadone for severe heroin addicts. We visited seven HAT treatment centres in four countries in order to observe diacetylmorphine (DAM) administration and to study the main concerns of the staff. Nurses were concerned by the risk taken if a previously intoxicated patient received his dose of DAM. Another concern was the smuggling of DAM doses. The HAT centres face a dilemma: treating patients while at the same time allowing their risky street habits in the centre.

  19. A qualitative study of Ottawa university students’ awareness, knowledge and perceptions of infertility, infertility risk factors and assisted reproductive technologies (ART)

    PubMed Central

    2013-01-01

    Background Awareness of infertility risk factors is an essential first step to safeguard future fertility. Whereas several studies have examined university students’ awareness of female fertility and related risk factors, the topic of male infertility has not been well examined. The objective of this study was to assess young men and women’s awareness, knowledge and perceptions of infertility, male and female infertility risk factors and assisted reproductive technologies (ART). Methods Semi-structured interviews were conducted in 2008 with a multi-ethnic sample of sixteen male and twenty-three female Ottawa university students, followed by qualitative data analysis to identify major themes. Interview topics included awareness of male and female infertility risk factors, infertility diagnosis/treatments and personal options in the event of future infertility. Results Participants were generally familiar with infertility as a biomedical health problem, could identify sex-specific risk factors but overestimated fertility of women in their thirties and ART success rates. Reproductive health knowledge gaps and confusion of the physiological life-stage of menopause with infertility were apparent. Most participants would pursue in vitro fertilization or international adoption in the event of personal infertility. Some participants wished to use a ‘natural’ approach and were concerned with potential side effects of ART-related medications. Conclusions The general awareness of infertility in young adults is promising and supports the potential uptake for health promotion of fertility preservation. This study underscores the continued need for comprehensive sexual and reproductive health education and promotion for adolescents and young adults. PMID:23962162

  20. Laser-assisted treatment of dentinal hypersensitivity: a literature review

    PubMed Central

    Biagi, Roberto; Cossellu, Gianguido; Sarcina, Michele; Pizzamiglio, Ilaria Tina; Farronato, Giampietro

    2015-01-01

    Summary The purpose of this literature review was to evaluate the effectiveness of the laser-assisted treatment of dentinal hypersensitivity. A review with inclusion and exclusion criteria was performed from January 2009 to December 2014 with electronic data-bases: MedLine via PubMed, Science Direct and Cochrane Library. Research of paper magazines by hand was not considered. Forty-three articles were selected between literature reviews, in vitro studies, clinical trials, pilot and preliminary studies. The items were divided into laser-used groups for an accurate description, and then the reading of results into various typologies. Laser-assisted treatment reduces dentinal hypersensitivity-related pain, but also a psychosomatic component must be considered, so further studies and more suitable follow-ups are necessary. PMID:26941892

  1. Assisted reproductive technologies in Portuguese law--commentary to the Judgment no. 101/2009, of March the 3rd of the Portuguese Constitutional Court.

    PubMed

    Raposo, Vera Lúcia; Vale e Reis, Rafael

    2009-01-01

    Recently the Portuguese Constitutional Court was asked to analyze the constitutionality of the law on assisted reproduction, Law nr 32/2006. The request was presented by a conservative group, arguing, basically, that the law disregarded the juridical protection due to the embryo and to the participants in reproductive techniques. The main critics pointed out were related with the legitimacy of using reproductive techniques, the absence of a maximum age for beneficiaries, the authorization of embryo experimentation, the decision of not criminalizing every contract of surrogate motherhood, among some other critics. However, the Court concluded that none of the pointed norms went against Constitutional rules and principles.

  2. Austenitic stainless steel patterning by plasma assisted diffusion treatments

    NASA Astrophysics Data System (ADS)

    Czerwiec, T.; Marcos, G.; Thiriet, T.; Guo, Y.; Belmonte, T.

    2009-09-01

    The new concept of surface texturing or surface patterning on austenitic stainless steel by plasma assisted diffusion treatment is presented in this paper. It allows the creation of uniform micro or nano relief with regularly shaped asperities or depressions. Plasma assisted diffusion treatments are based on the diffusion of nitrogen and/or carbon in a metallic material at moderate to elevated temperatures. Below 420°C, a plasma assisted nitriding treatment of austenitic stainless steel produces a phase usually called expanded austenite. Expanded austenite is a metastable nitrogen supersaturated solid solution with a disordered fcc structure and a distorted lattice. The nitrided layer with the expanded austenite is highly enriched in nitrogen (from 10 to 35 at%) and submitted to high compressive residual stresses. From mechanical consideration, it is shown that the only possible deformation occurs in the direction perpendicular to the surface. Such an expansion of the layer from the initial surface of the substrate to the gas phase is used here for surface patterning of stainless steel parts. The surface patterning is performed by using masks (TEM grid) and multi-dipolar plasmas.

  3. Beyond conception: legal determinations of filiation in the context of assisted reproductive technologies.

    PubMed

    Mykitiuk, R

    2001-01-01

    This article argues that legal determinations of filiation are normative ideological constructions about how societal relations between parents and children should be ordered. They are based upon regular understandings of the relationship between biological and social facts and, as this article demonstrates, operate to create an asymmetrical relationship between the categories between paternity and maternity. I suggest that fairly recent developments in reproductive and genetic filiation have been made and offer the potential for an expanded understanding of relatedness or kinship which does not take the two-parent--one of each sex--model of the family as its normative form. While the examples I draw on arise in the context of reproductive technologies, I suggest that the analysis has broader implications for the recognition of broader family forms and relationship.

  4. Assessment of wastewater treatment plant effluent effects on fish reproduction

    EPA Science Inventory

    Wastewater treatment plant (WWTP) effluents are known contributors of chemical mixtures into the environment. Of particular concern are endocrine-disrupting compounds that can affect hypothalamic-pituitary-gonadal axis function in exposed organisms. The present study examined t...

  5. Chemical analysis of plasma-assisted antimicrobial treatment on cotton

    NASA Astrophysics Data System (ADS)

    Kan, C. W.; Lam, Y. L.; Yuen, C. W. M.; Luximon, A.; Lau, K. W.; Chen, K. S.

    2013-06-01

    This paper explores the use of plasma treatment as a pretreatment process to assist the application of antimicrobial process on cotton fabric with good functional effect. In this paper, antimicrobial finishing agent, Microfresh Liquid Formulation 9200-200 (MF), and a binder (polyurethane dispersion, Microban Liquid Formulation R10800-0, MB) will be used for treating the cotton fabric for improving the antimicrobial property and pre-treatment of cotton fabric by plasma under atmospheric pressure will be employed to improve loading of chemical agents. The chemical analysis of the treated cotton fabric will be conducted by Fourier transform Infrared Spectroscopy.

  6. Rethinking reproductive "tourism" as reproductive "exile".

    PubMed

    Inhorn, Marcia C; Patrizio, Pasquale

    2009-09-01

    Whereas reproductive "tourism" implies leisure travel, reproductive "exile" bespeaks the numerous difficulties and constraints faced by infertile patients who are "forced" to travel globally for assisted reproduction. Given this reality, it is time to rethink the language of "reproductive tourism," replacing it with more accurate and patient-centered terms.

  7. Increased risk of placenta previa is associated with endometriosis and tubal factor infertility in assisted reproductive technology pregnancy.

    PubMed

    Takemura, Yuri; Osuga, Yutaka; Fujimoto, Akihisa; Oi, Nagisa; Tsutsumi, Ryo; Koizumi, Minako; Yano, Tetsu; Taketani, Yuji

    2013-02-01

    Although assisted reproductive technology (ART) is suspected to increase the risk of placenta previa, a life-threatening complication of pregnancy, the reason is poorly understood. We recruited consecutive 318 pregnancies conceived by ART in our clinic and examined relation of ten variables, i.e. maternal age, gravidity, parity, male or female fetus, previous abortion, previous cesarean delivery, endometriosis, ovulatory disorder, tubal disease, and male infertility, to placenta previa, by logistic regression analysis. As a result, we found that endometriosis (odds ratio = 15.1; 95% CI = 7.6-500.0) and tubal disease (odds ratio = 4.4; 95% CI = 1.1-26.3) were significantly associated with placenta previa. It would be preferable to take the increased risk of placenta previa into account in treating ART pregnancy with endometriosis and tubal disease.

  8. Psychosocial adjustment during the transition to parenthood of Portuguese couples who conceived spontaneously or through assisted reproductive technologies.

    PubMed

    Gameiro, Sofia; Moura-Ramos, Mariana; Canavarro, Maria Cristina; Soares, Isabel

    2010-06-01

    We examined the psychosocial adjustment of 35 Portuguese couples who conceived through Assisted Reproductive Technologies (ART) and 31 couples with a spontaneous conception during their transition to parenthood (pregnancy and 4 months postpartum). Couples completed self-report questionnaires regarding their perceptions of pregnancy and parenthood, psychological distress, quality of life, marital relationship, and parenting stress. Compared with parents who conceived spontaneously, parents who conceived through ART perceived pregnancy as being more risky and demanding, reported a decrease in their psychological quality of life, and ART fathers only perceived themselves as being more competent than fathers who conceived spontaneously. Healthcare professionals should be aware of need of couples in their efforts to adapt to the individual and relational challenges associated with the transition to parenthood.

  9. Sperm selection in natural conception: what can we learn from Mother Nature to improve assisted reproduction outcomes?

    PubMed Central

    Sakkas, Denny; Ramalingam, Mythili; Garrido, Nicolas; Barratt, Christopher L.R.

    2015-01-01

    BACKGROUND In natural conception only a few sperm cells reach the ampulla or the site of fertilization. This population is a selected group of cells since only motile cells can pass through cervical mucus and gain initial entry into the female reproductive tract. In animals, some studies indicate that the sperm selected by the reproductive tract and recovered from the uterus and the oviducts have higher fertilization rates but this is not a universal finding. Some species show less discrimination in sperm selection and abnormal sperm do arrive at the oviduct. In contrast, assisted reproductive technologies (ART) utilize a more random sperm population. In this review we contrast the journey of the spermatozoon in vivo and in vitro and discuss this in the context of developing new sperm preparation and selection techniques for ART. METHODS A review of the literature examining characteristics of the spermatozoa selected in vivo is compared with recent developments in in vitro selection and preparation methods. Contrasts and similarities are presented. RESULTS AND CONCLUSIONS New technologies are being developed to aid in the diagnosis, preparation and selection of spermatozoa in ART. To date progress has been frustrating and these methods have provided variable benefits in improving outcomes after ART. It is more likely that examining the mechanisms enforced by nature will provide valuable information in regard to sperm selection and preparation techniques in vitro. Identifying the properties of those spermatozoa which do reach the oviduct will also be important for the development of more effective tests of semen quality. In this review we examine the value of sperm selection to see how much guidance for ART can be gleaned from the natural selection processes in vivo. PMID:26386468

  10. Cryopreservation and other assisted reproductive technologies for the conservation of threatened amphibians and reptiles: bringing the ARTs up to speed.

    PubMed

    Clulow, John; Clulow, Simon

    2016-06-01

    Amphibians and reptiles are experiencing serious declines, with the number of threatened species and extinctions growing rapidly as the modern biodiversity crisis unfolds. For amphibians, the panzootic of chytridiomycosis is a major driver. For reptiles, habitat loss and harvesting from the wild are key threats. Cryopreservation and other assisted reproductive technologies (ARTs) could play a role in slowing the loss of amphibian and reptile biodiversity and managing threatened populations through genome storage and the production of live animals from stored material. These vertebrate classes are at different stages of development in cryopreservation and other ARTs, and each class faces different technical challenges arising from the separate evolutionary end-points of their reproductive biology. For amphibians, the generation of live offspring from cryopreserved spermatozoa has been achieved, but the cryopreservation of oocytes and embryos remains elusive. With reptiles, spermatozoa have been cryopreserved in a few species, but no offspring from cryopreserved spermatozoa have been reported, and the generation of live young from AI has only occurred in a small number of species. Cryopreservation and ARTs are more developed and advanced for amphibians than reptiles. Future work on both groups needs to concentrate on achieving proof of concept examples that demonstrate the use of genome storage and ARTs in successfully recovering threatened species to increase awareness and support for this approach to conservation.

  11. Do dopamine agonists prevent or reduce the severity of ovarian hyperstimulation syndrome in women undergoing assisted reproduction? A systematic review and meta-analysis.

    PubMed

    Baumgarten, Miriam; Polanski, Lukasz; Campbell, Bruce; Raine-Fenning, Nick

    2013-09-01

    Controlled ovarian stimulation is an integral part of assisted reproduction treatment. This can result in ovarian hyperstimulation syndrome (OHSS), which is associated with significant morbidity and potentially mortality. Recent approaches to ovarian stimulation have led to a reduction in the prevalence of OHSS but it still occurs. Dopamine agonists (DAs) have been used with some success during the ovarian stimulation phase when there are early signs of OHSS but there is no consensus on when to start and stop treatment or on the dose and specific agonist to use. EMBRASE, MEDLINE and Cochrane were searched using the following terms: ovarian hyperstimulation syndrome, controlled ovarian hyperstimulation, DAs, cabergoline, quinagolide, bromocriptide, pergolide, talipexole, ropinirole and pranipexole. The search yielded 20 publications. In total 1646 woman were included and 914 received a DA. In the treated group 86 (9.41%) developed OHSS, compared with 157 (21.45%) in the non-treated group. Nine studies were suitable for meta-analysis. This showed a benefit to the use of DAs (RR 0.51 [0.33, 0.78], Chi² = 16.07). The use of DAs appears to be effective for the prevention of OHSS. DAs are useful but less effective for the treatment of OHSS. No conclusions can be made regarding the most effective drug, the optimal dose or the most appropriate drug regimen.

  12. Urinary Concentrations of Phthalate Metabolites in Relation to Pregnancy Loss among Women Conceiving with Medically Assisted Reproduction

    PubMed Central

    Messerlian, Carmen; Wylie, Blair J.; Minguez-Alarcon, Lidia; Williams, Paige L.; Ford, Jennifer B.; Souter, Irene C.; Calafat, Antonia M.; Hauser, Russ

    2017-01-01

    Background Animal studies demonstrate that several phthalates are embryofetotoxic and are associated with increased pregnancy loss and malformations. Results from human studies on phthalates and pregnancy loss are inconsistent. Methods We examined pregnancy loss prospectively in relation to urinary phthalate metabolite concentrations among women undergoing medically assisted reproduction. We used data from 256 women conceiving 303 pregnancies recruited between 2004 and 2012 from the Massachusetts General Hospital Fertility Center. We quantified eleven phthalate metabolite concentrations and calculated the molar sum of four di(2-ethylhexyl) phthalate (DEHP) metabolites (ΣDEHP). We estimated risk ratios (RRs) and 95% confidence intervals (CIs) for biochemical loss and total pregnancy loss (<20 weeks’ gestation) across quartiles using repeated measures log-binomial models, adjusted for age, body mass index, smoking and infertility diagnosis. Results Of the 303 pregnancies, 83 (27%) ended in loss less than 20 weeks’ gestation and among these, 31 (10%) ended in biochemical loss. Although imprecise, the RRs for biochemical loss increased across quartiles of ∑DEHP and three individual DEHP metabolites. For ∑DEHP, the RRs (CIs) were: 2.3 (0.63, 8.5), 2.0 (0.58, 7.2), and 3.4 (0.97, 11.7) for quartiles two, three and four, compared to one, respectively (p-trend=0.04). RRs for total pregnancy loss were elevated in the highest quartiles of ΣDEHP and three DEHP metabolites. The remaining seven phthalate metabolite concentrations evaluated were not associated with either outcome. Conclusions We found a suggestive pattern of association between conception cycle-specific urinary concentrations of DEHP metabolites and biochemical and total pregnancy loss among women undergoing medically assisted reproduction. PMID:27299194

  13. EC assisted start-up experiments reproduction in FTU and AUG for simulations of the ITER case

    SciTech Connect

    Granucci, G.; Ricci, D.; Farina, D.; Figini, L.; Cavinato, M.; Stober, J.; Tudisco, O.

    2014-02-12

    The breakdown and plasma start-up in ITER are well known issues studied in the last few years in many tokamaks with the aid of calculation based on simplified modeling. The thickness of ITER metallic wall and the voltage limits of the Central Solenoid Power Supply strongly limit the maximum toroidal electric field achievable (0.3 V/m), well below the level used in the present generation of tokamaks. In order to have a safe and robust breakdown, the use of Electron Cyclotron Power to assist plasma formation and current rump up has been foreseen. This has raised attention on plasma formation phase in presence of EC wave, especially in order to predict the required power for a robust breakdown in ITER. Few detailed theory studies have been performed up to nowadays, due to the complexity of the problems. A simplified approach, extended from that proposed in ref[1] has been developed including a impurity multispecies distribution and an EC wave propagation and absorption based on GRAY code. This integrated model (BK0D) has been benchmarked on ohmic and EC assisted experiments on FTU and AUG, finding the key aspects for a good reproduction of data. On the basis of this, the simulation has been devoted to understand the best configuration for ITER case. The dependency of impurity distribution content and neutral gas pressure limits has been considered. As results of the analysis a reasonable amount of power (1 - 2 MW) seems to be enough to extend in a significant way the breakdown and current start up capability of ITER. The work reports the FTU data reproduction and the ITER case simulations.

  14. Conservation of wild animals by assisted reproduction and molecular marker technology.

    PubMed

    Shivaji, S; Kholkute, S D; Verma, S K; Gaur, Ajay; Umapathy, G; Singh, Anju; Sontakke, Sadanand; Shailaja, K; Reddy, Anuradha; Monika, S; Sivaram, V; Jyotsna, B; Bala, Satyare; Ahmed, M Shakeel; Bala, Aruna; Chandrashekar, B V N; Gupta, Sandeep; Prakash, Surya; Singh, Lalji

    2003-07-01

    Wild animals are an integral component of the ecosystem. Their decimation due to abrupt natural calamities or due to gradual human intervention would be disastrous to the ecosystem and would alter the balance in nature between various biotic components. Such an imbalance could have an adverse effect on the ecosystem. Therefore, there is an urgent need to put an end to the ever increasing list of endangered species by undertaking both in situ and ex situ conservation using tools of modern biology, to ascertain the degree of genetic variation and reproductive competence in these animals. This review highlights the development and use of molecular markers such as microsatellites, minisatellites, mitochondrial control region, cytochrome b and MHC loci to assess the genetic variation in various Indian wild animals such as the lion, tiger, leopard and deer. The review also presents data on the semen profile of the big cats of India. Reproductive technologies such as cryopreservation of semen and artificial insemination in big cats are also highlighted.

  15. Effects of Computer-Assisted Instruction (CAI) on 11th Graders' Attitudes to Biology and CAI and Understanding of Reproduction in Plants and Animals.

    ERIC Educational Resources Information Center

    Soyibo, Kola; Hudson, Ann

    2000-01-01

    Investigates whether the use of the combination of lecture, discussion, and computer-assisted instruction (CAI) significantly improved students' attitudes toward biology and their understanding of reproduction in plants and animals. Studies grade 11 Jamaican female students (n=77) from two traditional high schools in Kingston. (Contains 19…

  16. Can we sense ART? The blinded examiner is not blind-a problem with follow-up studies on children born after assisted reproduction.

    PubMed

    Ludwig, Annika K; Katalinic, Alexander; Entenmann, Andreas; Thyen, Ute; Sutcliffe, Alastair G; Diedrich, Klaus; Ludwig, M

    2009-09-01

    In a prospective, controlled, blinded follow-up study of children born after intracytoplasmic sperm injection (ICSI), blinded examiners correctly intuited the mode of conception (ICSI versus spontaneous) in three out of four children, which must be considered when interpreting outcome data for children born after assisted reproduction.

  17. Does Autism Diagnosis Age or Symptom Severity Differ among Children According to Whether Assisted Reproductive Technology Was Used to Achieve Pregnancy?

    ERIC Educational Resources Information Center

    Schieve, Laura A.; Fountain, Christine; Boulet, Sheree L.; Yeargin-Allsopp, Marshalyn; Kissin, Dmitry M.; Jamieson, Denise J.; Rice, Catherine; Bearman, Peter

    2015-01-01

    Previous studies report associations between conception with assisted reproductive technology (ART) and autism. Whether these associations reflect an ascertainment or biologic effect is undetermined. We assessed diagnosis age and initial autism symptom severity among >30,000 children with autism from a linkage study of California Department of…

  18. Parental Age and Assisted Reproductive Technology in Autism Spectrum Disorders, Attention Deficit Hyperactivity Disorder, and Tourette Syndrome in a Japanese Population

    ERIC Educational Resources Information Center

    Shimada, Takafumi; Kitamoto, Atsushi; Todokoro, Ayako; Ishii-Takahashi, Ayaka; Kuwabara, Hitoshi; Kim, Soo-Yung; Watanabe, Kei-ichiro; Minowa, Iwao; Someya, Toshikazu; Ohtsu, Hiroshi; Osuga, Yutaka; Kano, Yukiko; Kasai, Kiyoto; Kato, Nobumasa; Sasaki, Tsukasa

    2012-01-01

    We investigated whether advanced parental age and assisted reproductive technology (ART) are risk factors in autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS). Clinical charts of Japanese outpatients with ASD (n = 552), ADHD (n = 87), and TS (n = 123) were reviewed. Parental age of…

  19. A novel cupping-assisted plasma treatment for skin disinfection

    NASA Astrophysics Data System (ADS)

    Xiong, Zilan; Graves, David B.

    2017-02-01

    A novel plasma treatment method/plasma source called cupping-assisted plasma treatment/source for skin disinfection is introduced. The idea combines ancient Chinese ‘cupping’ technology with plasma sources to generate active plasma inside an isolated, pressure-controlled chamber attached to the skin. Advantages of lower pressure include reducing the threshold voltage for plasma ignition and improving the spatial uniformity of the plasma treatment. In addition, with reduced pressure inside the cup, skin pore permeability might be increased and it improves attachment of the plasma device to the skin. Moreover, at a given pressure, plasma-generated active species are restricted inside the cup, raising local reactive species concentration and enhancing the measured surface disinfection rate. A surface micro-discharge (SMD) device is used as an example of a working plasma source. We report discharge characteristics and disinfection efficiency as a function of pressure and applied voltage.

  20. Defect management on photomasks with dry treatment assistance

    NASA Astrophysics Data System (ADS)

    Shi, Irene; Guo, Eric; Lu, Max

    2016-10-01

    One of the key challenges of photomask manufacture is to achieve defect-free masks. Clean and repair has been applied to manage defects and particles on the mask imported during manufacturing processes. Since photomask patterns become smaller and more complicated as integrated circuit (IC) scaling to 28 nm node and below, the increasingly importance of mask quality compels us continuously research on more effective defect treatment solutions, to achieve mask yield enhancement and on-schedule delivery. In this paper, we would like to introduce new approaches of defect management with dry treatment assistance, according to particular defect types. One is using plasma etching gases of Cl2/O2 to change the properties of glue compounds adhering to the mask surface, and make them removed by conventional cleaning. Another is the application of O2 plasma dry treatment for the benefit of alleviation on scan damage phenomenon, which comes from contamination on the scan area due to excessive repair cycles.

  1. Medication-Assisted Treatment For Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43

    ERIC Educational Resources Information Center

    Tinkler, Emily; Vallejos Bartlett, Catalina; Brooks, Margaret; Gilbert, Johnatnan Max; Henderson, Randi; Shuman, Deborah, J.

    2005-01-01

    TIP 43 provides best-practice guidelines for medication-assisted treatment of opioid addiction in opioid treatment programs (OTPs). The primary intended audience for this volume is substance abuse treatment providers and administrators who work in OTPs. Recommendations in the TIP are based on both an analysis of current research and determinations…

  2. Laser-assisted treatment of patients with hemorrhagic diathesis

    NASA Astrophysics Data System (ADS)

    Neckel, Claus P.

    2000-03-01

    Today more and more patients with bleeding disorder come to our office for treatment. The number of patients with therapeutic anticoagulation is growing steadily. Discontinuation of this therapy can often be crucial. On the other hand are oralsurgical procedures extremely sensitive to bleeding due to the constant presents of saliva with its high fibrinolytic activity. The aim of this study was to evaluate the use of a surgical diode (wavelength 810 nm) laser as accessory tool in the treatment of patients with hemorrhagic diathesis. Enclosed in the study were 123 patients with: (1) Coumarintherapy, a Quick test ratio of 15 - 25%; (2) More than 300 mg of ASS/die; (3) Hemophilia, a factor activity under 35%; (4) Morbus Werlhof with less than 30000 thrombocytes. 179 Surgical procedures: (1) Tooth extraction 86%; (2) Apexectomy 3%; (3) Tumorexcision 9%; (4) Curettage and flapsurgery 1%; (5) Gingivectomy 1%. All procedures were laser-assisted with a diode laser emitting 810 nm. The glass fibers used were depending on the procedures either 200, 400, or 600 micron. No coagulating agents or tissue adhesives were used in addition. The postoperative outcome and complication rates were compared to substitution therapy and tissue adhesives. Laser-assisted treatment of these patients shows a high predictability and success rate leaving out side effects of drugs and human cryoprecipitates. Postoperative impairment is diminished.

  3. Treatment discrimination among assistant coaches of women's teams.

    PubMed

    Cunningham, George B; Sagas, Michael

    2003-12-01

    The purpose of this study was to examine organizational treatment discrimination (i.e., when members of a group receive fewer rewards, opportunities, or resources than they legitimately deserve based on job-related criteria) in the context of women's athletics. Data were collected from 170 assistant coaches of women's teams (i.e., women's basketball, softball, track, volleyball, soccer, and tennis). Results indicate that women's perceived work experiences and outcomes were comparable, and sometimes better, than those of men. We present competing explanations for this finding. First, it is possible that these women were not subjected to treatment discrimination. Alternatively, it is possible that this demonstrates the existence of the "paradox of the contented working woman." Additional analyses indicate that work experiences explained a large portion of the variance in organizational commitment and turnover intentions, thereby demonstrating their importance in the workplace.

  4. The novel POSEIDON stratification of ‘Low prognosis patients in Assisted Reproductive Technology’ and its proposed marker of successful outcome

    PubMed Central

    Humaidan, Peter; Alviggi, Carlo; Fischer, Robert; Esteves, Sandro C.

    2016-01-01

    In reproductive medicine little progress has been achieved regarding the clinical management of patients with a reduced ovarian reserve or poor ovarian response (POR) to stimulation with exogenous gonadotropins -a frustrating experience for clinicians as well as patients. Despite the efforts to optimize the definition of this subgroup of patients, the existing POR criteria unfortunately comprise a heterogeneous population and, importantly, do not offer any recommendations for clinical handling. Recently, the POSEIDON group ( Patient- Oriented Strategies Encompassing Individualize D Oocyte Number) proposed a new stratification of assisted reproductive technology (ART) in patients with a reduced ovarian reserve or unexpected inappropriate ovarian response to exogenous gonadotropins. In brief, four subgroups have been suggested based on quantitative and qualitative parameters, namely, i. Age and the expected aneuploidy rate; ii. Ovarian biomarkers (i.e. antral follicle count [AFC] and anti-Müllerian hormone [AMH]), and iii. Ovarian response - provided a previous stimulation cycle was performed. The new classification introduces a more nuanced picture of the “low prognosis patient” in ART, using clinically relevant criteria to guide the physician to most optimally manage this group of patients. The POSEIDON group also introduced a new measure for successful ART treatment, namely, the ability to retrieve the number of oocytes needed for the specific patient to obtain at least one euploid embryo for transfer. This feature represents a pragmatic endpoint to clinicians and enables the development of prediction models aiming to reduce the time-to-pregnancy (TTP). Consequently, the POSEIDON stratification should not be applied for retrospective analyses having live birth rate (LBR) as endpoint. Such an approach would fail as the attribution of patients to each Poseidon group is related to specific requirements and could only be made prospectively. On the other hand, any

  5. The biology and methodology of assisted reproduction in deer mice (Peromyscus maniculatus).

    PubMed

    Veres, Monika; Duselis, Amanda R; Graft, Audrey; Pryor, William; Crossland, Janet; Vrana, Paul B; Szalai, Gabor

    2012-01-15

    Although laboratory-reared species of the genus Peromyscus-including deer mice-are used as model animals in a wide range of research, routine manipulation of Peromyscus embryogenesis and reproduction has been lagging. The objective of the present study was to optimize conditions for oocyte and/or embryo retrieval and for in vitro culturing. On average, 6.4 oocytes per mouse were recovered when two doses of 15 IU of pregnant mare serum gonadotropin (PMSG) were given 24 h apart, followed by 15 IU of hCG 48 h later. Following this hormone priming, females mated overnight with a fertile male yielded an average of 9.1 two-cell stage embryos. Although two-cell stage embryos developed to 8-cell stage in Potassium Simplex Optimized Medium (KSOM; Millipore-Chemicon, Billerica, MA, USA) in vitro, but not further, embryos recovered at the 8- to 16-cell stages developed into fully expanded blastocysts when cultured in M16 media in vitro. These blastocysts had full potential to develop into late stage fetuses and possibly into live pups. As a result of the present work, all stages of Peromyscus preimplantation development are now obtainable in numbers sufficient for molecular or other analyses. These advances provide the opportunity for routine studies involving embryo transfer (e.g., chimeras, transgenics), and preservation of genetic lines by cryopreservation.

  6. Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction

    PubMed Central

    Kovac, Jason R; Smith, Ryan P; Cajipe, Miguel; Lamb, Dolores J; Lipshultz, Larry I

    2017-01-01

    In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010–2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF. PMID:27751992

  7. Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction.

    PubMed

    Kovac, Jason R; Smith, Ryan P; Cajipe, Miguel; Lamb, Dolores J; Lipshultz, Larry I

    2017-01-01

    In couples with infertility, abnormal strict morphology of 0% normal forms (NF) is a criterion to proceed rapidly to in vitro fertilization (IVF). Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies (ART). A cohort of 24 men with 0% NF were identified (2010-2013) with 27 randomly selected men with ≥4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board (IRB)-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy (controls = 55.6%, P ≤ 0.05). When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF (controls = thirty pregnancies; 76.7% did not require IVF). The average age of men and female partners was similar between men with 0% NF and ≥4% NF. All men had normal follicle-stimulating hormone (FSH), testosterone, prolactin, sex hormone-binding globulin (SHBG), and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception (NC), 100% of men with 0% NF (n = 7/7) and 37.5% of controls (n = 3/8) went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.

  8. Application of assisted reproduction for population management in felids: the potential and reality for conservation of small cats.

    PubMed

    Swanson, William F

    2006-07-01

    Assisted reproductive technology (ART), using the primary applied tools of AI, ET, and sperm and embryo cryopreservation, has been promoted over the past decades for its potential to conserve endangered wildlife, including felids. However, if the goal is efficient, consistent production of viable offspring for population management, then the 'potential' of ART has yet to become 'reality' for any non-domestic cat species. For the five small-sized felids (i.e., Brazilian ocelot, fishing cat, Pallas' cat, Arabian sand cat, black-footed cat) managed by Species Survival Plans (SSPs) in North American zoos, achieving this potential may be an absolute necessity if genetically viable captive populations are to be maintained into the next century. Modeling programs suggest that current SSP populations are not sustainable without periodic introduction of new founders and improved demographic parameters, including longer generation intervals and larger population sizes. ART provides the means to address each of these management challenges. In each small cat SSP species, fecal hormone metabolite assays and seminal analysis have proven useful for characterizing basal reproductive parameters, a necessary prerequisite to developing ART. Of the five SSP species, ART has been used to produce living offspring only in the ocelot, including after AI with frozen-thawed spermatozoa and following transfer of frozen-thawed IVF embryos. The true efficacy of these techniques, however, is still unknown. To improve the applicability of ART for population management, priorities for immediate research include further investigation of ovarian stimulation protocols, sperm and embryo cryopreservation methods, embryo culture systems, and fetal and neonatal viability following ART.

  9. Polycystic Ovary Syndrome, Body Mass Index and Outcomes of Assisted Reproductive Technologies

    PubMed Central

    Beydoun, Hind A.; Stadtmauer, Laurel; Beydoun, May A.; Russell, Helena; Zhao, Yueqin; Oehninger, Sergio

    2009-01-01

    The purpose of the study is to examine the effects of polycystic ovary syndrome (PCOS) and body mass index (BMI) on selected indicators of in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment success. A retrospective cohort study was conducted using existing data on 69 IVF/ICSI treatment cycles undergone by PCOS women and an individually matched sample of 69 IVF/ICSI treatment cycles undergone by non-PCOS women at a major fertility treatment center. BMI (kg/m2) was analyzed as a continuous and categorical (< 25, 25−29.9 ≥ 30) variable. Results indicated that PCOS was directly associated with the number of oocytes retrieved. Irrespective of PCOS status, continuous BMI was inversely associated with total and mature oocytes retrieved. Multiple linear regression analyses indicated no significant effects of PCOS or continuous BMI on the number of mature oocytes fertilized per mature oocyte retrieved or inseminated. Similarly, multiple logistic regression analyses suggested no significant effect of PCOS and continuous BMI on the odds of pregnancy, miscarriage or live birth. Furthermore, categorical BMI did not influence process and outcome measures of IVF/ICSI treatment success. PCOS and continuous BMI appear to have significant and distinct effects on early stages but not on later stages of IVF/ICSI treatment. PMID:19490792

  10. Heroin-assisted treatment: has a controversial treatment come of age?†.

    PubMed

    Farrell, Michael; Hall, Wayne

    2015-07-01

    This editorial considers the findings of the systematic review of heroin-assisted treatment, with six different studies from six different countries, published in this issue. The meta-analysis focuses on supervised injected heroin and reports significant crime reduction and an overall cost-effectiveness of treatment. Despite this body of evidence, policy makers remain reluctant to develop this treatment further. The question remains, what else is required to convince policy makers of the value of such treatment for severe and refractory heroin dependence?

  11. Cross-border-assisted reproduction: a qualitative account of UK travellers' experiences.

    PubMed

    Hudson, Nicky; Culley, Lorraine; Blyth, Eric; Norton, Wendy; Pacey, Allan; Rapport, Frances

    2016-06-01

    Surveys on patients' experiences of cross-border fertility treatment have reported a range of positive and challenging features. However, the number of such studies is limited, and there is no detailed qualitative account of the experiences of UK patients who travel overseas for fertility treatment. The present study used a cross-sectional, qualitative design and in-depth interviews. Fifty-one participants (41 women and 10 men, representing 41 treatment 'cases') participated in semi-structured interviews. The experiences reported were broadly positive with a large proportion of participants (39 cases, 95%) citing a favourable overall experience with only two cases (5%) reporting a more negative experience. Thematic analysis revealed 6 major categories and 20 sub-categories, which described the positive and challenging aspects of cross-border fertility travel. The positive aspects were represented by the categories: 'access', 'control' and 'care and respect'. The more challenging aspects were categorized as 'logistics and coordination of care', 'uncertainty' and 'cultural dissonance'. The study confirms findings from others that despite some challenges, there is a relatively high level of patient satisfaction with cross-border treatment with participants able to extend the boundaries of their fertility-seeking trajectories and in some cases, regain a sense of control over their treatment.

  12. In vitro fertilization in Japan — Early days of in vitro fertilization and embryo transfer and future prospects for assisted reproductive technology —

    PubMed Central

    SUZUKI, Masakuni

    2014-01-01

    Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and embryo transfer (ET) has been essential in the treatment of infertility. The world’s first IVF-ET baby was born in 1978 based on the technique developed by Dr. Robert Edwards and Dr. Patrick Steptoe.1) In Japan, the first IVF-ET birth was reported in 1983 by Prof. Masakuni Suzuki at Tohoku University School of Medicine.2,3) IVF-ET is a procedure used to achieve pregnancy that consists of extracting oocytes from an infertile woman, fertilizing them in vitro, and transferring fertilized eggs into the patient’s uterine cavity (Fig. 1). Since the first report of successful IVF-ET, numerous techniques related to ART, such as cryopreservation of oocytes and embryos, gamete intrafallopian transfer (GIFT), and microinsemination, have been developed and refined (Table 1). Herein we describe the history of basic research in IVF-ET that led to human applications, how the birth of the first IVF-ET baby was achieved in Japan, the current status of ART in Japan, issues related to ART, and future prospects for ART. PMID:24814992

  13. A physiological, rather than a superovulated, post-implantation environment can attenuate the compromising effect of assisted reproductive techniques on gene expression in developing mice embryos.

    PubMed

    Bonakdar, E; Edriss, M A; Bakhtari, A; Jafarpour, F; Asgari, V; Hosseini, S M; Boroujeni, N Sadeghi; Hajian, M; Rahmani, H R; Nasr-Esfahani, M H

    2015-03-01

    Assisted reproductive techniques (ARTs) may perturb the pre-/peri-conception microenvironments, which subsequently threaten the health of offspring. This study aimed to investigate the effects of superovulation, vitrification, in vitro culture, and embryo transfer on the expression of epigenetic modulators, imprinted genes, and pluripotency markers in expanded blastocysts and Day-9.5 (D9.5) concepti. Results revealed that 53.4% (8/15) and 86.7% (13/15) of genes in the fetus and placenta, respectively, have similar patterns of transcription in all D9.5 concepti, despite the perturbed mRNA expression observed at the blastocyst stage for each embryo-production technique. These observations indicate a counterbalancing of the abnormal expression pattern analyzed at the blastocyst stage during post-implantation development, particularly when the uterus of a naturally synchronized foster mother is employed. Superovulation resulted in the most abnormal expression patterns compared to other treatment groups, although these same blastocysts were able to develop in a synchronized uterus. Thus, superovulation creates a hormonal environment that negatively affected gene expression and impairs fetal growth more adversely during post-implantation development than other ART protocols, such as in vitro culture, vitrification, or embryo transfer-although each did contribute negatively to the implantation and development process. Together, these results may have implications for treating infertility in humans.

  14. Semen samples showing an increased rate of spermatozoa with imprinting errors have a negligible effect in the outcome of assisted reproduction techniques

    PubMed Central

    Camprubí, Cristina; Pladevall, Marta; Grossmann, Mark; Garrido, Nicolás; Pons, Maria; Blanco, Joan

    2012-01-01

    The topic of imprinting defects present in the sperm of infertile patients has been addressed by several reports in the last few years. However, whether methylation abnormalities at one or few CpGs within an imprinted locus are pathological is a matter of debate. Moreover, whether imprinting anomalies in sperm could interfere with fertility treatment outcomes is still unknown. In this report we analyze the sperm DNA methylation profile of H19-ICR, KvDMR, SNRPN-ICR, IG-DMR and MEG3-DMR by pyrosequencing in 107 infertile men series and a control population of 30 proven fertile males. DNA methylation was statistically evaluated from two points of view: first, the methylation of each CpG was analyzed in the control population and the mean, standard deviation and range were determined and compared with infertile population data; second, in order to define altered methylation patterns for each region, a hierarchical cluster analysis was performed by which individuals were grouped in different clusters according to the degree of similarity of their methylation pattern. Two pieces of data supported the results obtained in the multi-variate analysis: the classification of the vast majority of control individuals in clusters with normal methylation patterns and the significant differences in methylation levels found between individuals within the normal and abnormal clusters. Individuals included in normal and abnormal methylation clusters were compared according to seminal parameters as well as to the outcome of assisted reproduction. PMID:22885410

  15. In vitro fertilization in Japan - early days of in vitro fertilization and embryo transfer and future prospects for assisted reproductive technology.

    PubMed

    Suzuki, Masakuni

    2014-01-01

    Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and embryo transfer (ET) has been essential in the treatment of infertility. The world's first IVF-ET baby was born in 1978 based on the technique developed by Dr. Robert Edwards and Dr. Patrick Steptoe. In Japan, the first IVF-ET birth was reported in 1983 by Prof. Masakuni Suzuki at Tohoku University School of Medicine. IVF-ET is a procedure used to achieve pregnancy that consists of extracting oocytes from an infertile woman, fertilizing them in vitro, and transferring fertilized eggs into the patient's uterine cavity (Fig. 1). Since the first report of successful IVF-ET, numerous techniques related to ART, such as cryopreservation of oocytes and embryos, gamete intrafallopian transfer (GIFT), and microinsemination, have been developed and refined (Table 1). Herein we describe the history of basic research in IVF-ET that led to human applications, how the birth of the first IVF-ET baby was achieved in Japan, the current status of ART in Japan, issues related to ART, and future prospects for ART.

  16. [Anti mullerian hormone (AMH)--is it a new reliable marker of the ovarian reserve? Its role in predicting the ovarian response in assisted reproductive technology (ART)].

    PubMed

    Alshiek, Jonia Amer; Lessing, Joseph B; Amit, Ami; Azem, Foad

    2012-07-01

    Anti-Müllerian hormone (AMH) is predominantly known for its important role in the differentiation of the male and female sexual system during the early embryonic period. Recently, many animal and human researches have been studying the role of the AMH in the postnatal ovarian function. In the female, AMH is produced by the granulosa cells of early developing follicles. It plays a major role in the folliculogenesis and seems to be able to inhibit the initiation of the growth of primordial follicles and FSH-induced follicles. As AMH is expressed throughout the folliculogenesis, from the primary follicular stage to the antral stage, the serum levels of AMH may represent both the quantity and the quality of ovarian follicles. Thus, the AMH levels may be useful as a new potential marker of the ovarian reserve. As compared to other ovarian reserve tests, the AMH has unique characteristics which make it a favorable marker. The measurement of AMH levels may be useful in the prediction of poor response and cycle cancellation as well as hyper-response and the ovarian hyperstimulation syndrome in assisted reproductive technology (ART). We assume that the measurement of AMH Levels may play a role in the individualization of treatment strategies among patients who are treated by ART. However, the AMH cannot predict the qualitative ovarian response in ART. In men, the AMH was not found to have satisfactory clinical utility as a single marker of spermatogenesis.

  17. Risk during pregnancy and birth after assisted reproductive technologies: an integral view of the problem.

    PubMed

    Ludwig, Michael

    2005-11-01

    Pregnancy and obstetric outcome are the final steps in infertility treatment. Additional data from recent studies demonstrate an increased risk for pregnancy course and obstetric outcome. These risks include an increased risk for intrauterine growth retardation, preeclampsia, and premature birth. Children born after in vitro fertilization and intracytoplasmic sperm injection (ICSI) have an increased risk for major malformations compared with spontaneously conceived pregnancies. Patients have to be counseled about these risks. The question is where these increased risks originate. At present, there are insufficient data available from pregnancies established following hormonal treatment or intrauterine insemination cycles. Therefore, the question is still open for debate, whether either in vitro culture or infertility per se or perhaps other components of the treatment cycle contribute to this risk. There is some evidence that at least the ICSI technique or the in vitro culture technique is not the only or most prominent factor. A long time to pregnancy with subsequent spontaneous pregnancy results in a similar risk profile as pregnancies following infertility treatment. This article discusses a possible pathogenetic model for these observations.

  18. Cluster Headache: Special Considerations for Treatment of Female Patients of Reproductive Age and Pediatric Patients.

    PubMed

    VanderPluym, Juliana

    2016-01-01

    Cluster headache is a rare disorder that is more common in adult male patients. It has a unique phenotype of unilateral, severe, to very severe headaches lasting 15 to 180 min with ipsilateral autonomic symptoms. Time to correct diagnosis can be protracted. A number of treatment options exist for the standard cluster headache patient, but special considerations must be made for female patients of reproductive age and pediatric patients. The objective of this article is to explore the current literature pertaining to special considerations in cluster headache management, including treatment of pregnant or breastfeeding patients and pediatric patients.

  19. Association between assisted reproductive technology and the risk of autism spectrum disorders in the offspring: a meta-analysis.

    PubMed

    Liu, Liang; Gao, Junwei; He, Xie; Cai, Yulong; Wang, Lian; Fan, Xiaotang

    2017-04-07

    The association between the use of assisted reproductive technology (ART) and autism spectrum disorder (ASD) risk in offspring has been explored in several studies, but the result is still inconclusive. We assessed the risk of ASD in offspring in relation to ART by conducting a meta-analysis. A literature search in PubMed, Embase, and Web of Knowledge databases through April 30, 2016 was conducted to identify all the relevant records. Risk ratios (RRs) and 95% confidence intervals (95%CIs) were computed to analyze the strength of association by using fixed- or random-effect models based on heterogeneity test in total and subgroup analyses. Analysis of the total 11 records (3 cohort studies and 8 case-control studies) revealed that the use of ART is associated with higher percentage of ASD (RR = 1.35, 95% CI: 1.09-1.68, P = 0.007). In addition, subgroup analyses based on study design, study location and study quality were conducted, and some subgroups also showed a statistically significant association. Our study indicated that the use of ART may associated with higher risk of ASD in the offspring. However, further prospective, large, and high-quality studies are still required.

  20. Audio reproduction for personal ambient home assistance: concepts and evaluations for normal-hearing and hearing-impaired persons.

    PubMed

    Huber, Rainer; Meis, Markus; Klink, Karin; Bartsch, Christian; Bitzer, Joerg

    2014-01-01

    Within the Lower Saxony Research Network Design of Environments for Ageing (GAL), a personal activity and household assistant (PAHA), an ambient reminder system, has been developed. One of its central output modality to interact with the user is sound. The study presented here evaluated three different system technologies for sound reproduction using up to five loudspeakers, including the "phantom source" concept. Moreover, a technology for hearing loss compensation for the mostly older users of the PAHA was implemented and evaluated. Evaluation experiments with 21 normal hearing and hearing impaired test subjects were carried out. The results show that after direct comparison of the sound presentation concepts, the presentation by the single TV speaker was most preferred, whereas the phantom source concept got the highest acceptance ratings as far as the general concept is concerned. The localization accuracy of the phantom source concept was good as long as the exact listening position was known to the algorithm and speech stimuli were used. Most subjects preferred the original signals over the pre-processed, dynamic-compressed signals, although processed speech was often described as being clearer.

  1. [The risk of congenital malformations and genomic imprinting defects in assisted reproductive technologies and nuclear transfer cloning].

    PubMed

    Valenzuela, Carlos Y

    2005-09-01

    Recent studies show that assisted reproductive technologies (ART), whether in vitro fertilization (IVF) or intra-cytoplasmatic sperm injection (ICSI) or applied to cloning by somatic cell nuclear transfer (SCNT) are associated to a higher risk of congenital malformations and errors in deprogramming, maintenance or reprogramming genomic imprinting in humans and animals. IVF and ICSI are also associated to an increased admission to neonatal intensive care units and more need for health care resources in infancy. A mutagenic effect of a chemical used in SCNT has been reported and gene depression was found in bovine embryos obtained by IVF or SCNT. The causes of these anomalies could be pathological conditions for which ART is applied, a direct effect of technologies on the zygotes or embryos, avoidance for zygotes or embryos of the oviduct path that is needed to elicit necessary immunity or genomic programming processes, or adaptive selective steps acquired during thousands of millions of generations in evolution. The knowledge of evolution is emphasized as essential in the scientific ethical analysis.

  2. A twin sibling with Prader-Willi syndrome caused by type 2 microdeletion following assisted reproductive technology: A case report

    PubMed Central

    HAN, JI YOON; PARK, JOONHONG; JANG, WOORI; CHAE, HYOJIN; KIM, MYUNGSHIN; KIM, YONGGOO

    2016-01-01

    Prader-Willi syndrome (PWS) is a neurobehavioral imprinting disorder, which arises due to an absence of paternally expressed genes within the 15q11.2-q13 region. This occurs via one of the three main genetic mechanisms, as follows: Deletion of the paternally inherited 15q11.2-q13 region, maternal uniparental disomy and imprinting defect. Recent studies have reported an association between imprinting disorders and assisted reproductive technologies (ART). The current study presents a 6-year-old female patient who is a dizygotic twin, in which one was born with de novo microdeletion at 15q11.2-q13.1 following in vitro fertilization. The patient had characteristic facial features including narrow bifrontal diameter, strabismus, downturned mouth, feeding problems and generalized hypotonia during infancy, developmental delay, mental retardation and rapid weight gain. Based upon phenotypic resemblance and the medical records, methylation-specific multiplex ligation-dependent probe amplification and array-based comparative genome hybridization analyses demonstrate type 2 microdeletion between breaking point 2 (BP2) and BP3, which occur from MKRN3 through HERC2 at 15q11.2-q13.1. To the best of our knowledge, the present study is the first to report a PWS case born following ART reported in South Korea. In addition to previous studies, the present study contributes to the consensus regarding genotype-phenotype comparisons in this respect. PMID:27330749

  3. Granulocyte Macrophage Colony Stimulating Factor Supplementation in Culture Media for Subfertile Women Undergoing Assisted Reproduction Technologies: A Systematic Review

    PubMed Central

    Siristatidis, Charalampos; Vogiatzi, Paraskevi; Salamalekis, George; Creatsa, Maria; Vrachnis, Nikos; Glujovsky, Demián; Iliodromiti, Zoe; Chrelias, Charalampos

    2013-01-01

    Granulocyte macrophage colony stimulating factor (GM-CSF) is a cytokine/growth factor produced by epithelial cells that exerts embryotrophic effects during the early stages of embryo development. We performed a systematic review, and six studies that were performed in humans undergoing assisted reproduction technologies (ART) were located. We wanted to evaluate if embryo culture media supplementation with GM-CSF could improve success rates. As the type of studies and the outcome parameters investigated were heterogeneous, we decided not to perform a meta-analysis. Most of them had a trend favoring the supplementation with GM-CSF, when outcomes were measured in terms of increased percentage of good-quality embryos reaching the blastocyst stage, improved hatching initiation and number of cells in the blastocyst, and reduction of cell death. However, no statistically significant differences were found in implantation and pregnancy rates in all apart from one large multicenter trial, which reported favorable outcomes, in terms of implantation and live birth rates. We propose properly conducted and adequately powered randomized controlled trials (RCTs) to further validate and extrapolate the current findings with the live birth rate to be the primary outcome measure. PMID:23509457

  4. The Evolution of Legislation in the Field of Medically Assisted Reproduction and Embryo Stem Cell Research in European Union Members

    PubMed Central

    Busardò, Francesco Paolo; Napoletano, Simona; Zaami, Simona; Frati, Paola

    2014-01-01

    Medically Assisted Reproduction (MAR), involving in vitro fertilisation (IVF), and research on embryos have created expectation to many people affected by infertility; at the same time it has generated a surplus of laws and ethical and social debates. Undoubtedly, MAR represents a rather new medical field and constant developments in medicine and new opportunities continue to defy the attempt to respond to those questions. In this paper, the authors reviewed the current legislation in the 28 EU member states trying to evaluate the different legislation paths adopted over the last 15 years and highlighting those EU countries with no specific legislation in place and MAR is covered by a general health Law and those countries in which there are no laws in this field but only “guidelines.” The second aim of this work has been to compare MAR legislation and embryo research in EU countries, which derive from different origins ranging from an extremely prohibitive approach versus a liberal one, going through a cautious regulatory approach. PMID:25147794

  5. The cumulative effect of assisted reproduction procedures on placental development and epigenetic perturbations in a mouse model.

    PubMed

    de Waal, Eric; Vrooman, Lisa A; Fischer, Erin; Ord, Teri; Mainigi, Monica A; Coutifaris, Christos; Schultz, Richard M; Bartolomei, Marisa S

    2015-12-15

    Assisted reproductive technologies (ART) are associated with several complications including low birth weight, abnormal placentation and increased risk for rare imprinting disorders. Indeed, experimental studies demonstrate ART procedures independent of existing infertility induce epigenetic perturbations in the embryo and extraembryonic tissues. To test the hypothesis that these epigenetic perturbations persist and result in adverse outcomes at term, we assessed placental morphology and methylation profiles in E18.5 mouse concepti generated by in vitro fertilization (IVF) in two different genetic backgrounds. We also examined embryo transfer (ET) and superovulation procedures to ascertain if they contribute to developmental and epigenetic effects. Increased placental weight and reduced fetal-to-placental weight ratio were observed in all ART groups when compared with naturally conceived controls, demonstrating that non-surgical embryo transfer alone can impact placental development. Furthermore, superovulation further induced overgrowth of the placental junctional zone. Embryo transfer and superovulation defects were limited to these morphological changes, as we did not observe any differences in epigenetic profiles. IVF placentae, however, displayed hypomethylation of imprinting control regions of select imprinted genes and a global reduction in DNA methylation levels. Although we did not detect significant differences in DNA methylation in fetal brain or liver samples, rare IVF concepti displayed very low methylation and abnormal gene expression from the normally repressed allele. Our findings suggest that individual ART procedures cumulatively increase placental morphological abnormalities and epigenetic perturbations, potentially causing adverse neonatal and long-term health outcomes in offspring.

  6. The cumulative effect of assisted reproduction procedures on placental development and epigenetic perturbations in a mouse model

    PubMed Central

    de Waal, Eric; Vrooman, Lisa A.; Fischer, Erin; Ord, Teri; Mainigi, Monica A.; Coutifaris, Christos; Schultz, Richard M.; Bartolomei, Marisa S.

    2015-01-01

    Assisted reproductive technologies (ART) are associated with several complications including low birth weight, abnormal placentation and increased risk for rare imprinting disorders. Indeed, experimental studies demonstrate ART procedures independent of existing infertility induce epigenetic perturbations in the embryo and extraembryonic tissues. To test the hypothesis that these epigenetic perturbations persist and result in adverse outcomes at term, we assessed placental morphology and methylation profiles in E18.5 mouse concepti generated by in vitro fertilization (IVF) in two different genetic backgrounds. We also examined embryo transfer (ET) and superovulation procedures to ascertain if they contribute to developmental and epigenetic effects. Increased placental weight and reduced fetal-to-placental weight ratio were observed in all ART groups when compared with naturally conceived controls, demonstrating that non-surgical embryo transfer alone can impact placental development. Furthermore, superovulation further induced overgrowth of the placental junctional zone. Embryo transfer and superovulation defects were limited to these morphological changes, as we did not observe any differences in epigenetic profiles. IVF placentae, however, displayed hypomethylation of imprinting control regions of select imprinted genes and a global reduction in DNA methylation levels. Although we did not detect significant differences in DNA methylation in fetal brain or liver samples, rare IVF concepti displayed very low methylation and abnormal gene expression from the normally repressed allele. Our findings suggest that individual ART procedures cumulatively increase placental morphological abnormalities and epigenetic perturbations, potentially causing adverse neonatal and long-term health outcomes in offspring. PMID:26401051

  7. A retrospective study of New Zealand case law involving assisted reproduction technology and the social recognition of 'new' family.

    PubMed

    Legge, M; Fitzgerald, R; Frank, N

    2007-01-01

    The New Zealand Human Assisted Reproductive Technology (HART) Act became law in 2004. In this article, we provide a retrospective analysis of New Zealand case law from September 1990 to March 2004, leading up to the creation of the HART Act. We examine the new understandings of parenting (developed through the routine use of ART in New Zealand) which the case law attempted to test. We examine these concepts against the previous understandings of family enshrined in the pre-existing legislation, which formed the basis for judicial rulings in the various cases to which we refer. In conclusion, we provide a brief summary of the 2004 HART legislation and draw comparisons between the old and new legislative and bureaucratic frameworks that define and support New Zealand family structure. We suggest that a change in cultural backdrop is occurring from the traditional western ideology of the nuclear family towards the traditional Maori concept of family formation, which includes a well-accepted traditional practice of guardianship and a more open and extended family structure. This 'new' structure reflects the contemporary lived experience of family kinship in western societies as individualized and open to choice.

  8. Association between assisted reproductive technology and the risk of autism spectrum disorders in the offspring: a meta-analysis

    PubMed Central

    liu, Liang; Gao, Junwei; He, Xie; Cai, Yulong; Wang, Lian; Fan, Xiaotang

    2017-01-01

    The association between the use of assisted reproductive technology (ART) and autism spectrum disorder (ASD) risk in offspring has been explored in several studies, but the result is still inconclusive. We assessed the risk of ASD in offspring in relation to ART by conducting a meta-analysis. A literature search in PubMed, Embase, and Web of Knowledge databases through April 30, 2016 was conducted to identify all the relevant records. Risk ratios (RRs) and 95% confidence intervals (95%CIs) were computed to analyze the strength of association by using fixed- or random-effect models based on heterogeneity test in total and subgroup analyses. Analysis of the total 11 records (3 cohort studies and 8 case-control studies) revealed that the use of ART is associated with higher percentage of ASD (RR = 1.35, 95% CI: 1.09–1.68, P = 0.007). In addition, subgroup analyses based on study design, study location and study quality were conducted, and some subgroups also showed a statistically significant association. Our study indicated that the use of ART may associated with higher risk of ASD in the offspring. However, further prospective, large, and high-quality studies are still required. PMID:28387368

  9. Antibiotic Prophylaxis for Gynecologic Procedures prior to and during the Utilization of Assisted Reproductive Technologies: A Systematic Review

    PubMed Central

    Hutchinson, Anne P.; Lekovich, Jovana P.; Hobeika, Elie; Elias, Rony T.

    2016-01-01

    The use of assisted reproductive technologies (ART) has increased steadily. There has been a corresponding increase in the number of ART-related procedures such as hysterosalpingography (HSG), saline infusion sonography (SIS), hysteroscopy, laparoscopy, oocyte retrieval, and embryo transfer (ET). While performing these procedures, the abdomen, upper vagina, and endocervix are breached, leading to the possibility of seeding pelvic structures with microorganisms. Antibiotic prophylaxis is therefore important to prevent or treat any procedure-related infections. After careful review of the published literature, it is evident that routine antibiotic prophylaxis is generally not recommended for the majority of ART-related procedures. For transcervical procedures such as HSG, SIS, hysteroscopy, ET, and chromotubation, patients at risk for pelvic infections should be screened and treated prior to the procedure. Patients with a history of pelvic inflammatory disease (PID) or dilated fallopian tubes are at high risk for postprocedural infections and should be given antibiotic prophylaxis during procedures such as HSG, SIS, or chromotubation. Antibiotic prophylaxis is recommended prior to oocyte retrieval in patients with a history of endometriosis, PID, ruptured appendicitis, or multiple prior pelvic surgeries. PMID:27047692

  10. Role of the mitochondrial genome in assisted reproductive technologies and embryonic stem cell-based therapeutic cloning.

    PubMed

    Brenner, Carol A; Kubisch, H Michael; Pierce, Kenneth E

    2004-01-01

    Mitochondria play a pivotal role in cellular metabolism and are important determinants of embryonic development. Mitochondrial function and biogenesis rely on an intricate coordination of regulation and expression of nuclear and mitochondrial genes. For example, several nucleus-derived transcription factors, such as mitochondrial transcription factor A, are required for mitochondrial DNA replication. Mitochondrial inheritance is strictly maternal while paternally-derived mitochondria are selectively eliminated during early embryonic cell divisions. However, there are reports from animals as well as human patients that paternal mitochondria can occasionally escape elimination, which in some cases has led to severe pathologies. The resulting existence of different mitochondrial genomes within the same cell has been termed mitochondrial heteroplasmy. The increasing use of invasive techniques in assisted reproduction in humans has raised concerns that one of the outcomes of such techniques is an increase in the incidence of mitochondrial heteroplasmy. Indeed, there is evidence that heteroplasmy is a direct consequence of ooplasm transfer, a technique that was used to 'rescue' oocytes from older women by injecting ooplasm from young oocytes. Mitochondria from donor and recipient were found in varying proportions in resulting children. Heteroplasmy is also a byproduct of nuclear transfer, as has been shown in studies on cloned sheep, cattle and monkeys. As therapeutic cloning will depend on nuclear transfer into oocytes and the subsequent generation of embryonic stem cells from resulting blastocysts, the prospect of mitochondrial heteroplasmy and its potential problems necessitate further studies in this area.

  11. Glucose parameters are altered in mouse offspring produced by assisted reproductive technologies and somatic cell nuclear transfer.

    PubMed

    Scott, Karen A; Yamazaki, Yukiko; Yamamoto, Miyuki; Lin, Yanling; Melhorn, Susan J; Krause, Eric G; Woods, Stephen C; Yanagimachi, Ryuzo; Sakai, Randall R; Tamashiro, Kellie L K

    2010-08-01

    Fortunately, the majority of children conceived through assisted reproductive technologies (ARTs) appear healthy; however, metabolic abnormalities, including elevated glucose and increased and altered adipose tissue deposition, have been reported in adolescents. To parse out factors that may be responsible, we investigated the effects of two different ARTs--in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI)--as well as somatic cell nuclear transfer (SCNT) on glucose clearance, body weight, and body composition of young adult mice. Female and male mice generated through ART weighed more than control (naturally conceived [STOCK]) mice at birth. No differences in body weight were observed in males up to 8 wk of age. ART females took longer than control mice to clear a glucose bolus, with glucose clearance most impaired in SCNT females. IVF females secreted more insulin and had a higher insulin peak 15 min after glucose injection compared with all other groups. Male mice exhibited no differences in glucose clearance, but IVF males required more insulin to do so. SCNT females weighed more than IVF, ICSI, and STOCK females, and they had higher fat content than ICSI females and higher leptin levels than all other groups. These results show that glucose parameters are altered in young adult mice conceived through techniques associated with ART before onset of obesity and may be responsible for its development later in life. The present study suggests that more investigation regarding the long-term effects of manipulations associated with ART is warranted.

  12. Pregnancy Complications and Neonatal Outcomes in Multiple Pregnancies: A Comparison between Assisted Reproductive Techniques and Spontaneous Conception

    PubMed Central

    Kaveh, Mahbod; Ghajarzadeh, Mahsa; Davari Tanha, Fatemeh; Nayeri, Fatemeh; Keramati, Zahra; Shariat, Mamak; Ghaheri, Azadeh

    2015-01-01

    Background This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies (ART) to spontaneous pregnancies. Materials and Methods In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student’s t test, chi square and logistic regression (p<0.05). Results There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups (p<0.001). The ART group had significantly higher preterm labor and premature rupture of membranes (PROM) whereas pregnanc-induced hypertension (PIH) was higher in the spontaneous group (p=0.01). Newborn intensive care unit (NICU) admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome (RDS), NICU admission and Apgar score were independent predictors for neonatal complications. Conclusion Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART. PMID:25780517

  13. Investigation of the association between the outcomes of sperm chromatin condensation and decondensation tests, and assisted reproduction techniques.

    PubMed

    Irez, T; Sahmay, S; Ocal, P; Goymen, A; Senol, H; Erol, N; Kaleli, S; Guralp, O

    2015-05-01

    The main purpose of this prospective study is to examine possible influences of abnormalities of sperm nuclear condensation and chromatin decondensation with sodium dodecyl sulphate (SDS)-EDTA on outcomes of intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI) cycles. Semen samples from 122 IUI and 236 ICSI cycles were evaluated. Before semen preparation for IUI or ICSI, basic semen analysis was performed and a small portion from each sample was spared for fixation. The condensation of sperm nuclear chromatin was evaluated with acidic aniline blue, followed by sperm chromatin decondensation by SDS-EDTA and evaluation under light microscope. Ongoing pregnancy rate was 24% and 26.2% in the IUI and ICSI groups respectively. The chromatin condensation rate was significantly higher in the ongoing pregnancy-positive group compared to the negative group, both in IUI (P = 0.042) and ICSI groups (P = 0.027), and it was positively correlated with ongoing pregnancy rate in both IUI and ICSI groups (P = 0.015, r = 0.214 and P = 0.014, r = 0.312 respectively). Chromatin decondensation rates were not significantly different in neither of the groups. These results indicate that IUI and ICSI outcome is influenced by the rate of spermatozoa with abnormal chromatin condensation. Sperm chromatin condensation with aniline blue is useful for selecting assisted reproduction techniques (ART) patients.

  14. Effects of Pharmaceuticals Used for Breast Cancer Treatment on Reproduction and Aromatase Activity in a Marine Fish

    EPA Science Inventory

    Laboratory experiments were conducted with the marine fish cunner (Tautogolabrus adspersus) to evaluate whether four pharmaceuticals used in breast cancer treatment have an impact on reproduction or aromatase activity. Tamoxifen binds to estrogen receptors, while anastrozole, let...

  15. Reproductive and metabolic responses of desert adapted common spiny male mice (Acomys cahirinus) to vasopressin treatment.

    PubMed

    Bukovetzky, Elena; Fares, Fuad; Schwimmer, Hagit; Haim, Abraham

    2012-08-01

    Sufficient amounts of water and food are important cues for reproduction in an unpredictable environment. We previously demonstrated that increased osmolarity levels, or exogenous vasopressin (VP) treatment halt reproduction of desert adapted golden spiny mice Acomys russatus. In this research we studied gonad regulation by VP and food restriction (FR) in desert adapted common spiny mouse (A. cahirinus) males, kept under two different photoperiod regimes-short (SD-8L:16D) and long (LD-16L:8D) days. Mice were treated with VP, FR, and VP+FR for three weeks. Response was assessed from changes in relative testis mass, serum testosterone levels and mRNA receptor gene expression of VP, aldosterone and leptin in treated groups, compared with their controls. SD-acclimation increased testosterone levels, VP treatment decreased expression of aldosterone mRNA receptor in the testes of SD-acclimated males. FR under SD-conditions resulted in testosterone decrease and elevation of VP- receptor gene expression in testes. Aldosterone receptor mRNA expression was also detected in WAT. These results support the idea that water and food availability in the habitat may be used as signals for activating the reproductive system through direct effects of VP, aldosterone and leptin on the testes or through WAT by indirect effects.

  16. Evidence-based medicine and the role of the National Health Service in assisted reproduction.

    PubMed

    Fishel, Simon

    2013-11-01

    The wholesale introduction of any new procedure to medical practice requires an acceptance based on evidence-based medicine, which is primarily acquired using prospective randomized controlled trials. However, for self-funded treatments, as are the majority of IVF cycles, this has always been very difficult to achieve. Generally, new technologies are introduced and adopted by patients who have failed in previous attempts at IVF. Urging patients to enter into a prospective randomized controlled trial is problematic, especially when they are self-funding; eagerness to conceive when time is against them, and/or having undergone previously failed treatment attempts, convince most patients to fund the new technology/opportunity rather than risk falling into the control arm and repeating their previous failure(s). The UK is uniquely placed to advance IVF medicine by helping practitioners and patients gain access to vital trials through the National Health Service.

  17. [The juridical desprotection of the human embryos post the new law of human assisted reproduction and the law of biomedical investigation].

    PubMed

    Corral García, Eduardo

    2009-01-01

    This research try to analyse the juridical statute of the human embryos in accordance with two recent laws which contain ordesr what affects him: the new Law of assisted reproduction technology -Law 14/2006, of 26 may (LRA)-, and the law of biomedical investigation -Law 14/2007, of 3 july (LIB)-, because the embryos in vitro is considered devoid of the quality what give the human dignity, why is allowed not only to research and to test with the remaining preembryos of assisted reproduction, but also to clone embryos with therapeutic purposes and to make a embryonic selection in order to cure other sons of the woman that recourse to fertilization in vitro through the donation of genetic material from the future baby.

  18. Sexual and gender minority peoples' recommendations for assisted human reproduction services.

    PubMed

    Ross, Lori E; Tarasoff, Lesley A; Anderson, Scott; Green, Datejie; Epstein, Rachel; Marvel, Stu; Steele, Leah S

    2014-02-01

    Objectif : Chercher à connaître les recommandations que formuleraient les personnes lesbiennes, gaies, bisexuelles, transgenres et allosexuelles (LGBTQ) en ce qui concerne l’offre de services de procréation assistée (PA) à leurs communautés. Méthodes : En utilisant un guide semi-structuré, nous avons interviewé un échantillon choisi à dessein de 66 personnes s’identifiant comme étant LGBTQ et provenant de partout dans la province de l’Ontario qui avaient utilisé ou qui avaient envisagé d’utiliser des services de PA depuis 2007. Résultats : Les participantes étaient principalement des femmes cisgenres (non transgenres), blanches, ayant une partenaire du même sexe et vivant en milieu urbain qui comptaient des niveaux relativement élevés de scolarité et de revenu. Les participantes ont formulé des recommandations visant l’apport de modifications aux aspects suivants de l’offre de services de PA : (1) accès à des renseignements pertinents pour les personnes LGBTQ, (2) adoption de pratiques axées sur la patiente par les fournisseurs de services de PA, (3) formation et éducation des fournisseurs de services à l’égard des enjeux et des besoins des personnes LGBTQ, (4) accroissement de la visibilité des personnes LGBTQ en milieu clinique et (5) octroi d’une attention aux lacunes en matière de services qui préoccupent particulièrement les personnes LGBTQ. Conclusion : Bon nombre des recommandations formulées par les participantes à l’étude illustrent la façon dont l’adoption de modèles axés sur la patiente pourrait combler les inégalités en ce qui concerne l’offre de services aux personnes LGBTQ et à d’autres patientes pouvant avoir des besoins particuliers en matière de PA. Nos résultats semblent indiquer que des ressources éducatives devraient être mises à la disposition des fournisseurs de services pour leur permettre de mettre en œuvre de telles pratiques axées sur les patientes et d’offrir des

  19. Assisted Reproductive Technologies in Alberta: An Economic Analysis to Inform Policy Decision-Making.

    PubMed

    Vaidya, Anil; Stafinski, Tania; Nardelli, Alexa; Motan, Tarek; Menon, Devidas

    2015-12-01

    Objectif : La réglementation et le financement public des techniques de procréation assistée (TPA) varient d’une province canadienne à l’autre. En Alberta, les TPA ne sont ni réglementées ni financées par les deniers publics. Nous avons mené cette étude dans le but d’évaluer la rentabilité de l’offre de TPA en Alberta et les effets d’une telle mesure sur le budget albertain en fonction de trois scénarios de politique différents (une politique « restrictive », une politique fondée sur le modèle québécois et une politique « permissive »), par comparaison avec le statu quo. Méthodes : Pour prédire la rentabilité de ces trois options de politique (prévoyant l’offre de TPA financées par les deniers publics en Alberta) et leurs effets sur le budget provincial, nous avons élaboré un modèle économique en combinant un modèle Markov (transitions d’état) et un arbre décisionnel. Le coût par nouveau-né en santé issu d’une grossesse monofœtale constituait le critère d’évaluation principal. Des analyses simples de la variance en matière de sensibilité et des analyses probabilistes ont été menées. Résultats : La politique « restrictive » a constitué l’option la plus rentable dans deux sous-groupes d’âge (< 35 ans et 35-39 ans), tandis que la politique fondée sur l’approche québécoise a constitué l’option la plus rentable dans le sous-groupe des ≥ 40 ans. L’analyse des effets sur le budget (jusqu’à ce que les enfants générés par le modèle ait atteint l’âge de 18 ans) a indiqué l’obtention d’économies de 8,33 millions de dollars pour ce qui est de la politique « restrictive » dans le sous-groupe des < 35 ans. Dans le sous-groupe des ≥ 40 ans, l’option de la politique fondée sur l’approche québécoise a mené à l’obtention d’économies totales de 3,75 millions de dollars. Les analyses de la sensibilité ont indiqué que les résultats modélisés

  20. Follicular fluid levels of vascular endothelial growth factor and early corpus luteum function during assisted reproductive technology cycles

    PubMed Central

    Coppola, F; Ferrari, B; Barusi, L; Caccavari, V; Salvarani, MC; Piantelli, G

    2005-01-01

    Background The relation between vascular endothelial growth factor (VEGF) and early luteal function has rarely been proven in humans. The purpose of this study was to define the relation between follicular fluid concentrations of VEGF (FF VEGF) and early luteal function at the preimplantation stage during assisted reproductive technology (ART) cycles. Methods 71 women were divided into two groups, based on reproductive outcome: women who became pregnant after embryo transfer (ET) (n = 18, Group A) and non-pregnant women (n = 53, Group B). Serum progesterone (Se P) and inhibin A on ET day, and FF VEGF levels were measured in all women. Data were expressed as mean ± standard deviation. Statistical analysis was performed using Excel Office 98 for Student's t-test, linear regression test and chi-square test. A p value of < 0.05 was considered statistically significant. Results The groups were comparable for age, ovarian reserve, number and quality of the oocytes retrieved and of the embryos obtained and transferred. FF VEGF levels were increased (4235 ± 1433 vs 3432 ± 1231 pg/ml), while Se P and inhibin A levels were significantly reduced (83.1 ± 34.1 vs 112.0 ± 58.8 ng/ml and 397.4 ± 223 vs 533.5 ± 283 pg/ml, respectively) in the non-pregnant group and were negatively correlated with FF VEGF (r = -0.482, p < 0.05; r = -0.468, p < 0.05) only in pregnant women. Conclusion Much has to be learned about the regulation and role of VEGF during the early luteal phase. We advance the hypothesis that the existence of a negative correlation between FF VEGF/Se P and FF VEGF/inhibin A in pregnant women might indicate the existence of a normal VEGF-mediated paracrine response when Se P and inhibin A levels are decreased. Excess production of FF VEGF and the absence of a correlation between FF VEGF/Se P and FF VEGF/inhibin A in non-pregnant women may be a paracrine reaction to immature luteal vasculature, resulting in luteal dysfunction. PMID:16197554

  1. Gonadotropin therapy in assisted reproduction: an evolutionary perspective from biologics to biotech

    PubMed Central

    Leão, Rogério de Barros F.; Esteves, Sandro C.

    2014-01-01

    Gonadotropin therapy plays an integral role in ovarian stimulation for infertility treatments. Efforts have been made over the last century to improve gonadotropin preparations. Undoubtedly, current gonadotropins have better quality and safety profiles as well as clinical efficacy than earlier ones. A major achievement has been introducing recombinant technology in the manufacturing processes for follicle-stimulating hormone, luteinizing hormone, and human chorionic gonadotropin. Recombinant gonadotropins are purer than urine-derived gonadotropins, and incorporating vial filling by mass virtually eliminated batch-to-batch variations and enabled accurate dosing. Recombinant and fill-by-mass technologies have been the driving forces for launching of prefilled pen devices for more patient-friendly ovarian stimulation. The most recent developments include the fixed combination of follitropin alfa + lutropin alfa, long-acting FSH gonadotropin, and a new family of prefilled pen injector devices for administration of recombinant gonadotropins. The next step would be the production of orally bioactive molecules with selective follicle-stimulating hormone and luteinizing hormone activity. PMID:24714837

  2. Epigenetic heterogeneity of developmentally important genes in human sperm: Implications for assisted reproduction outcome

    PubMed Central

    Kuhtz, Juliane; Schneider, Eberhard; El Hajj, Nady; Zimmermann, Lena; Fust, Olga; Linek, Bartosz; Seufert, Rudolf; Hahn, Thomas; Schorsch, Martin; Haaf, Thomas

    2014-01-01

    The molecular basis of male infertility is poorly understood, the majority of cases remaining unsolved. The association of aberrant sperm DNA methylation patterns and compromised semen parameters suggests that disturbances in male germline epigenetic reprogramming contribute to this problem. So far there are only few data on the epigenetic heterogeneity of sperm within a given sample and how to select the best sperm for successful infertility treatment. Limiting dilution bisulfite sequencing of small pools of sperm from fertile donors did not reveal significant differences in the occurrence of abnormal methylation imprints between sperm with and without morphological abnormalities. Intracytoplasmic morphologically selected sperm injection was not associated with an improved epigenetic quality, compared to standard intracytoplasmatic sperm injection. Deep bisulfite sequencing (DBS) of 2 imprinted and 2 pluripotency genes in sperm from men attending a fertility center showed that in both samples with normozoospermia and oligoasthenoteratozoospermia (OAT) the vast majority of sperm alleles was normally (de)methylated and the percentage of epimutations (allele methylation errors) was generally low (<1%). However, DBS allowed one to identify and quantify these rare epimutations with high accuracy. Sperm samples not leading to a pregnancy, in particular in the OAT group, had significantly more epimutations in the paternally methylated GTL2 gene than samples leading to a live birth. All 13 normozoospermic and 13 OAT samples leading to a child had <1% GTL2 epimutations, whereas one (7%) of 14 normozoospermic and 7 (50%) of 14 OAT samples without pregnancy displayed 1–14% GTL2 epimutations. PMID:25625849

  3. Egg freezing and egg banking: empowerment and alienation in assisted reproduction

    PubMed Central

    Robertson, John A.

    2014-01-01

    With the development of rapid freezing of human oocytes, many programs have reported IVF success rates comparable to those achieved with fresh eggs and thawed frozen embryos. Egg freezing is now gaining professional and regulatory acceptance as a safe and effective technique for women who wish to avoid discarding excess embryos, who face fertility-threatening medical treatments, or who want to preserve their eggs for use when they are better situated to have a family. This article focuses on the uses of and justification for egg freezing, the path to professional acceptance, the variability in success rates, and the controversy over freezing eggs for social rather than medical reasons. It also addresses the emergence of egg banking as a separate sector in the infertility industry, the regulatory issues that it poses, and its effect on egg donation. Key here is the legal control of stored eggs by banking women and their options when they wish to dispose of those eggs. The analysis is framed around empowerment and alienation. Egg freezing is generally empowering for women, but the donation or sale of unused eggs to infertile women, egg bankers, and researchers also raises issues of alienation. PMID:27774158

  4. Egg freezing and egg banking: empowerment and alienation in assisted reproduction.

    PubMed

    Robertson, John A

    2014-06-01

    With the development of rapid freezing of human oocytes, many programs have reported IVF success rates comparable to those achieved with fresh eggs and thawed frozen embryos. Egg freezing is now gaining professional and regulatory acceptance as a safe and effective technique for women who wish to avoid discarding excess embryos, who face fertility-threatening medical treatments, or who want to preserve their eggs for use when they are better situated to have a family. This article focuses on the uses of and justification for egg freezing, the path to professional acceptance, the variability in success rates, and the controversy over freezing eggs for social rather than medical reasons. It also addresses the emergence of egg banking as a separate sector in the infertility industry, the regulatory issues that it poses, and its effect on egg donation. Key here is the legal control of stored eggs by banking women and their options when they wish to dispose of those eggs. The analysis is framed around empowerment and alienation. Egg freezing is generally empowering for women, but the donation or sale of unused eggs to infertile women, egg bankers, and researchers also raises issues of alienation.

  5. Appropriate timing of uterine cavity length measurement positively affects assisted reproduction cycle outcome.

    PubMed

    Madani, Tahereh; Ashrafi, Mahnaz; Abadi, Akram Bahman; Kiani, Kiandokht

    2009-11-01

    An appropriate and easy embryo transfer has a direct impact on pregnancy rates. Proper evaluation of the uterocervical axis and uterine depth are necessary for suitable embryo transfer. The aim of this study was to assess the appropriate time for cervical axis evaluation and uterine measurement. A total of 124 patients undergoing IVF treatment were included in the study. They were divided equally into two groups. In group I (62 women), uterine cavity depth was measured and the uterocervical axis was determined on day 2 or 3 of the menstrual cycle, and in group II (62 women) at the time of oocyte retrieval. There was a statistically significant difference in clinical pregnancy rates between the two groups (P = 0.006). Thirty-four women became pregnant in group I (64.2%) versus 19 women in group II (35.8%). In conclusion, uterine cavity measurement is necessary for suitable embryo transfer. It seems that the time of measurement significantly affects clinical pregnancy rate in IVF cycles. The best time for uterine measurement is on day 2 or 3 of menstruation.

  6. Effects of flushing and hormonal treatment on reproductive performance of Iranian Markhoz goats.

    PubMed

    Daghigh Kia, H; Mohamadi Chapdareh, W; Hossein Khani, A; Moghaddam, G; Rashidi, A; Sadri, H; Alijani, S

    2012-12-01

    Forty-eight Iranian Markhoz goats were allocated to six groups (n = 8) to study the effect of flushing and hormonal treatments on reproductive performance. Treatments were divided into two categories including, hormonal treatments and flushing. The goats in each group were fed the same basal ration and received one of the following treatments: Groups A and B--injection of GnRH and equine chorionic gonadotropin (eCG) respectively; Groups C, D and E--a supplement of barley grain, soybean oil and sunflower oil in flushing diets, respectively, were offered and Group F--control (only received basal diet). In the flushing treatments, only the source of energy was different between rations. Both hormonal treatments and flushing treatments improved fertility and kidding rates. Treatment B with 16 and control with seven kids represented the highest and the lowest number of progeny respectively. Among flushing treatments, group C resulted in the highest number of kids being 15. Oestrogen levels in follicular phase increased with the injection of eCG and consumption of barley grain. GnRH injection and consumption of oil sources in the diet increased blood progesterone levels during ovulation and post-ovulation periods. Under current market conditions, using hormone or flushing can be profitable for Markhoz goats farmers.

  7. Assisted conception and South Asian communities in the UK: public perceptions of the use of donor gametes in infertility treatment.

    PubMed

    Culley, Lorraine; Hudson, Nicky; Rapport, Frances

    2013-03-01

    This paper explores 'public' attitudes to the use of donated gametes in infertility treatment amongst members of British South Asian communities in the UK. The study included 14 single-sex focus groups with a total of 100 participants of Indian, Pakistani and Bangladeshi origins in three English cities and 20 individual semi-structured interviews with key informants. It explores five themes from the data: childlessness and stigma; using sperm and using eggs; cultural connections; choosing gametes; religion and the use of donated gametes; and disclosure and the management of information. The paper demonstrates that the socio-cultural context of fertility treatment is highly relevant and those delivering services and those consulting the public need to be aware of cultural and gender differences. Third party assisted conception represents a challenge to received ideas of identity and has implications for social reproduction and kinship which go well beyond immediate conjugal relationships.

  8. Chromosomal aberrations, Yq microdeletion, and sperm DNA fragmentation in infertile men opting for assisted reproduction.

    PubMed

    Shamsi, Monis B; Kumar, Rajeev; Malhotra, Neena; Singh, Nita; Mittal, Suneeta; Upadhyay, Ashish D; Dada, Rima

    2012-09-01

    Male infertility is a multi-factorial disorder, and identification of its etiology in an individual is critical for treatment. Systematically elucidating the underlying genetic causes (chromosomal and Yq microdeletion) and factors, such as reactive oxygen species (ROS) levels and total antioxidant capacity (TAC), which contribute to sperm DNA damage, may help to reduce the number of men with idiopathic infertility and provide them with the most suitable therapeutics and counseling. This study was done to comprehensively investigate genetic and oxidative stress factors that might be the etiology of a large percentage of men with idiopathic infertility. One hundred twelve infertile men and 76 fertile controls were screened for chromosomal aberrations and Yq microdeletions. ROS, TAC, and sperm DNA damage were assessed in cytogenetically normal, non-azoospermic men with intact Y chromosome (n = 93). ROS was assessed in neat and washed semen by chemiluminescence; seminal TAC with a commercially available kit; and sperm DNA damage by the comet assay. Two men had cytogenetic abnormalities and seven men harbored Yq microdeletions. ROS levels in neat and washed semen of infertile men were significantly higher (P < 0.01) than controls. Infertile men had significantly lower (P < 0.01) TAC levels (1.79 mM), whereas sperm DNA fragmentation in infertile men was significantly higher (P < 0.01) than controls. Genetic factors and oxidative stress cumulatively account for large number of idiopathic infertile cases. Unlike, genetic causes, which cannot be cured, timely identification and management of oxidative stress may help to reverse/reduce the effects on induced DNA damage, and improve the outcomes for infertile males.

  9. Ovarian response markers lead to appropriate and effective use of corifollitropin alpha in assisted reproduction.

    PubMed

    La Marca, Antonio; D'Ippolito, Giovanni

    2014-02-01

    Corifollitropin alpha is a highly effective gonadotrophin, which maintains multifollicular growth for a week. The advantages of its administration include ease of use of the drug, making the treatment more patient friendly, resulting in a lower level of distress for the patient. At the same time, the pregnancy rate resulting from its use in IVF/intracytoplasmic sperm injection cycles is similar to that found when daily recombinant FSH is administered. The ovarian response to corifollitropin alpha is dependent on clinically established predictors such as baseline FSH, antral follicle count (AFC) and age. There is a general trend towards a higher ovarian response with an increasing AFC and the number of oocytes per attempt decreased with increasing baseline FSH and age. Even if the risk of ovarian hyperstimulation syndrome following corifollitropin alpha is very similar to the rate reported in literature for young women undergoing IVF, the risk of overstimulation may be reduced by avoiding maximal ovarian stimulation in women anticipated to be hyperresponders. High basal anti-Müllerian hormone and/or AFC can identify women with enhanced functional ovarian reserve at risk of overstimulation, and the risk is even higher if maximally stimulated with corifollitropin alpha or high dose of daily recombinant FSH. Corifollitropin alpha is a highly effective gonadotrophin which maintains multifollicular growth for a week. The ovarian response to corifollitropin was demonstrated to be dependent on clinically established predictors such as baseline FSH, antral follicle count (AFC) and age. There was a general trend toward a higher ovarian response with an increasing AFC and the mean number of oocytes per attempt decreased with increasing baseline FSH and age. Even if the risk of ovarian hyperstimulation syndrome (OHSS) following corifollitropin alpha is very similar to the rate of OHSS reported in literature for young women undergoing IVF, the risk of overstimulation may be

  10. Anticancer treatment and fertility: Effect of therapeutic modalities on reproductive system and functions.

    PubMed

    Vassilakopoulou, Maria; Boostandoost, Erfaneh; Papaxoinis, George; de La Motte Rouge, Thibault; Khayat, David; Psyrri, Amanda

    2016-01-01

    The significant improvement of cancer treatments entailed a longer life in cancer survivors and raised expectations for higher quality of life with minimized long-term toxicity. Infertility and gonadal dysfunction are adverse effects of anticancer therapy or may be related to specific tumors. In female cancer survivors, premature ovarian failure is common after antineoplastic treatments resulting in infertility and other morbidities related to oestrogen deficiency such as osteoporosis. In male cancer survivors, infertility and persistent a zoospermia is a more common long-term adverse effect than hypogonadism because germ cells are more sensitive to chemotherapy and radiotherapy than leydig cells. Gonadal toxicity and compromise of reproductive functions will be more efficiently prevented and treated if addressed before treatment initiation. This review focuses on these issues in young cancer survivors of childbearing age, where methods of protecting or restoring endocrine function and fertility need to be considered.

  11. From Embryos to Adults: A DOHaD Perspective on In Vitro Fertilization and Other Assisted Reproductive Technologies

    PubMed Central

    Feuer, Sky; Rinaudo, Paolo

    2016-01-01

    Human in vitro fertilization (IVF) as a treatment for infertility is regarded as one of the most outstanding accomplishments of the 20th century, and its use has grown dramatically since the late 1970s. Although IVF is considered safe and the majority of children appear healthy, reproductive technologies have been viewed with some skepticism since the in vitro environment deviates substantially from that in vivo. This is increasingly significant because the Developmental Origins of Health and Disease (DOHaD) hypothesis has illuminated the sensitivity of an organism to its environment at critical stages during development, including how suboptimal exposures restricted specifically to gamete maturation or the preimplantation period can affect postnatal growth, glucose metabolism, fat deposition, and vascular function. Today, some of the physiological metabolic phenotypes present in animal models of IVF have begun to emerge in human IVF children, but it remains unclear whether or not in vitro embryo manipulation will have lasting health consequences in the offspring. Our expanding knowledge of the DOHaD field is fueling a paradigm shift in how disease susceptibility is viewed across the life course, with particular emphasis on the importance of collecting detailed exposure information, identifying biomarkers of health, and performing longitudinal studies for any medical treatment occurring during a developmentally vulnerable period. As IVF use continues to rise, it will be highly valuable to incorporate DOHaD concepts into the clinical arena and future approaches to public health policy. PMID:27517965

  12. Argon laser-assisted treatment of benign eyelid lesions.

    PubMed

    Korkmaz, Şafak; Ekici, Feyzahan; Sül, Sabahattin

    2015-02-01

    We investigated the treatment of benign eyelid lesions with argon laser as an alternative therapy to surgical excision. The charts of 73 patients with 95 lesions treated with argon laser photocoagulation were reviewed retrospectively. In all patients, the procedure was performed for cosmetic reasons. The laser spot size ranged from 50 to 200 μm, the power varied from 300 to 700 mW, and the exposure time ranged between 0.1 and 0.2 s. The lesions were mostly located on the upper eyelid (66%); the lid margin was involved in 30 cases. The mean follow-up time was 7.2 ± 3.5 months (range 3-15 months). A histopathological diagnosis was confirmed for 81 lesions (85.3%). All patients were satisfied with the cosmetic result. No intraoperative complications occurred, and none of the patients complained of pain during laser application. All wounds epithelialized in 3-4 weeks with skin that appeared normal. Hypopigmentation of the treated areas were observed in three cases. No recurrence occurred during the follow-up period. Argon laser-assisted benign eyelid tumor excision is a useful, cheap, accessible, and well-tolerated alternative to traditional surgery.

  13. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6180... used for assisted reproduction procedures. Media include liquid and powder versions of...

  14. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6180... used for assisted reproduction procedures. Media include liquid and powder versions of...

  15. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6180... used for assisted reproduction procedures. Media include liquid and powder versions of...

  16. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6180... used for assisted reproduction procedures. Media include liquid and powder versions of...

  17. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) MEDICAL DEVICES OBSTETRICAL AND GYNECOLOGICAL DEVICES Assisted Reproduction Devices § 884.6180... used for assisted reproduction procedures. Media include liquid and powder versions of...

  18. Medication Assisted Treatment for the 21st Century: Community Education Kit.

    ERIC Educational Resources Information Center

    Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment.

    The need to support the success of individuals in methadone-assisted recovery, and the recent availability of new pharmacologic treatment options for opioid dependence, calls for an information tool that underscores the evidence-based benefits of medication assisted treatment for opioid dependence. The U.S. Department of Health and Human Services'…

  19. Free radicals and male reproduction.

    PubMed

    Agarwal, Ashok; Allamaneni, Shyam S R

    2011-03-01

    Male factor accounts for almost 50% cases of infertility. The exact mechanism of sperm dysfunction is not known in many cases. Extensive research in the last decade has led to the identification of free radicals (reactive oxygen species) as mediators of sperm dysfunction in both specific diagnoses and idiopathic cases of male infertility. Elevated levels of reactive oxygen species are seen in up to 30-80% of men with male infertility. The role of free radicals has been studied extensively in the process of human reproduction. We know now that a certain level of free radicals is necessary for normal sperm function, whereas an excessive level of free radicals can cause detrimental effect on sperm function and subsequent fertilisation and offspring health. Oxidative stress develops when there is an imbalance between generation of free radicals and scavenging capacity of anti-oxidants in reproductive tract. Oxidative stress has been shown to affect both standard semen parameters and fertilising capacity. In addition, high levels of free radicals have been associated with lack of or poor fertility outcome after natural conception or assisted reproduction. Diagnostic techniques to quantify free radicals in infertile patients can assist physicians treating patients with infertility to plan for proper treatment strategies. In vivo anti-oxidants can be used against oxidative stress in male reproductive tract. Supplementation of in vitro anti-oxidants can help prevent the oxidative stress during sperm preparation techniques in assisted reproduction.

  20. Assisted Reproductive Technology (ART)

    MedlinePlus

    ... Control and Prevention compiles annual reports on the success rates of ART. These reports can be accessed ... the chance of pregnancy in some cases. The success of IUI depends on the cause of the ...

  1. Assisted Reproductive Technologies

    MedlinePlus

    ... Should I Join ASRM? How to Join ASRM Benefits of ASRM Membership Membership Dues Welcome New ASRM Members! ASRM Member Groups Find a Member Volunteer for an ASRM Committee Contact ASRM Member Services My ASRM My Account My Online Learning My Communities My Journals Login Join Donate ASRM Store ASRM ...

  2. Assisted Reproductive Technology

    MedlinePlus

    ... the female partner and the sperm from the male partner. The most common complication of ART is a multiple pregnancy. It can be prevented or minimized by limiting the number of embryos that are put into the woman's body.

  3. Effectivity of advanced wastewater treatment: reduction of in vitro endocrine activity and mutagenicity but not of in vivo reproductive toxicity.

    PubMed

    Giebner, Sabrina; Ostermann, Sina; Straskraba, Susanne; Oetken, Matthias; Oehlmann, Jörg; Wagner, Martin

    2016-09-06

    Conventional wastewater treatment plants (WWTPs) have a limited capacity to eliminate micropollutants. One option to improve this is tertiary treatment. Accordingly, the WWTP Eriskirch at the German river Schussen has been upgraded with different combinations of ozonation, sand, and granulated activated carbon filtration. In this study, the removal of endocrine and genotoxic effects in vitro and reproductive toxicity in vivo was assessed in a 2-year long-term monitoring. All experiments were performed with aqueous and solid-phase extracted water samples. Untreated wastewater affected several endocrine endpoints in reporter gene assays. The conventional treatment removed the estrogenic and androgenic activity by 77 and 95 %, respectively. Nevertheless, high anti-estrogenic activities and reproductive toxicity persisted. All advanced treatment technologies further reduced the estrogenic activities by additional 69-86 % compared to conventional treatment, resulting in a complete removal of up to 97 %. In the Ames assay, we detected an ozone-induced mutagenicity, which was removed by subsequent filtration. This demonstrates that a post treatment to ozonation is needed to minimize toxic oxidative transformation products. In the reproduction test with the mudsnail Potamopyrgus antipodarum, a decreased number of embryos was observed for all wastewater samples. This indicates that reproductive toxicants were eliminated by neither the conventional nor the advanced treatment. Furthermore, aqueous samples showed higher anti-estrogenic and reproductive toxicity than extracted samples, indicating that the causative compounds are not extractable or were lost during extraction. This underlines the importance of the adequate handling of wastewater samples. Taken together, this study demonstrates that combinations of multiple advanced technologies reduce endocrine effects in vitro. However, they did not remove in vitro anti-estrogenicity and in vivo reproductive toxicity. This

  4. 'Emotional rights', moral reasoning, and Jewish-Arab alliances in the regulation of in-vitro-fertilization in israel: theorizing the unexpected consequences of assisted reproductive technologies.

    PubMed

    Gooldin, Sigal

    2013-04-01

    Consumption rates of assisted reproductive technologies (ARTs) in Israel is internationally unprecedented, a phenomenon that has been the subject of growing anthropological and sociological attention. Explanations for the singular extent of ARTs use in Israel tend to pre-assume and conceptually prioritize the symbolic and political power of pro-natalist discourses, Jewish religious values, and the demographic interests of the Jewish state. This article attempts to understand the exceptional usage of IVF in Israel in terms of its emergent meanings and unexpected effects in a particular local setup. The question that this article tries to answer is: How is the 'Israeli character' of IVF emerges within and through the interactive practice of moral justifications, and how might this medical technology affect the networks within which it is enmeshed? The article is based on a case-study analysis of a public dispute that took place in 2003-2004 over the extent of public funding for fertility treatments. Ethnographic analysis of parliament discussions, media coverage, and an online forum of IVF consumers recorded three frames of justification for the uniquely generous public funding scheme of IVF in Israel: 'rational-economic', 'nationalist', and 'liberal'. The latter assumes shared 'emotional vulnerability' of all 'childless' Israelis, Jews and Arabs alike and advocates a universal language of 'emotional rights' and 'human rights'. This liberal framing of IVF, which is the most persuasive justification in the dispute, blurs dichotomous rivalries between Jews and Arabs and generates a potential for alliances between traditionally rival sectors. These are some of the unexpected and non-intuitive consequences of ARTs in Israel.

  5. Effect of Melatonin on the Outcome of Assisted Reproductive Technique Cycles in Women with Diminished Ovarian Reserve: A Double-Blinded Randomized Clinical Trial

    PubMed Central

    Jahromi, Bahia Namavar; Sadeghi, Sara; Alipour, Shohreh; Parsanezhad, Mohammad Ebrahim; Alamdarloo, Shaghayegh Moradi

    2017-01-01

    Diminished ovarian reserve (DOR) significantly decreases the success rate of the assisted reproductive technique (ART). In this study, we assessed the effect of melatonin on the ART outcomes in women with DOR. A double-blinded, randomized, clinical trial was performed on 80 women with DOR as a pilot study in Shiraz, between 2014 and 2015. DOR was defined as the presence of 2 of the following 3 criteria: 1) anti-Müllerian hormone ≤1, 2) follicle-stimulating hormone ≥10, and 3) bilateral antral follicle count ≤6. The women received 3 mg/d melatonin or a placebo since the fifth day of one cycle prior to gonadotropin stimulation and continued the treatment up to the time of ovum pickup. The ART outcomes were compared between the groups using SPSS software. Finally, there were 32 women in the case and 34 in the placebo groups. The mean age and basal ovarian reserve test were the same between the groups. The serum estradiol level on the triggering day was significantly higher in the case group (P=0.005). The mean number of MII oocytes was higher in the case group, but the difference did not reach statistical significance. Number of the patients who had mature MII oocytes (P=0.014), top-quality embryos with grade 1 (P=0.049), and embryos with grades 1 and 2 (P=0.014) was higher among the women who received melatonin. However, the other ART outcomes were not different between the groups. The serum estradiol level was higher and more women with DOR had good-quality oocytes and embryos after receiving melatonin; however, no other outcome was different between the case and control groups. Trial Registration Number: IRCT2014041417264N1 PMID:28293053

  6. Correlation between male age, WHO sperm parameters, DNA fragmentation, chromatin packaging and outcome in assisted reproduction technology.

    PubMed

    Nijs, M; De Jonge, C; Cox, A; Janssen, M; Bosmans, E; Ombelet, W

    2011-06-01

    In the human, male ageing results in reproductive hormonal and cellular changes that can influence semen quality (volume, motility, concentration and morphology) and ultimately result in a reduced fertilising capacity and a longer 'time to pregnancy' for ageing men as well as an increased risk for miscarriage. This prospective cohort study of 278 patients undergoing a first in vitro fertilisation or intracytoplasmic sperm injection treatment was undertaken to examine whether patient's age was reflected in sperm motility, concentration, morphology as well as in DNA fragmentation (DFI) and immature chromatin (unprocessed nuclear proteins and/or poorly condensed chromatin) as measured by the sperm chromatin structure assay. This study also investigated the possible influence of male age (after correcting for female age) on their fertilising capacity, on obtaining a pregnancy and a healthy baby at home. Logistic regression analysis did not reveal any male age-related influences on sperm parameters like concentration, motility or morphology. No significant male age-related increase in DFI or immature chromatin was demonstrable for these patients. Elevated male age, after correcting for female age, was not related to lower fertilisation rates or significant decreases in the chance for a healthy baby at home.

  7. Reproductive efficiency of cows with endometritis after treatment with intrauterine infusions or prostaglandin injections, or no treatment.

    PubMed

    Knutti, B; Küpfer, U; Busato, A

    2000-12-01

    Data from 3276 cows with 6598 lactations in 85 herds participating in a herd health monitoring programme were selected for an observational study. Cases of endometritis were diagnosed based on a clinical examination after 21 days postpartum. The cases were grouped by the severity of endometritis (mild, severe) and by the treatment performed (intrauterine infusion, prostaglandin injection, no treatment). The conception rates and the calving-to-conception intervals of these groups were compared statistically. Conception rate was lower in cows with severe endometritis compared to cows with mild endometritis while it did not differ between treatment groups. In cows with mild endometritis a significantly longer calving-to-conception interval was observed if intrauterine infusions were performed compared to the other two treatment options. The occurrence of other fertility problems during the same service period had a significant effect on conception rate and calving-to-conception intervals. In cows with severe endometritis intrauterine or prostaglandin treatments appeared to be beneficial, whereas intrauterine infusions in cows with slight endometritis had a negative effect on reproductive efficiency.

  8. National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment

    PubMed Central

    Campopiano, Melinda; Baldwin, Grant; McCance-Katz, Elinore

    2015-01-01

    Objectives. We estimated national and state trends in opioid agonist medication-assisted treatment (OA-MAT) need and capacity to identify gaps and inform policy decisions. Methods. We generated national and state rates of past-year opioid abuse or dependence, maximum potential buprenorphine treatment capacity, number of patients receiving methadone from opioid treatment programs (OTPs), and the percentage of OTPs operating at 80% capacity or more using Substance Abuse and Mental Health Services Administration data. Results. Nationally, in 2012, the rate of opioid abuse or dependence was 891.8 per 100 000 people aged 12 years or older compared with national rates of maximum potential buprenorphine treatment capacity and patients receiving methadone in OTPs of, respectively, 420.3 and 119.9. Among states and the District of Columbia, 96% had opioid abuse or dependence rates higher than their buprenorphine treatment capacity rates; 37% had a gap of at least 5 per 1000 people. Thirty-eight states (77.6%) reported at least 75% of their OTPs were operating at 80% capacity or more. Conclusions. Significant gaps between treatment need and capacity exist at the state and national levels. Strategies to increase the number of OA-MAT providers are needed. PMID:26066931

  9. The issue of constitutional law legitimacy on "human assisted reproduction" between reasonableness of the choices and effectiveness of the protection of all involved subjects.

    PubMed

    Penasa, Simone

    2006-01-01

    This artiche analyzes the constitutionality petition to the constitutional Court against Law 40 of 2004 on "human assisted reproduction", where it prohibits the "preimplantatory genetical diagnosis", because it could be against the mother's right to health (art. 32 Italian Constitution) and the egalitarian protection clause (art. 3 Italian Constitution). In the constitutionally petition the ordinary judge proposes an interpretation in accordance with Constitution of the contested disposition (art. 13 of Law 40 of 2004) and this could be the possibility to teste the "living law" theory and its relation with the "adequate interpretation" of the law and the Constitution.

  10. Stent-assisted coiling strategies for the treatment of wide-necked basilar artery bifurcation aneurysms.

    PubMed

    Zhang, Jian-Zhong; Yang, Peng-Fei; Huang, Qing-Hai; Xu, Yi; Hong, Bo; Zhao, Wen-Yuan; Liu, Jian-Min

    2014-06-01

    Stent-assisted coiling is now the preferred treatment option for wide-necked basilar artery bifurcation aneurysms (BABA). However, the optimal choice of specific treatment strategies is still not well documented. In this paper, based on the "two-neck" theory of BABA, we classified the stent-assisted coiling treatment of BABA into three types: unilateral stent-assisted coiling, unilateral stent plus contralateral microcatheter or microwire-assisted coiling, and bilateral stent-assisted coiling. We assessed the feasibility and effectiveness of different stent-assisted coiling strategies for the treatment of BABA. Twenty-three BABA patients treated with stent-assisted coiling between May 2003 and September 2012 were included. Of the 23 aneurysms, 16 were treated with unilateral stent-assisted coiling, two were treated with unilateral stent and microcatheter or microwire-assisted coiling, and five were treated with bilateral stent-assisted coiling. All 23 BABA were successfully embolized, with a technical success rate of 100%. According to the Raymond classification, the immediate procedural outcome was grade I in nine patients, grade II (neck residue) in four patients and grade III (body filling) in 10 patients. The rate of procedure-related complications was 4.3% (1/23), where intra-operative hemorrhage occurred during coiling due to rupture of the aneurysm. Of the 23 patients, 16 (69.6%) had angiographic follow-up. The mean follow-up duration was 13.5 months (range 1-46 months). Angiographic follow-up showed complete occlusion in 10 patients (62.5%), improvement in two patients (12.5%), stability in three patients (18.7%), and recanalization in one patient (6.25%). The various stent-assisted coiling strategies available at present are feasible and effective for the treatment of wide-necked BABA.

  11. The effect of treatment of clinical endometritis on reproductive performance in dairy cows.

    PubMed

    LeBlanc, S J; Duffield, T F; Leslie, K E; Bateman, K G; Keefe, G P; Walton, J S; Johnson, W H

    2002-09-01

    The objective of this field trial was to compare the effect of intrauterine (i.u.) antibiotic or intramuscular (i.m.) prostaglandin F2 alpha (PGF2 alpha) on time to pregnancy in dairy cows diagnosed with clinical endometritis between 20 and 33 days in milk (DIM). The case definition of endometritis was the presence of purulent uterine discharge or cervical diameter > 7.5 cm, or the presence of muco-purulent discharge after 26 DIM. There were 316 cows with endometritis from 27 farms assigned randomly within herd to receive 500 mg of cephapirin benzathine intrauterine (i.u.), 500 micrograms of cloprostenol i.m., or no treatment. The rate of resolution of clinical signs 14 d after treatment was 77% and was not affected by treatment. Reproductive performance was monitored for a minimum of 7 mo after treatment. Survival analysis (multivariable proportional hazards regression) was used to measure the effect of treatment on time to pregnancy. There was no benefit of treatment of endometritis before 4 wk postpartum. Administration of PGF2 alpha between 20 and 26 DIM to cows with endometritis that did not have a palpable corpus luteum was associated with a significant reduction in pregnancy rate. Between 27 and 33 DIM, cows with endometritis treated with cephapirin i.u. had a significantly shorter time to pregnancy than untreated cows (hazard ratio = 1.63). In this time period, there was no difference in pregnancy rate between PGF2 alpha and untreated cows, but the difference in pregnancy rate between cows treated with cephapirin i.u. and with PGF2 alpha was not statistically significant. Treatment of postpartum endometritis should be reserved for cases diagnosed after 26 DIM, based on criteria that are associated with subsequent pregnancy rate.

  12. Human reproduction: current status.

    PubMed

    Izzo, Carlos Roberto; Monteleone, Pedro Augusto Araújo; Serafini, Paulo C

    2015-01-01

    The concern about the maintenance of the human species has existed since the earliest civilizations. Progress in the diagnosis and treatment of infertility has led to the development of assisted reproductive techniques (ART) which, along with the evolution of genetics and molecular biology studies, have contributed in a concrete way to the management of infertile couples. Classic in vitro fertilization was initially developed 35 years ago for the treatment of women with tubal blockage, however, it remains inaccessible to a significant proportion of infertile couples around the world. This can be explained by the lack of specialized clinics in some countries and by the high cost of the procedures. Efforts have been employed to increase the number of treatment cycles for assisted reproduction, as for example, the creation of low-cost programs. Even today, infertility remains a problem of global proportions, affecting millions of couples. The estimate of the incidence of infertility is uncertain, mainly because of the criteria used for its definition. This article aims to review the most important aspects, succinctly, regarding the incidence, etiology, and treatment options available to infertile couples.

  13. The Ethical Treatment of Research Assistants: Are We Forsaking Safety for Science?

    ERIC Educational Resources Information Center

    Naufel, Karen Z.; Beike, Denise R.

    2013-01-01

    Science inevitably involves ethical discussions about how research should be implemented. However such discussions often neglect the potential unethical treatment of a third party: the research assistant. Extensive anecdotal evidence suggests that research assistants can experience unique physical, psychological, and social risks when implementing…

  14. Reproductive planning in times of Zika: getting pregnant or delaying plans? The opinion of the Brazilian Society of Assisted Reproduction Committee - a basis for a bioethical discussion

    PubMed Central

    de Carvalho, Bruno R.; Taitson, Paulo F.; Brandão, Karina S. A. G.; Ferriani, Rui Alberto; Nakagawa, Hitomi M.; Silva, Adelino A.; Lopes, Joaquim R. C.

    2016-01-01

    Although the causality between Zika virus, microcephaly, and other central nervous system disorders has been taken for granted by the scientific community, many uncertainties remain. The gap of knowledge at the moment is large enough to remove part of the confidence physicians have on the advice given to patients - and infertile women in particular - on their reproductive plans. Pretreatment serologic screening is a possible strategy to offer more confidence for individuals choosing to bear children regardless of the Zika virus, but the tests currently available do not seem to be sufficiently adequate. Until now, there is no formal recommendation to avoid pregnancy solely because of the Zika virus outbreak, and the choice of becoming pregnant has been regarded as a personal decision to be made by each woman and her family. PMID:27584610

  15. Reproductive planning in times of Zika: getting pregnant or delaying plans? The opinion of the Brazilian Society of Assisted Reproduction Committee - a basis for a bioethical discussion.

    PubMed

    Carvalho, Bruno R de; Taitson, Paulo F; Brandão, Karina S A G; Ferriani, Rui Alberto; Nakagawa, Hitomi M; Silva, Adelino A; Lopes, Joaquim R C

    2016-08-01

    Although the causality between Zika virus, microcephaly, and other central nervous system disorders has been taken for granted by the scientific community, many uncertainties remain. The gap of knowledge at the moment is large enough to remove part of the confidence physicians have on the advice given to patients - and infertile women in particular - on their reproductive plans. Pretreatment serologic screening is a possible strategy to offer more confidence for individuals choosing to bear children regardless of the Zika virus, but the tests currently available do not seem to be sufficiently adequate. Until now, there is no formal recommendation to avoid pregnancy solely because of the Zika virus outbreak, and the choice of becoming pregnant has been regarded as a personal decision to be made by each woman and her family.

  16. Variance Assistance Document: Land Disposal Restrictions Treatability Variances and Determinations of Equivalent Treatment

    EPA Pesticide Factsheets

    This document provides assistance to those seeking to submit a variance request for LDR treatability variances and determinations of equivalent treatment regarding the hazardous waste land disposal restrictions program.

  17. Treatments to Optimize the Use of Artificial Insemination and Reproductive Efficiency in Beef Cattle under Tropical Environments

    PubMed Central

    de Sá Filho, Ocilon Gomes; Vasconcelos, José Luiz Moraes

    2011-01-01

    Bos indicus cattle, the preferred genetic group in tropical climates, are characterized by having a lower reproductive efficiency than Bos taurus. The reasons for the poorer reproductive efficiency of the Bos indicus cows include longer lengths of gestation and postpartum anestrus, a short length of estrous behavior with a high incidence of estrus occurring during the dark hours, and puberty at older age and at a higher percentage of body weight relative to mature body weight. Moreover, geography, environment, economics, and social traditions are factors contributing for a lower use of reproductive biotechnologies in tropical environments. Hormonal protocols have been developed to resolve some of the reproductive challenges of the Bos indicus cattle and allow artificial insemination, which is the main strategy to hasten genetic improvement in commercial beef ranches. Most of these treatments use exogenous sources of progesterone associated with strategies to improve the final maturation of the dominant follicle, such as temporary weaning and exogenous gonadotropins. These treatments have caused large impacts on reproductive performance of beef cattle reared under tropical areas. PMID:21076547

  18. Treatments to Optimize the Use of Artificial Insemination and Reproductive Efficiency in Beef Cattle under Tropical Environments.

    PubMed

    de Sá Filho, Ocilon Gomes; Vasconcelos, José Luiz Moraes

    2010-11-08

    Bos indicus cattle, the preferred genetic group in tropical climates, are characterized by having a lower reproductive efficiency than Bos taurus. The reasons for the poorer reproductive efficiency of the Bos indicus cows include longer lengths of gestation and postpartum anestrus, a short length of estrous behavior with a high incidence of estrus occurring during the dark hours, and puberty at older age and at a higher percentage of body weight relative to mature body weight. Moreover, geography, environment, economics, and social traditions are factors contributing for a lower use of reproductive biotechnologies in tropical environments. Hormonal protocols have been developed to resolve some of the reproductive challenges of the Bos indicus cattle and allow artificial insemination, which is the main strategy to hasten genetic improvement in commercial beef ranches. Most of these treatments use exogenous sources of progesterone associated with strategies to improve the final maturation of the dominant follicle, such as temporary weaning and exogenous gonadotropins. These treatments have caused large impacts on reproductive performance of beef cattle reared under tropical areas.

  19. Determination of pyruvate and lactate as potential biomarkers of embryo viability in assisted reproduction by capillary electrophoresis with contactless conductivity detection.

    PubMed

    Mádr, Aleš; Celá, Andrea; Klejdus, Bořivoj; Pelcová, Marta; Crha, Igor; Žáková, Jana; Glatz, Zdeněk

    2015-06-01

    Human-assisted reproduction is increasing in importance due to the constantly rising number of couples suffering from infertility issue. A key step in in vitro fertilization is the proper assessment of embryo viability in order to select the embryo with the highest likelihood of resulting in a pregnancy. This study proposes a method based on CE with contactless conductivity detection for the determination of pyruvate and lactate in spent culture media used in human-assisted reproduction. A fused-silica capillary of 64.0 cm total length and 50 μm inner diameter was used. The inner capillary wall was modified by the coating of successive layers of the ionic polymers polybrene and dextran sulfate to reverse EOF. The BGE was composed of 10 mM MES/lithium hydroxide, pH 6.50. The sample was injected by pressure 50 mbar for 18 s, separation voltage was set to -24 kV, and capillary temperature to 15°C. The presented method requires only 2 μL of the culture medium, with LODs for pyruvate and lactate of 0.03 and 0.02 μM, respectively. The results demonstrated the method's suitability for the analysis of spent culture media to support embryo viability assessment by light microscopy, providing information about key metabolites of the energy metabolism of a developing embryo.

  20. Computer Assisted Diagnosis of Chest Pain. Adjunctive Treatment Protocols

    DTIC Science & Technology

    1984-07-30

    or dyspnea is present. a. Musculöskeletal pain b. Pleurisy c. Pulmonary embolus d. Spontaneous mediastinal emphysema a) Musculoskeletal chest...analgesics, heat therapy, and, perhaps, rest. b) Pleurisy denotes inflammation of the pleura. It is seen in the setting of bronchitis or pneumonia...the symptoms of both assist in differentiating pleurisy from pneumothorax. Chest discomfort is pleuritic. unless there are signs of pneumonia, lung

  1. Weight loss improves reproductive outcomes in obese women undergoing fertility treatment: a randomized controlled trial.

    PubMed

    Sim, K A; Dezarnaulds, G M; Denyer, G S; Skilton, M R; Caterson, I D

    2014-04-01

    For women attempting pregnancy, obesity reduces fertility and is an independent risk factor for obstetric and neonatal complications. The aim of this evaluator-blinded, randomized controlled trial was to evaluate a weight loss intervention on pregnancy rates in obese women undertaking fertility treatment. Forty-nine obese women, aged ≤ 37 years, presenting for fertility treatment were randomized to either a 12-week intervention (n = 27) consisting of a very-low-energy diet for the initial 6 weeks followed by a hypocaloric diet, combined with a weekly group multidisciplinary programme; or a control group (n = 22) who received recommendations for weight loss and the same printed material as the intervention. Anthropometric and reproductive parameters were measured at baseline and at 12 weeks. The 22 women who completed the intervention had greater anthropometric changes (-6.6 ± 4.6 kg and -8.7 ± 5.6 cm vs. -1.6 ± 3.6 kg and -0.6 ± 6.3 cm) compared with the control group (n = 17; P < 0.001). The intervention group achieved a pregnancy rate of 48% compared with 14% (P = 0.007), took a mean two fertility treatment cycles to achieve each pregnancy compared with four in the control group (P = 0.002), and had a marked increase in the number of live births (44% vs. 14%; P = 0.02). A group weight loss programme, incorporating dietary, exercise and behavioural components, is associated with a significant improvement in pregnancy rates and live births in a group of obese women undergoing fertility treatment.

  2. Variation of DNA Fragmentation Levels During Density Gradient Sperm Selection for Assisted Reproduction Techniques: A Possible New Male Predictive Parameter of Pregnancy?

    PubMed

    Muratori, Monica; Tarozzi, Nicoletta; Cambi, Marta; Boni, Luca; Iorio, Anna Lisa; Passaro, Claudia; Luppino, Benedetta; Nadalini, Marco; Marchiani, Sara; Tamburrino, Lara; Forti, Gianni; Maggi, Mario; Baldi, Elisabetta; Borini, Andrea

    2016-05-01

    Predicting the outcome of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is one main goal of the present research on assisted reproduction. To understand whether density gradient centrifugation (DGC), used to select sperm, can affect sperm DNA integrity and impact pregnancy rate (PR), we prospectively evaluated sperm DNA fragmentation (sDF) by TUNEL/PI, before and after DGC. sDF was studied in a cohort of 90 infertile couples the same day of IVF/ICSI treatment. After DGC, sDF increased in 41 samples (Group A, median sDF value: 29.25% [interquartile range, IQR: 16.01-41.63] in pre- and 60.40% [IQR: 32.92-93.53] in post-DGC) and decreased in 49 (Group B, median sDF value: 18.84% [IQR: 13.70-35.47] in pre- and 8.98% [IQR: 6.24-15.58] in post-DGC). PR was 17.1% and 34.4% in Group A and B, respectively (odds ratio [OR]: 2.58, 95% confidence interval [CI]: 0.95-7.04, P = 0.056). After adjustment for female factor, female and male age and female BMI, the estimated OR increased to 3.12 (95% CI: 1.05-9.27, P = 0.041). According to the subgroup analysis for presence/absence of female factor, heterogeneity in the association between the Group A and B and PR emerged (OR: 4.22, 95% CI: 1.16-15.30 and OR: 1.53, 95% CI: 0.23-10.40, respectively, for couples without, n = 59, and with, n = 31, female factor).This study provides the first evidence that the DGC procedure produces an increase in sDF in about half of the subjects undergoing IVF/ICSI, who then show a much lower probability of pregnancy, raising concerns about the safety of this selection procedure. Evaluation of sDF before and after DGC configures as a possible new prognostic parameter of pregnancy outcome in IVF/ICSI. Alternative sperm selection strategies are recommended for those subjects who undergo the damage after DGC.

  3. Monitoring Cavitation in HIFU as an Aid to Assisting Treatment

    NASA Astrophysics Data System (ADS)

    Hsieh, Chang-yu; Smith, Penny Probert; Kennedy, James; Leslie, Thomas

    2007-05-01

    Rapid hypothermia resulting in tissue necrosis is often associated with bubble activity (normally from cavitation) in HIFU treatment. Indeed in some HIFU protocols, the evidence of cavitation is taken as an indicator of tissue lesions. In this paper we discuss two methods to delineate reliably the region in which cavitation occurs, so that a history of the cavitation events can be provided automatically during treatment. Results are shown on simulated images and from a clinical treatment session.

  4. Endometritis treatment with a PGF2alpha analog does not improve reproductive performance in a large dairy herd in Argentina.

    PubMed

    Mejía, Miguel Eduardo; Lacau-Mengido, Isabel María

    2005-03-15

    In Argentina, most dairy cows with endometritis are treated with prostaglandin (PGF(2alpha) or its analogs) and insemination is withheld until there are no signs of endometritis. The objective of the present study was to evaluate if this method of managing endometritis enhances reproductive performance. Three experiments were conducted over 4 years in a large farm in the west of Buenos Aires province. In Experiment 1, half of the cows diagnosed with endometritis (>1.5-fold difference in diameter of uterine horns, as determined by rectal palpation) received standard endometritis management (treatment with tiaprost, a PGF(2alpha) analog, rectal palpation every 20 days, and withholding of AI until endometritis apparently resolved) and the other half was untreated, with AI at the first estrus after the voluntary waiting period. Untreated cows were inseminated and conceived 20 days earlier than treated cows, and the pregnancy rate by Day 90 postpartum was higher in the untreated group. In Experiment 2, cows with endometritis were divided into four groups according to the severity of symptoms; within each group, cows were allocated to treatment or control, as in Experiment 1. Although first service conception rate decreased as endometritis severity increased, reproductive performance in treated versus control cows was similar to that of Experiment 1 (with no interaction due to degree of endometritis). Re-evaluation of the treated cow (to confirm uterine "normality") may have been responsible for the delay in conception in both experiments. The objective of Experiment 3 was to determine the effects of tiaprost treatment on clinically normal postpartum cows (no evidence of endometritis). Tiaprost treatment reduced the interval from calving to conception in multiparous cows, but it delayed conception and reduced the conception rate in primiparous cows. In conclusion, treatment with tiaprost impaired reproductive performance in primiparous cows (in the absence of

  5. Gonadal status and reproductive function following treatment for Hodgkin's disease in childhood: The Stanford experience

    SciTech Connect

    Ortin, T.T.; Shostak, C.A.; Donaldson, S.S. )

    1990-10-01

    To ascertain the impact of therapy on gonadal function and reproductive outcome among children treated for Hodgkin's disease, we reviewed the experience at Stanford University Medical Center during the years 1965-1986. There were 240 children 15 years of age or younger, 92 girls and 148 boys; with median follow-up of 9 years, maximum follow-up was 26 years. Of this cohort, data on gonadal function were available on 20 boys, 5 of whom were considered prepubescent; they had no clinical evidence of sexual maturation and were less than 13 years of age. Evaluation of the boys included testicular biopsy, semen analyses and the ability to procreate. Serum gonadotropin hormone levels (FSH, LH) were studied in 11 boys who also had semen analyses. Sexual maturation was attained in all boys without the need for androgen replacement. Among the eight boys treated with radiation alone, four were able to father a child (3 following 40-45 Gy pelvic radiation dose, 1 without pelvic radiation) from 3-19 years following treatment. Three others who received 30-44 Gy pelvic radiation were oligospermic when tested at 10 to 15 years post-treatment. Semen analyses in 10 of 12 (83%) boys who had been treated with six cycles of MOPP with or without pelvic radiation revealed absolute azoospermia with no evidence of recovery as along as 11 years of follow-up. Following prolonged azoospermia, 2 of the 12 boys (17%) had recovery of fertility, with normalization of sperm count and/or ability to procreate at 12 and 15 years following treatment. There was no correlation with serum gonadotropin levels and sterility. Data on menstrual history, pregnancy and offspring were available in 86 (92%) of the girls. Seventy-five of the 86 girls (87%) have normal menstrual function. However, none of the females who underwent pelvic radiation without prior oophoropexy has maintained ovarian function.

  6. [Heroin-assisted treatment of opiate addicts--former and current research emphasis].

    PubMed

    Steffen, T; Kaufmann, B; Blättler, R; Dobler-Mikola, A; Gutzwiller, F; Uchtenhagen, A

    1999-01-01

    Heroin-assisted treatment has been examined broadly in Switzerland since 1994 within the context of scientific studies. The goal was to clarify the suitability of this treatment for opiate addicts whom previous therapy had failed to reach. Results of the initial research phase show that the target group could be reached for treatment extending 18 months with a satisfactory retention rate of 69%. The patients could improve their health and social situation during treatment and reduce illegal consumption of narcotics. Studies during the initial years primarily examined the viability of heroin-assisted treatment and its effects on the patients' psychosocial and somatic development. A second study phase ongoing since 1998 pursues the specific importance of medical and psychosocial treatment for patients' health and social development in heroin-assisted treatment. The focal point is the effort to optimise treatment of patients with comorbidity of psychiatric disorders and severe somatic diseases, particularly AIDS. Investigations carried out in Switzerland have been discussed broadly at an international level. Studies on heroin-assisted treatment are also being conducted at present in various countries. In future, co-operation should be further intensified with researchers on an international scale.

  7. Reproductive Medicine in Amphibians.

    PubMed

    Chai, Norin

    2017-02-04

    Reproduction of amphibians includes ovulation, spermiation, fertilization, oviposition, larval stage and development, and metamorphosis. A problem at any stage could lead to reproductive failure. To stimulate reproduction, environmental conditions must be arranged to simulate changes in natural habits. Reproductive life history is well documented in amphibians; a thorough knowledge of this subject will aid the practitioner in diagnosis and treatment. Technologies for artificial reproduction are developing rapidly, and some protocols may be transferable to privately kept or endangered species. Reproductive tract disorders are rarely described; no bacterial or viral diseases are known that specifically target the amphibian reproductive system.

  8. Society for Assisted Reproductive Technology position statement on donor suitability of recipients of smallpox vaccine (vaccinia virus).

    PubMed

    2006-11-01

    Although there is presently no definitive evidence linking vaccinia virus transmission through reproductive cells, SART/ASRM accordingly recommends that ART practitioners consider deferring donors who have recently received smallpox vaccine or contracted symptomatic vaccinia virus infection through close contact with a vaccine recipient (until after the vaccine or infectious scab has spontaneously separated). Good donor practice further suggests that donors who are not in good health, including those with recent complications from smallpox vaccine, should be similarly deferred.

  9. Honeymoon, medical treatment or big business? An analysis of the meanings of the term “reproductive tourism” in German and Israeli public media discourses

    PubMed Central

    2013-01-01

    Background/Introduction Infertile couples that travel to another country for reproductive treatment do not refer to themselves as “reproductive tourists”. They might even be offended by this term. “Tourism” is a metaphor with hidden connotations. We will analyze these connotations in public media discourses on “reproductive tourism” in Israel and Germany. We chose to focus on these two countries since legal, ethical and religious restrictions give couples a similar motivation to travel for reproductive care, while the cultural backgrounds and conceptions of reproduction are different. Results Our research shows that the use of the metaphor “reproductive treatment” and its hidden messages depends on the writers’ intention and the target population. Although the phenomenon of patients travelling for reproductive treatment can fit into the definitions of tourism, the term emphasizes aspects that do not reflect patients’ reality. In both the German and the Israeli public media debate the term “reproductive tourism” is either used to criticize the economic aspects of the phenomenon or to attract patients as potential clients. Conclusions Ethicists should be cautious when borrowing metaphors like “reproductive tourism” from the public debate. Our findings support Penning’s suggestion to use instead an unloaded term like cross-border reproductive care to describe the phenomenon in a more neutral way and to make it explicit whenever criticism is necessary. PMID:23962355

  10. A Computer-Assisted Instruction Course in the Diagnosis and Treatment of Respiratory Diseases.

    ERIC Educational Resources Information Center

    Crocco, John A.; And Others

    1975-01-01

    A computer-assisted simulation of the "chart method" of teaching has been developed and was used to provide instruction in clinical decision-making in the diagnosis and treatment of pulmonary diseases. The course requires a student to reach and defend a diagnosis and to provide appropriate treatment for each of 10 simulated cases.…

  11. Utility of the national embryo morphology data collection by the Society for Assisted Reproductive Technologies (SART): correlation between day-3 morphology grade and live-birth outcome.

    PubMed

    Vernon, Michael; Stern, Judy E; Ball, G David; Wininger, David; Mayer, Jacob; Racowsky, Catherine

    2011-06-30

    Analysis of the "grade" field in the first embryo morphology data collected under the classification system developed by Society for Assisted Reproductive Technology (SART) and reported to the SART Clinic Outcomes Reporting System (SART CORS) database showed that when two embryos of the same grade were transferred on day 3, the live-birth rate declined with decreasing grade (<35 years old: good = 50.4%; fair = 42.2%; poor = 22.0%; ≥ 35 years old: good = 35.1%; fair = 23.4%; poor = 20.0%). These findings provide the first evidence that collecting the "grade" field in the national morphology collection system is valid and can be developed into a standard for use by individual SART programs for quality assurance assessment and for improved embryo selection.

  12. Effects of assisted reproductive technology and of women's quality of life on depressive symptoms in the early postpartum period: a prospective case-control study.

    PubMed

    Monti, Fiorella; Agostini, Francesca; Paterlini, Marcella; Andrei, Federica; De Pascalis, Leonardo; Palomba, Stefano; La Sala, Giovanni Battista

    2015-05-01

    This study explored the influence of both assisted reproductive technology (ART) and reduced quality of life (QoL) during pregnancy on postpartum blues (PPB). Sixty-three sub-fertile patients who conceived through ART and 72 women who naturally conceived were enrolled in this prospective study. At 22nd and 32nd gestational weeks, women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Short-Form 36 (SF-36), to investigate depressive symptoms and QoL, respectively; EPDS was again used at 15 days after birth to assess PPB. At both time points, higher EPDS scores and lower mental well-being scores (SF-36) significantly predicted PPB. The number of previous ART cycles emerged as the strongest predictor, whereas no significant effect was observed for the conceiving method. The results suggest the usefulness of assessing QoL during pregnancy and considering previous ART failures in preventing PPB.

  13. Turbulence Investigation and Reproduction for Assisting Downstream Migrating Juvenile Salmonids, Part I of II, 2001-2002 Final Report.

    SciTech Connect

    Hotchkiss, Rollin H.

    2002-12-01

    Turbulence in gravel bed rivers plays a critical role in most stream processes including contaminant and nutrient transport, aquatic habitat selection, and natural channel design. While most hydraulic designs and fluid models are based on bulk velocity, migrating juvenile salmon experience and react to the temporally varied turbulent fluctuations. Without properly understanding and accounting for the continuous turbulent motions proper fishway design and guidance are impossible. Matching temporally varied flow to fish reactions is the key to guiding juvenile salmonids to safe passageways. While the ideal solution to fish guidance design would be to use specific fluid action-fish reaction mechanisms, such concrete cause and effect relations have not been established. One way to approach the problem of guidance is to hypothesize that in an environment lacking obvious bulk flow cues (like the reservoir environment), turbulent flow conditions similar to those experienced by juvenile salmonids in natural migration corridors will be attractive to juvenile salmonids. Proof of this hypothesis requires three steps: (1) gathering data on turbulence characteristics in natural migration corridors, (2) reproduction of the turbulence parameters in a controlled environment, and (3) testing the reproduced turbulence on actively migrating juvenile salmonids for increased passage efficiencies. The results from the third step have not been finalized, therefore this report will focus on understanding turbulent processes in gravel bed rivers and reproduction of turbulence in controlled environments for use in fish passage technologies. The purposes of this report are to (1) present data collected in natural gravel bed rivers, (2) present a simple method for reproduction of appropriate turbulence levels in a controlled environment, (3) compare these results to those from one prototype surface collector (PSC), and (4) discuss the implications on fish passage design.

  14. Investigation of sewage sludge treatment using air plasma assisted gasification.

    PubMed

    Striūgas, Nerijus; Valinčius, Vitas; Pedišius, Nerijus; Poškas, Robertas; Zakarauskas, Kęstutis

    2017-03-18

    This study presents an experimental investigation of downdraft gasification process coupled with a secondary thermal plasma reactor in order to perform experimental investigations of sewage sludge gasification, and compare process parameters running the system with and without the secondary thermal plasma reactor. The experimental investigation were performed with non-pelletized mixture of dried sewage sludge and wood pellets. To estimate the process performance, the composition of the producer gas, tars, particle matter, producer gas and char yield were measured at the exit of the gasification and plasma reactor. The research revealed the distribution of selected metals and chlorine in the process products and examined a possible formation of hexachlorobenzene. It determined that the plasma assisted processing of gaseous products changes the composition of the tars and the producer gas, mostly by destruction of hydrocarbon species, such as methane, acetylene, ethane or propane. Plasma processing of the producer gas reduces their calorific value but increases the gas yield and the total produced energy amount. The presented technology demonstrated capability both for applying to reduce the accumulation of the sewage sludge and production of substitute gas for drying of sewage sludge and electrical power.

  15. Reproductive tourism as moral pluralism in motion.

    PubMed

    Pennings, G

    2002-12-01

    Reproductive tourism is the travelling by candidate service recipients from one institution, jurisdiction, or country where treatment is not available to another institution, jurisdiction, or country where they can obtain the kind of medically assisted reproduction they desire. The more widespread this phenomenon, the louder the call for international measures to stop these movements. Three possible solutions are discussed: internal moral pluralism, coerced conformity, and international harmonisation. The position is defended that allowing reproductive tourism is a form of tolerance that prevents the frontal clash between the majority who imposes its view and the minority who claim to have a moral right to some medical service. Reproductive tourism is moral pluralism realised by moving across legal borders. As such, this pragmatic solution presupposes legal diversity.

  16. Addiction, Heroin-Assisted Treatment and the Idea of Abstinence: A reply to Henden.

    PubMed

    Uusitalo, Susanne; Broers, Barbara

    2016-11-01

    In our previous article on the question whether heroin addicts are able to give informed consent voluntarily to research on heroin-assisted treatment, we criticized the ongoing bioethical discussion of a flawed conceptualization of heroin addicts' options. As a participant in this discussion, Edmund Henden defends the conceptualization as sufficient for determining whether heroin addicts are able to give informed consent to the research on heroin-assisted treatment voluntarily. This discussion on research on heroin-assisted treatment seems to go astray in several respects. In his reply to our article Henden maintains some of the biases, such as the necessity of abstinence in recovery, that seem to prevail in addiction research on a more general level as well. These biases run the danger of having implausible ethical implications on stakeholders in addiction research and treatment. In our reply to him, we will further clarify and discuss the importance of describing the relevant issues in plausible terms that do justice to the realities of the cases of informed consent in research on heroin-assisted treatment and also raise a wider issue of the ethics of wording as well as of the narrow scope, or 'tunnel vision', in addiction research as currently conducted.

  17. Evaluation of Efficacy of Herbal Intrauterine Infusion Uterofix Liquid in Treatment of Various Reproductive Disorders in Cows: A Field Study

    PubMed Central

    Verma, Satinder; Choudhary, Adarsh; Maini, Shivi; Ravikanth, K.

    2016-01-01

    Objective: To evaluate the efficacy of herbal intrauterine infusion Uterofix liquid in the treatment of various reproductive disorders in cows. Materials and Methods: Based on symptoms of endometritis, anestrous, metritis, and repeat breeders, 28 cows were selected to study the efficacy of herbal intrauterine infusion Uterofix liquid (M/S Ayurvet Limited) in uterine infections study. Group T0 (n = 8) cows served as control group, no treatment was given to this group, Group T1 (n = 5) repeat breeder cows, Group T2 (n = 5) endometritis effected cows, Group T3 (n = 5) anoestrus cows, and Group T4 (n = 5) metritis suffered cows were treated with Uterofix liquid (25 ml as intrauterine infusion once a day for 3–5 days). Total observational period was 60 days. Number of treatments needed, nature of discharge in first posttreatment estrus (physical examination), after treatment number of animal showing heat/estrus out of total treated, and posttreatment conception rate were used as criteria to judge the success or failure of treatment. Results: Results revealed that 18 out of 20 animals (90%) showed signs of heat with clear discharge, recovered completely without causing any irritation, or severe irritation/sloughing of genital mucous membrane after Uterofix liquid treatment. Conclusion: Herbal intrauterine infusion Uterofix liquid significantly treated the uterine infections in cows. SUMMARY Uterine infection is a major problem in reproductive management. A wide variety of genital tract diseases of female domestic animals are known to produce significant losses and responsible for poor fertility. Amongst these highly prevalent are metritis and repeat breeding in high-producing dairy cows which if remains untreated are associated with low conception rate per artificial insemination (AI), extended interval to pregnancy, increased culling, and economic losses. As herbal remedy the Uterofix liquid (Ayurvet Limited, India) was highly efficacious as an intrauterine infusion

  18. Rethinking Informed Consent in Research on Heroin-Assisted Treatment.

    PubMed

    Uusitalo, Susanne; Broers, Barbara

    2015-09-01

    Can heroin addicts give consent to research on trials in which heroin is prescribed to them? Analyses of addicts and informed consent have been objects of debate in several articles. Informed consent requires the agent not only to be competent but also to give consent voluntarily. This has been questioned because of alleged features of heroin addiction. Until recently the discussion has focused on heroin addicts' desires for heroin, whether these are irresistible and thus pose a problem for giving consent. Still, in light of empirical evidence, there seems to be a consensus more or less that the problem is not whether the addicts can resist their desire for heroin. A recent article concentrates specifically on heroin addicts' false assumptions of options and voluntariness. We argue that the prevailing framing of the options in this discussion in terms of heroin and access to it is problematic. The way in which the options are typically laid out suggests an assumption that participation in the research is allegedly based on the addicts' views on using the drug. We argue that this way of presenting the options is, first, a mismatch to the studies carried out and, second, symptomatic of potential misconceptions about heroin addiction and addicts. Furthermore, we also suggest that the account of voluntariness needs to be realistic in order for subjects to be able to give consent voluntarily in actual situations, and for medical research to carry out studies on improving outcomes in addiction treatment in an ethical way.

  19. The Acceptability of Therapist-Assisted, Internet-Delivered Treatment for College Students

    ERIC Educational Resources Information Center

    Travers, M. Fallon; Benton, S. A.

    2014-01-01

    University and college counseling centers struggle with rising service demands without a corresponding increase in resources. Consequently, counseling centers must seek creative ways to not only maintain the status quo, but expand capacity while preserving effectiveness. In other countries, therapist-assisted, Internet-delivered treatment has been…

  20. Evaluating Animal-Assisted Therapy in Group Treatment for Child Sexual Abuse

    ERIC Educational Resources Information Center

    Dietz, Tracy J.; Davis, Diana; Pennings, Jacquelyn

    2012-01-01

    This study evaluates and compares the effectiveness of three group interventions on trauma symptoms for children who have been sexually abused. All of the groups followed the same treatment protocol, with two of them incorporating variations of animal-assisted therapy. A total of 153 children ages 7 to 17 who were in group therapy at a Child…

  1. Medication assisted treatment in the treatment of drug abuse and dependence in HIV/AIDS infected drug users.

    PubMed

    Kresina, Thomas F; Bruce, R Douglas; McCance-Katz, Elinore F

    2009-07-01

    Drug use and HIV/AIDS are global public health issues. The World Health Organization (WHO) estimates that up to 30% of HIV infections are related to drug use and associated behaviors. The intersection, of the twin epidemics of HIV and drug/alcohol use, results in difficult medical management issues for the health care providers and researchers who work in the expanding global HIV prevention and treatment fields. Access to care and treatment, medication adherence to multiple therapeutic regimens, and concomitant drug -drug interactions of prescribed treatments are difficult barriers for drug users to overcome without directed interventions. Injection drug users are frequently disenfranchised from medical care and suffer sigma and discrimination creating additional barriers to care and treatment for their drug abuse and dependence as well as HIV infection. In an increasing number of studies, medication assisted treatment of drug abuse and dependence has been shown to be an important HIV prevention intervention. Controlling the global transmission of HIV will require further investment in evidence-based interventions and programs to enhance access to care and treatment of individuals who abuse illicit drugs and alcohol. In this review, we present the cumulative evidence of the importance of medication assisted treatment in the prevention, care, and treatment of HIV infected individuals who also abuse drugs and alcohol.

  2. Male reproductive proteins and reproductive outcomes.

    PubMed

    Ness, Roberta B; Grainger, David A

    2008-06-01

    Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible for carrying male genes into the next generation. Evolutionary biologists have focused on their capacity to control conception. Immunologists have shown that MRPs cause female genital tract inflammation as preparatory for embryo implantation and placentation. These observations argue that MRPs are critically important to reproductive success. Yet the impact of male reproductive proteins on obstetrical outcomes in women is largely unstudied. Epidemiologic and clinical observations suggest that shorter-duration exposure to MRPs prior to conception may elevate the risk for preeclampsia. A limited literature has also linked sexual behavior to bacterial vaginosis and preterm birth. We offer a clinical opinion that MRPs may have broad implications for successful reproduction, potentially involved in the composition of vaginal microflora, risks of preterm birth and preeclampsia, and success of assisted reproduction.

  3. Comparing Treatment Policies with Assistance from the Structural Nested Mean Model

    PubMed Central

    Lu, Xi; Lynch, Kevin G.; Oslin, David W.; Murphy, Susan

    2015-01-01

    Summary Treatment policies, also known as dynamic treatment regimes, are sequences of decision rules that link the observed patient history with treatment recommendations. Multiple, plausible, treatment policies are frequently constructed by researchers using expert opinion, theories and reviews of the literature. Often these different policies represent competing approaches to managing an illness. Here we develop an “assisted estimator” that can be used to compare the mean outcome of competing treatment policies. The term “assisted” refers to the fact estimators from the Structural Nested Mean Model, a parametric model for the causal effect of treatment at each time point, are used in the process of estimating the mean outcome. This work is motivated by our work on comparing the mean outcome of two competing treatment policies using data from the ExTENd study in alcohol dependence. PMID:26363892

  4. Multiple Pregnancy and Birth: Considering Fertility Treatments

    MedlinePlus

    ... use advanced therapies and the choices of timing, technologies and other key issues should be discussed by ... used advanced fertility treatments are ART (Assisted Reproductive Technology) and COH (Controlled Ovarian Hyperstimulation). ART is defined ...

  5. Impact of childlessness on life and attitudes towards continuation of medically assisted reproduction and/or adoption.

    PubMed

    Petersen, Gitte L; Blenstrup, Lene T; Peterson, Brennan D; Knudsen, Lisbeth B; Schmidt, Lone

    2015-06-01

    Infertility and fertility treatment have the potential to impact and disrupt a couple's overall life. In order to study the associations between the impact of childlessness on one's life, and men and women's attitudes towards fertility treatment continuation and/or adoption, we analysed data from a one-year follow-up questionnaire in a prospective, longitudinal cohort study of consecutive couples initiating fertility treatment in Denmark. The study comprised 302 couples with no children at baseline and no joint children at one-year follow-up. In total, 71.9% of women and 72.5% of men reported that they wished to continue fertility treatment, while 20.2% of women and 19.2% of men reported that they wished to pursue adoption. The attitudes of nearly 8 in 10 couples were congruent towards further fertility treatments, while nearly 7 in 10 couples were congruent in their attitudes to pursuing adoption. Significantly more men who reported a lower impact of childlessness on their daily life wished to continue fertility treatment, compared with those reporting that childlessness had a greater impact on their life. Among women, significantly more were undecided about whether or not to pursue adoption when reporting a greater impact of childlessness on social life, compared with those reporting a lower impact of their childlessness.

  6. HIV treatment and reproductive health in the health system in Burkina Faso: resource allocation and the need for integration.

    PubMed

    Windisch, Ricarda; de Savigny, Don; Onadja, Geneviève; Somda, Antoine; Wyss, Kaspar; Sié, Ali; Kouyaté, Bocar

    2011-11-01

    Organizational changes, increased funding and the demands of HIV antiretroviral (ARV) treatment create particular challenges for governance in the health sector. We assess resource allocation, policy making and integration of the national responses to ARV provision and reproductive health in Burkina Faso, using national and district budgets related to disease burden, policy documents, organizational structures, and coordination and implementation processes. ARV provision represents the concept of a "crisis scenario", in which reforms are pushed due to a perception of urgent need, whereas the national reproductive health programme, which is older and more integrated, represents a "politics-as-usual scenario". Findings show that the early years of the national response to HIV and AIDS were characterized by new institutions with overlapping functions, and failure to integrate with and strengthen existing structures. National and district budget allocations for HIV compared to other interventions were disproportionately high when assessed against burden of disease. Strategic documents for ARV provision were relatively less developed and referred to, compared to those of the Ministry of Health Directorates for HIV and for Family Health and district health planning teams for reproductive health services. Imbalances and new structures potentially trigger important adverse effects which are difficult to remedy and likely to increase due to the dynamics they create. It therefore becomes crucial, from the outset, to integrate HIV/AIDS funding and responses into health systems.

  7. Depression and Anxiety Outcomes Associated with Failed Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

    PubMed Central

    Elshaug, Adam G.; Hemphill, Sheryl A.; Hiller, Janet E.

    2016-01-01

    Objective Our study examined the psychological outcomes associated with failed ART treatment outcomes in men and women. Search Strategy A systematic search for studies published between January 1980 and August 2015 was performed across seven electronic databases. Inclusion Criteria Studies were included if they contained data on psychosocial outcomes taken pre and post ART treatment. Data Extraction and Synthesis A standardised form was used to extract data and was verified by two independent reviewers. Studies were meta-analysed to determine the association of depression and anxiety with ART treatment outcomes. Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies. Main Results Both depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 (95% CI: 0.27, 0.55) for depression and 0.21 (95% CI: 0.13, 0.29) for anxiety. In contrast, depression decreased after a successful treatment, SMD of -0.24 (95% CI: -0.37,-0.11). Both depression and anxiety decreased as time passed from ART procedure. Nonetheless, these remained higher than baseline measures in the group with the failed outcome even six months after the procedure. Studies included in the narrative synthesis also confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure. Conclusion Linking ART failure and psychosocial outcomes may elucidate the experience of treatment subgroups, influence deliberations around recommendations for resource allocation and health policy and guide patient and clinician decision making. PMID:27835654

  8. Heroin-assisted treatment as a response to the public health problem of opiate dependence.

    PubMed

    Fischer, Benedikt; Rehm, Jürgen; Kirst, Maritt; Casas, Miguel; Hall, Wayne; Krausz, Michael; Metrebian, Nicky; Reggers, Jean; Uchtenhagen, Ambros; van den Brink, Wim; van Ree, Jan M

    2002-09-01

    Injection drug use (involving the injection of illicit opiates) poses serious public health problems in many countries. Research has indicated that injection drug users are at higher risk for morbidity in the form of HIV/AIDS and Hepatitis B and C, and drug-related mortality, as well as increased criminal activity. Methadone maintenance treatment is the most prominent form of pharmacotherapy treatment for illicit opiate dependence in several countries, and its application varies internationally with respect to treatment regulations and delivery modes. In order to effectively treat those patients who have previously been resistant to methadone maintenance treatment, several countries have been studying and/or considering heroin-assisted treatment as a complementary form of opiate pharmacotherapy treatment. This paper provides an overview of the prevalence of injection drug use and the opiate dependence problem internationally, the current opiate dependence treatment landscape in several countries, and the status of ongoing or planned heroin-assisted treatment trials in Australia, Canada and certain European countries.

  9. Thyroid diseases and female reproduction.

    PubMed

    Mintziori, G; Anagnostis, P; Toulis, K A; Goulis, D G

    2012-02-01

    Thyroid diseases are very common in women of reproductive age. The aim of this study was to review the current evidence on physiology, pathophysiology, diagnosis and management of women with thyroid disorders that are currently seeking fertility, undergoing assisted reproduction technologies (ART) or being pregnant. Normal thyroid function is essential for normal function of the gonadal axis, thus important in maintaining normal reproductive capacity. On the contrary, any type of thyroid dysfunction may reduce the likelihood of pregnancy; the latter can be restored to normal after appropriate treatment. Over eight million children have been born as a result of assisted reproduction techniques (ART) since 1978. As these procedures are becoming more common in clinical practice, the exact impact of thyroid status on reproductive outcomes as well as that of drugs used in ART on thyroid function has to be fully elucidated. Maternal thyroid function is crucial, especially during the first weeks of gestation, for offspring's wellness and brain development. On the other hand, normal physiological mechanisms during gestation can have a major impact on maternal thyroid function. As human chorionic gonadotropin (hCG) has a thyroid stimulating hormone (TSH)-like effect, high hCG concentrations are associated with thyroid stimulation, both functionally (lower serum TSH concentrations) and anatomically (increased thyroid volume). Although the association between maternal hypothyroidism and increased perinatal morbidity has been described for over a century, more recently, even the presence of anti-thyroid antibodies has been associated with adverse pregnancy outcomes, such as recurrent abortions and placental abruption. This is of major clinical significance, as anti-thyroid antibodies are surprisingly prevalent in pregnancy, especially during the first two trimesters.

  10. Comparison Between Balloon-Assisted and Stent-Assisted Technique for Treatment of Unruptured Internal Carotid Artery Aneurysms

    PubMed Central

    Park, Keun Young; Kim, Dong Joon

    2016-01-01

    Purpose To compare clinical and angiographic outcomes between balloon-assisted (BAC) and stent-assisted coiling for internal carotid artery unruptured aneurysms (ICA-UA). Materials and Methods A total of 227 ICA-UA in 190 patients were treated with BAC (120 patients, 141 ICA-UA) or SAC (70 patients, 86 ICA-UA. We compared characteristics of patients and ICA-UA, and clinical and angiographic outcomes between groups. Results Aneurysm size and neck diameter were greater for SAC than in BAC, but aneurysm volume and coil packing density were not different between groups. Immediate angiographic occlusion grade was better for BAC than for SAC. Periprocedural thromboembolic events were more frequent during SAC (11.6%) than BAC (2.4%) per aneurysm, but hemorrhagic events were the opposite (2.4% for BAC and none for SAC per aneurysm) (p < 0.05). At discharge, treatment-related morbi-mortality rates were 1.6% for BAC and 1.4% per patient for SAC. At clinical follow-up (BAC, 118 patients [98.3%] for a mean of 48.4 months; SAC, 69 patients [98.6%], for a mean of 37.4 months), 1 additional treatment-related infarction occurred during SAC, resulting in a modified Rankin scale score of 4. Thus, overall treatment-related morbi-mortality rates were 1.7% in BAC and 2.9% in SAC. At imaging follow-up (BAC, 135 aneurysms [95.7%] for 28.3 months; SAC, 81 aneurysms [94.1%] for 23.9 months), BAC and SAC showed stable or improved occlusion in 94.1% and 95.0%, minor recurrence in 4.4% and 2.5%, and major recurrence in 1.5% and 2.5%, respectively. Conclusion Both BAC and SAC were safe and effective techniques for ICA-UA. There were no differences in morbi-mortality and recurrence rates between groups. PMID:27621946

  11. A Computer-Assisted Interactive Treatment Planning System for Mental Health

    PubMed Central

    Hammond, Kenric W.; Munnecke, Thomas H.

    1981-01-01

    The authors describe a MUMPS based system capable of assisting clinicians in developing written psychiatric treatment plans in inpatient and outpatient services in a VA hospital. This interactive system relies upon a series of hierarchically arranged topical frames addressing a broad range of psychosocial and medical problems, treatment goals, and methods. It speeds multi-disciplinary treatment planning, employs objective language, serves an educational purpose, and structures hierarchically organized entry of detailed information into the data base. Significantly, this system is compatible with other MUMPS applications developed in the VA. Future modifications, expansions, and export of methodology can be accomplished without extensive reworking of existing software or data storage design.

  12. Is there a need for recombinant human luteinizing hormone (lutropin alfa) supplementation in ovarian stimulation for assisted reproduction?

    PubMed

    Nawroth, Frank; Ludwig, Michael

    2006-05-01

    Luteinizing hormone is now available as the recombinant product, lutropin alfa for the treatment of female infertility. It is necessary in the natural process of follicular growth and maturation. It is not yet clear which patients really benefit from the addition of this medication to conventional gonadotropin stimulation procedures in infertility treatment. Certainly, it has a proven benefit in patients suffering from hypogonadotropic hypogonadism (WHO I). Others may be older patients, patients with a profound gonadotropin suppression stimulated in long gonadotropin-releasing hormone agonist protocols, or patients with poor ovarian response to conventional stimulation strategies. The available data are reviewed herein.

  13. Minimally Invasive Procedures - Direct and Video-Assisted Forms in the Treatment of Heart Diseases

    PubMed Central

    Castro, Josué Viana; Melo, Emanuel Carvalho; Silva, Juliana Fernandes; Rebouças, Leonardo Lemos; Corrêa, Larissa Chagas; Germano, Amanda de Queiroz; Machado, João José Aquino

    2014-01-01

    Background Minimally invasive cardiovascular procedures have been progressively used in heart surgery. Objective To describe the techniques and immediate results of minimally invasive procedures in 5 years. Methods Prospective and descriptive study in which 102 patients were submitted to minimally invasive procedures in direct and video-assisted forms. Clinical and surgical variables were evaluated as well as the in hospital follow-up of the patients. Results Fourteen patients were operated through the direct form and 88 through the video-assisted form. Between minimally invasive procedures in direct form, 13 had aortic valve disease. Between minimally invasive procedures in video-assisted forms, 43 had mitral valve disease, 41 atrial septal defect and four tumors. In relation to mitral valve disease, we replaced 26 and reconstructed 17 valves. Aortic clamp, extracorporeal and procedure times were, respectively, 91,6 ± 21,8, 112,7 ± 27,9 e 247,1 ± 20,3 minutes in minimally invasive procedures in direct form. Between minimally invasive procedures in video-assisted forms, 71,6 ± 29, 99,7 ± 32,6 e 226,1 ± 42,7 minutes. Considering intensive care and hospitalization times, these were 41,1 ± 14,7 hours and 4,6 ± 2 days in minimally invasive procedures in direct and 36,8 ± 16,3 hours and 4,3 ± 1,9 days in minimally invasive procedures in video-assisted forms procedures. Conclusion Minimally invasive procedures were used in two forms - direct and video-assisted - with safety in the surgical treatment of video-assisted, atrial septal defect and tumors of the heart. These procedures seem to result in longer surgical variables. However, hospital recuperation was faster, independent of the access or pathology. PMID:24553983

  14. Factors Associated with Monozygosity in Assisted Reproductive Technology (ART) Pregnancies And Risk of Recurrence Using Linked Cycles

    PubMed Central

    Luke, Barbara; Brown, Morton B.; Wantman, Ethan; Stern, Judy E.

    2014-01-01

    Objective To evaluate factors associated with monozygosity (number of fetal heartbeats on early ultrasound greater than number of embryos transferred) and the risk of recurrence in subsequent pregnancies using a national ART database Design Historical cohort study Setting Clinic-based data Patients 197,327 pregnancies (including 2,824 with evidence of monozygosity) from cycles reported to SART CORS between 2004 and 2010. Adjusted odds ratios and their 95% confidence intervals were computed from logistic regression models. Interventions None Main Outcome Measures Evidence of monozygosity. Results In the univariate analysis, the risk of MZ was increased with ovulation disorders, donor oocytes, GnRHA suppression, assisted hatching (AZH), and day 5–6 transfer, and decreased with higher FSH doses (≥3,000 IU). In the multivariate analysis, the risk of MZ was increased with GnRHA suppression, AZH, and decreased with ICSI and higher FSH dose. The interaction showed that although MZ was more likely with day 5–6 embryos, AZH had a minimal nonsignificant effect, whereas in day 2–3 embryos, AZH had a substantial significant effect. Only one woman had a recurrence of monozygosity in a subsequent ART pregnancy, which is consistent with randomness. Conclusions The risk of MZ was higher with fresh day 5–6 embryos, donor oocytes, GnRHA suppression, lower FSH doses, and AZH (particularly with day 2–3 embryos). PMID:24388206

  15. Impact of Breast Cancer Treatments on Gonadal Function and Reproductive Health

    DTIC Science & Technology

    1999-10-01

    cardiovascular disease , as well as premature osteoporosis. Further, numerous epidemiological studies support the benefits of supplemental estrogen therapy in the postmenopause as an effective means of reducing mortality from both cardiovascular disease and osteoporotic fractures. There is uncertainty about how all of these factors play out in breast cancer survivors who have experienced premenopausal disease. Therefore, the primary focus of this cross-sectional study is to examine gonadal function and reproductive health comprehensively in long-term

  16. Inhibin activity in male rat reproductive organs during treatment with dihydrotestosterone

    SciTech Connect

    Gladkova, A.I.

    1986-09-01

    The effect of dihydrotestosterone (DHT) on the inhibin level in the male reproductive system is studied. Hormones were determined in the peripheral blood of the donor rats by radioimmunoassay. Inhibin activity in the male rats is shown. DHT caused a very small increase in inhibin activity in the testis. Further study of relations between androgens and inhibin at peripheral and central levels will facilitate fertility control.

  17. Retention in medication-assisted treatment for opiate dependence: A systematic review.

    PubMed

    Timko, Christine; Schultz, Nicole R; Cucciare, Michael A; Vittorio, Lisa; Garrison-Diehn, Christina

    2016-01-01

    Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010-2014) found wide variability in retention rates (i.e., 19%-94% at 3-month, 46%-92% at 4-month, 3%-88% at 6-month, and 37%-91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified.

  18. Magnetic activated cell sorting: an effective method for reduction of sperm DNA fragmentation in varicocele men prior to assisted reproductive techniques.

    PubMed

    Degheidy, T; Abdelfattah, H; Seif, A; Albuz, F K; Gazi, S; Abbas, S

    2015-10-01

    Semen parameters of varicocele men have been usually suspected to exhibit higher levels of abnormalities including DNA fragmentation, reactive oxygen species (ROS) and apoptotic markers. Negative correlation between increased level of DNA fragmentation and assisted reproductive techniques (ART) outcome has been studied by several authors. In the current study, we aim to evaluate the possible value of magnetic activated cell sorting (MACs) technology in reduction of DNA fragmentation in infertile varicocele patients prior to ART. Semen samples, collected from 36 varicocele patients, were prepared by density gradient centrifugation (DGC). Every sample was subsequently divided into two aliquots. One aliquot was kept untouched as pre-MACs control while the other aliquot was subjected to MACs technique, for depletion of apoptotic spermatozoa, and serves as post-MACs test. Sperm count, motility and DNA fragmentations were evaluated for both control and test samples. Post-MACs samples showed no deleterious reduction in total sperm motility (80.64 ± 6.97%) compared with control samples (80.97 ± 7.74%) while sperm DNA fragmentations were significantly reduced in post-MACs samples (9.61 ± 5.62%) compared with pre-MACs controls (12.43 ± 6.29%) (P < 0.05). It can be concluded that MACs technique is a simple, noninvasive, technique that can efficiently reduce DNA fragmentation in infertile varicocele patients prior to ART.

  19. Health and development of children born after assisted reproductive technology and sub-fertility compared to naturally conceived children: data from a national study.

    PubMed

    Sutcliffe, Alastair G; Melhuish, Edward; Barnes, Jacqueline; Gardiner, Julian

    2014-02-17

    In a non-matched case-control study using data from two large national cohort studies, we investigated whether indicators of child health and development up to 7 years of age differ between children conceived using assisted reproductive technology (ART), children born after sub-fertility (more than 24 months of trying for conception) and other children. Information on ART use/sub-fertility was available for 23,649 children. There were 227 cases (children conceived through ART) and two control groups: 783 children born to sub-fertile couples, and 22,639 children born to couples with no fertility issues. In models adjusted for social and demographic factors there were significant differences between groups in rate of hospital admissions before the children were 9 months old (P=0.029), with the ART group showing higher rates of hospital admission than the no fertility issues control group, the sub-fertile control group being intermediate between the two. Children born after ART had comparable health and development beyond 9 months of age to their naturally conceived peers. This applied to the whole sample and to a sub-sample of children from deprived neighborhoods.

  20. Are assisted reproduction technologies associated with categorical or dimensional aspects of psychopathology in childhood, adolescence or early adulthood? Results from a Danish prospective nationwide cohort study.

    PubMed

    Klausen, T; Juul Hansen, K; Munk-Jørgensen, P; Mohr-Jensen, C

    2017-01-24

    An increasing number of children are conceived using assisted reproduction technologies (ART), but little is known about the long-term risk in terms of mental health outcomes. All twin and singleton children conceived via ART and born in 1995 were sampled from the Danish in vitro fertilization registry and matched to four spontaneously conceived (SC) children. The children were followed-up at the age of 3, 7, 14 and 18 years in the Danish Psychiatric Central Research Registry, to estimate the prevalence of all possible psychiatric diagnoses; dimensional aspects of psychopathology were assessed at the age of 14 years, using the Child Behavior Checklist (CBCL). The study included 858 ART children and 3436 SC children. ART and SC children were not clinically distinguishable on either the categorical measures of psychopathology at the age of 3, 7, 14 and 18 years, or on CBCL scale scores at the age of 14 years. The findings remained nonsignificant after controlling for sample differences. This large, prospective, nationwide cohort study provides evidence to support that ART exposure does not increase the risk of adverse mental health outcomes considered as a whole, while power was limited to discard an effect of ART on specific mental health disorders.

  1. A healthy delivery of twins by assisted reproduction followed by preimplantation genetic screening in a woman with X-linked dominant incontinentia pigmenti

    PubMed Central

    Kim, Myung Joo; Lyu, Sang Woo; Seok, Hyun Ha; Park, Ji Eun

    2014-01-01

    The purpose of this study is to report a successful twin pregnancy and delivery in a female patient with X-linked dominant incontinentia pigmenti (IP) who underwent assisted reproductive technology followed by preimplantation genetic screening (PGS). A 29-year-old female with IP had a previous history of recurrent spontaneous abortion. A molecular analysis revealed the patient had a de novo mutation, 1308_1309insCCCCTTG(p.Ala438ProfsTer26), in the inhibitor of the kappa B kinase gamma gene located in the Xq28 region. IVF/ICSI and PGS was performed, in which male embryos were sexed using array-based comparative genomic hybridization (aCGH). After IVF/ICSI and PGS using aCGH on seven embryos, two euploid male blastocysts were transferred with a 50% probability of a viable male pregnancy. The dizygotic twin pregnancy was confirmed and the amniocentesis results of each twin were normal with regard to the mutation found in the mother. The patient delivered healthy twin babies during the 37th week of gestation. This case shows the beneficial role of PGS in achieving a successful pregnancy through euploid male embryo gender selection in a woman with X-linked dominant IP with a history of multiple male miscarriages. PMID:25599040

  2. Social nesting: changes in social network and support across the transition to parenthood in couples that conceived spontaneously or through assisted reproductive technologies.

    PubMed

    Gameiro, Sofia; Boivin, Jacky; Canavarro, Maria Cristina; Moura-Ramos, Mariana; Soares, Isabel

    2010-04-01

    Research showed that following the birth of a first child, parents increase contact with family members and diminish contact with friends, however, these changes may differ when conception is achieved through assisted reproductive technologies (ART). Based on the convoy model (Kahn & Antonucci, 1980) perspective of close relationships, we examined changes across the transition to parenthood in the social networks and support of men and women that conceived spontaneously or through ART. Thirty one women and 22 men (22 couples) that conceived through ART and 28 women and 24 men (24 couples) with a spontaneous conception provided data on social network and support from nuclear family, extended family, and friends twice: at 24-weeks pregnancy and 4-months postpartum. Results demonstrated that, regardless of method of conception, during the transition to parenthood new parents showed a strong nesting movement towards their nuclear family, perceiving increasing levels of nuclear family support across time. Extended family seemed to have only a secondary role on the social nesting movement and a withdrawal from friends was also observed. Considering the primary role nuclear family members seem to have on providing effective support to child-rearing, a greater emphasis on the importance of parents' relationship with their own parents and siblings could be made and social and working policies that prevent the displacement of families geographically also should be considered.

  3. Can assisted reproductive technologies help to offset population ageing? An assessment of the demographic and economic impact of ART in Denmark and UK.

    PubMed

    Hoorens, S; Gallo, F; Cave, J A K; Grant, J C

    2007-09-01

    Governments worldwide are searching for ways to cope with ageing populations as the demographic shift towards fewer and later births takes hold. The potential contribution of assisted reproductive technologies (ART) to increasing fertility rates has not yet been explored. This paper describes a preliminary study into the impact ART policies might have on population ageing. A deterministic model is developed to quantify the effects of ART policies on total fertility rate (TFR), and tested using data from the UK and Denmark. The population structure for 2050 is modelled to translate fertility rates into time-dependent population dynamics, and the costs of potential ART policies are investigated. If access to ART in the UK were increased to the level of Denmark, the TFR would increase by 0.04, from 1.64 to 1.68. The cumulative effect on the population structure would be a 1.7% decrease in old-age dependency ratio in 2050. Although the empirical models do not include behavioural components, the results demonstrate that ART does have potential to contribute to TFR and influence population structure, and that the direct costs associated with adopting ART as a population policy are comparable with those of existing policies commonly used by governments to influence fertility.

  4. Flow behavior and plasticity of Ti-6Al-4V under different electrically assisted treatments

    NASA Astrophysics Data System (ADS)

    Jiang, Tianhao; Peng, Linfa; Yi, Peiyun; Lai, Xinmin

    2016-12-01

    Both electrically assisted tension (EAT) and electrically assisted pre-treatment tension (EAPT) were conducted to compare different effects on improving deformation resistance and ductility of Ti-6Al-4V. It is found EAPT obviously enhanced the ductility of Ti-6Al-4V compared with that obtained in EAT. In order to decouple the thermal effect from electro-plastic effect, thermally assisted tension (TAT) as well as thermally assisted pre-treatment tension (TAPT) were also conducted. The result indicates deformation mechanism of alpha phase with h.c.p crystal structure in Ti-6Al-4V was insensitive to electric current when current duty is less than 20%. However, the elevated temperature alone is insufficient to account for additional stress drop in the initial yielding stress observed in EAT and EAPT when current duty is higher than 20%. According to XRD investigation on specimens treated in original state, TAPT and EAPT, it is found electric current accelerates the annihilation of alpha phase and formation of beta phase in Ti-6Al-4V more effectively than the rising temperature does and such microstructure evolution also throws light on the improvement of flow stress and ductility observed in EAPT both experimentally and theoretically.

  5. A Mix-up During Assisted Reproductive Technique: What is in the Best Interest of the New-Born?

    PubMed

    Frati, Paola; Zaami, Simona; La Russa, Raffaele; Pinchi, Enrica; Busardò, Francesco P

    2016-01-01

    A woman, after undergoing fertility treatment in hospital in Rome, became pregnant but three months later she was informed that she was carrying he twins of another couple. The error had gone unnoticed until the mother had a genetic test revealing that neither she nor her husband were the genetic parents. In December 2013 an embryo exchange took place, because embryos belonging to one couple, who had undergone a treatment of homologous fertilization, were erroneously implanted in another woman's uterus. This other couple had undertaken the same kind of treatment. The genetic parents urgently appealed to stop the new-born registration practices and to give the newborn twins to their genetic parents. On August 8(th), 2014, the Civil Court of Rome issued a judgement, which rejected the appeal, stating that the uterine mother and her husband must be considered the legal parents of the twins. In the present paper, the Authors will explore the grounds of this judgment, moreover, taking into account this serious adverse event, which raises numerous issues from a human, ethical and legal point of view, several considerations will be made.

  6. Medication assisted treatment of drug abuse and dependence: global availability and utilization.

    PubMed

    Kresina, Thomas F

    2007-01-01

    Clinical trials and clinical studies, using patented drugs and drugs off patent, provide data that impact the best treatment practices for substance abuse and dependence. In the United States, medications have been approved for use in the treatment of both alcohol and opioid dependence. Medications are used in the detoxification from drug abuse and dependence in the symptomatic relief of withdrawal. For long term treatment or medical maintenance treatment, medications eliminate the physiological effects of drug use by blocking drug-receptor binding in the brain. Therefore, patented drugs showing interactions with neurotransmitters in the brain, are attractive candidates for treatment efficacy trials. An effective long term treatment paradigm for reducing drug dependence is the combinatorial use of medications that block the effects of drug use with behavior change counseling and psychotherapy. Medications used for the long term treatment of opioid dependence are methadone, buprenorphine, and naltrexone. Pharmacotherapies used in the treatment of alcohol dependence include acamprosate, antabuse and naltrexone. A reliable indicator for successful treatment of drug dependence is time in treatment. Patients remain in long term treatment when they perceive that their health care environment is supportive and non-stigmatizing and with a good patient-provider relationship where their needs are identified and met. Additional medications are needed for individual comprehensive substance abuse treatment plans, particularly for individuals who abuse stimulants. Patented drugs remain an important source of candidate pharmacotherapies comprising medication assistant treatment, part of a comprehensive treatment plan for drug dependence that addresses the medical, social, and psychological needs of the patient. Adapting this drug treatment paradigm globally requires identifying and testing new drug candidates while building and changing programs to patient centered treatment

  7. Fertility treatment and reproductive health of male offspring: a study of 1,925 young men from the general population.

    PubMed

    Jensen, Tina Kold; Jørgensen, Niels; Asklund, Camilla; Carlsen, Elisabeth; Holm, Mette; Skakkebaek, Niels E

    2007-03-01

    Little is known the about the reproductive health of offspring after fertility treatment. In 2001-2005, the authors approached young Danish men attending a compulsory physical examination to determine their fitness for military service. A total of 1,925 men volunteered, delivered a semen sample, had a physical examination performed and a blood sample drawn, and responded to a questionnaire. Their mothers were questioned about whether they had received fertility treatment in order to conceive their sons. Forty-seven mothers reported having received fertility treatment to conceive the index subject. After control for confounders, men whose mothers had received fertility treatment to conceive them had a 46% lower sperm concentration (95% confidence interval (CI): -63, -20) and a 45% lower total sperm count (95% CI: -64, -16). They had a smaller testis size (-0.9 ml, 95% CI: -2.2, 0.4), fewer motile sperm (-4.0%, 95% CI: -8.0, -0.1), and fewer morphologically normal spermatozoa (-2.0%, 95% CI: -4.1, 0.0). They also had a lower serum testosterone level and free androgen index (results not statistically significant). These findings should be viewed in light of the increasing use of fertility treatments. Although the cause of these findings is unknown, they raise concern about possible late effects of fertility treatment. Larger-scale studies of children born after fertility treatment should be performed.

  8. 'The bloke can be a bit hazy about what's going on': men and cross-border reproductive treatment.

    PubMed

    Hudson, Nicky; Culley, Lorraine

    2013-09-01

    While social science research has begun to demonstrate the significant impact of infertility and involuntary childlessness for men, far fewer studies have specifically explored the male experience of, or men's involvement in, infertility treatment-seeking and there are few published studies which specifically describe men's experiences with cross-border reproduction. This paper presents data from the first UK study of transnational treatment-seeking and specifically explores men's involvement in this process. Data from interviews with 10 men and 34 women who were seeking treatment abroad are organized according to three themes: 'going along with it'; 'being a rock'; and 'doing their bit'. The paper argues that gender is an important aspect of the cross-border treatment experience and that both traditional and emergent gender identities are expressed in the process of treatment-seeking. Healthcare providers need to actively explore men's perspectives of the treatment process in all locations, to improve quality of care by reducing men's feelings of marginalization and enhancing their experience of treatment, especially but not exclusively, around the issue of semen collection.

  9. Adopting evidence-based medically assisted treatments in substance abuse treatment organizations: roles of leadership socialization and funding streams.

    PubMed

    Blum, Terry C; Davis, Carolyn D; Roman, Paul M

    2014-01-01

    This paper examines the organizational adoption of medically assisted treatments (MAT) for substance use disorders (SUDs) in a representative sample of 555 US for-profit and not-for-profit treatment centers. The study examines organizational adoption of these treatments in an institutionally contested environment that traditionally has valued behavioral treatment, using sociological and resource dependence frameworks. The findings indicate that socialization of leadership, measured by formal clinical education, is related to the adoption of MAT. Funding patterns also affect innovation adoption, with greater adoption associated with higher proportions of earned income from third party fees for services, and less adoption associated with funding from criminal justice sources. These findings may generalize to other social mission-oriented organizations where innovation adoption may be linked to private and public benefit values inherent in the type of socialization of leadership and different patterns of funding support.

  10. Effect of acoustically assisted treatments on vitamins, antioxidant activity, organic acids and drying kinetics of pineapple.

    PubMed

    Rodríguez, Óscar; Gomes, Wesley; Rodrigues, Sueli; Fernandes, Fabiano A N

    2017-03-01

    The effects of the application of an acoustically assisted treatment on the vitamins (C, B1, B2, B3, and B5), the antioxidant activity (DPPH, FRAP), the polyphenol and flavonoid contents, the organic acid contents (citric and malic) and drying kinetics of pineapple (Ananas comosus var. Perola) have been studied. Treatments were carried out using two different soaking media: distilled water and pineapple juice at 30°C during 10, 20 and 30min without and with acoustic assistance (23.2W/L). After treatment, samples were dried at 60°C and 0.5m/s during 8h. The quality parameters were determined in untreated, treated, and treated-dried samples. The acoustic assistance promoted an increment of vitamins B1, B2, B3 and B5, total flavonoid and malic acid contents, and a reduction of vitamin C, total polyphenol content, antioxidant activity and citric acid content in treated samples. However, in all treated-dried samples the final content of those quality parameters was higher than the observed in the untreated dried sample.

  11. Successful treatment of a continuous flow left ventricular assist device thrombosis with eptifibatide.

    PubMed

    Jennings, Douglas L; Cabrera, Rafael; Wang, Dee Dee; Tita, Cristina

    2012-01-01

    Left ventricular assist device thrombosis is a rare but potentially lethal complication of mechanical circulatory support. Here, we present a case of successful treatment of a suspected HeartMate II thrombosis with the glycoprotein IIb/IIIa inhibitor, eptifibatide. The patient presented with signs and symptoms of heart failure, along with acute kidney injury and hemolytic anemia that did not respond to diuresis, inotrope support, or anticoagulation. Treatment with eptifibatide resulted in marked clinical and hemodynamic improvement within 24 hrs. The patient was transitioned to clopidogrel and discharged without further incident. Eptifibatide may represent a potential therapeutic option for patients with device thrombosis.

  12. Stent-Assisted Endovascular Treatment of Anterior Communicating Artery Aneurysms – Literature Review

    PubMed Central

    Kocur, Damian; Ślusarczyk, Wojciech; Przybyłko, Nikodem; Bażowski, Piotr; Właszczuk, Adam; Kwiek, Stanisław

    2016-01-01

    Summary The anterior cerebral artery is a common location of intracranial aneurysms. The standard coil embolization technique is limited by its inability to occlude wide-neck aneurysms. Stent deployment across the aneurysm neck supports the coil mass inside the aneurysmal sac, and furthermore, has an effect on local hemodynamic and biologic changes. In this article, various management strategies and techniques as well as angiographic outcomes and complications related to stent-assisted endovascular treatment of anterior communicating artery aneurysms are presented. This treatment method is safe and associated with low morbidity and mortality rates. PMID:27559426

  13. Patients Undergoing Substance Abuse Treatment and Receiving Financial Assistance for a Physical Disability Respond Well to Contingency Management Treatment.

    PubMed

    Burch, Ashley E; Morasco, Benjamin J; Petry, Nancy M

    2015-11-01

    Physical illness and disability are common in individuals with substance use disorders, but little is known about the impact of physical disability status on substance use treatment outcomes. This study examined the main and interactive effects of physical disability payment status on substance use treatment. Participants (N = 1,013) were enrolled in one of six prior randomized clinical trials comparing contingency management (CM) to standard care; 79 (7.8%) participants reported receiving disability payments, CM improved all three primary substance use outcomes: treatment retention, percent negative samples and longest duration of abstinence. There was no significant main effect of physical disability payment status on treatment outcomes; however, a significant treatment condition by physical disability status interaction effect emerged in terms of retention in treatment and duration of abstinence achieved. Patients who were receiving physical disability payments responded particularly well to CM, and their time in treatment and durations of drug and alcohol abstinence increased even more markedly with CM than did that of their counterparts who were not receiving physical disability assistance. These findings suggest an objectively defined cohort of patients receiving substance use treatment who respond particularly well to CM.

  14. Associations between paternal urinary phthalate metabolite concentrations and reproductive outcomes among couples seeking fertility treatment

    PubMed Central

    Dodge, LE; Williams, PL; Williams, MA; Missmer, SA; Souter, I; Calafat, AM; Hauser, R

    2015-01-01

    INTRODUCTION Limited evidence suggests that male exposure to ubiquitous environmental phthalates may result in poor reproductive outcomes among female partners. METHODS This analysis included male-female couples undergoing in vitro fertilization (IVF) and/or intrauterine insemination (IUI). We evaluated associations between the geometric mean of paternal specific gravity-adjusted urinary phthalate concentrations prior to the female partners’ cycle and fertilization, embryo quality, implantation, and live birth using generalized linear mixed models. RESULTS Two-hundred eighteen couples underwent 211 IVF and 195 IUI cycles. Trends were observed between paternal urinary mono-3-carboxypropyl phthalate (MCPP; P=0.01) and mono(carboxyoctyl) phthalate (MCOP; P=0.01) and decreased odds of implantation. MCPP and MCOP were also associated with decreased odds of live birth following IVF (P=0.01 and P=0.04, respectively), and monobutyl phthalate above the first quartile was significantly associated with decreased odds of live birth following IUI (P=0.04). However, most urinary phthalate metabolites were not associated with these reproductive outcomes. CONCLUSION Selected phthalates were associated with decreased odds of implantation and live birth. PMID:26456810

  15. Reproductive and immune effects of chronic corticosterone treatment in male White’s treefrogs, Litoria caerulea

    PubMed Central

    Kaiser, Kristine; Devito, Julia; Jones, Caitlin G.; Marentes, Adam; Perez, Rachel; Umeh, Lisa; Weickum, Regina M.; McGovern, Kathryn E.; Wilson, Emma H.; Saltzman, Wendy

    2015-01-01

    Amphibian populations are declining globally. The potential contribution of glucocorticoid hormones to these declines has received little attention, but chronic elevation of glucocorticoids has been linked to a suite of negative outcomes across vertebrate taxa. Recently, chronic environmental stress has been associated with precipitous declines in sperm count and sperm viability in White’s treefrogs (Litoria caerulea), but the mechanism remains unknown. In order to determine whether corticosterone is responsible for suppressing reproductive and immune function in this species, we elevated circulating concentrations of corticosterone in 10 male captive-bred frogs via transdermal application for 7 days. We compared sperm count, sperm viability, splenic cell count and circulating leucocyte counts in corticosterone-treated frogs with those in untreated control frogs. Chronic application of exogenous corticosterone led to supraphysiological circulating concentrations of corticosterone, but had no effect on sperm count or viability. However, corticosterone-treated frogs demonstrated a significant decrease in circulating eosinophils, which are immune cells implicated in fighting a variety of pathogens, including extracellular parasites. These findings suggest that although chronic elevation of circulating corticosterone is not necessarily associated with reproductive suppression in this species, it may cause immunosuppression. Thus, chronic glucocorticoid elevations in amphibians might enhance susceptibility to infection with pathogens and parasites, and their potential contributions to global population declines warrant further study. PMID:27293707

  16. Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger)

    PubMed Central

    de Oliveira, Sofia Andrade; Calsavara, Vinícius Fernando; Cortés, Gemma Castillón

    2016-01-01

    Final oocyte maturation with Human Chorionic Gonadotropin (hCG) and ovarian stimulation with Follicle Stimulation Hormone (FSH) combined with Gonadotrophin-releasing Hormone (GnRH) antagonist to block Luteinizing hormone (LH) surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). However, GnRH agonist has been replacing the use of hCG in certain situations, especially in patients at risk of Ovarian Hyperstimulation Syndrome (OHSS). Some studies have also shown advantages in the combined use of GnRH agonist concurrently with hCG in inducing final oocyte maturation, a treatment known as "Dual Trigger". In theory, this method combines the advantages of both induction regimens, and it has brought promising results. The objective of this study is to compare Dual Trigger with the use of hCG alone or the use of GnRH agonist alone. A systematic review of articles on Dual Trigger and a retrospective cohort study comparing the three methods of induction of final oocyte maturation have been conducted. It has been found that Dual Triggering for poor responder patients had a statistically significant increase in the number of retrieved oocytes, mature oocytes, and fertilized embryos in the positive beta hCG rate, implantation rate, and newborn/transferred embryo (TE) rate. PMID:28050961

  17. Final Oocyte Maturation in Assisted Reproduction with Human Chorionic Gonadotropin and Gonadotropin-releasing Hormone agonist (Dual Trigger).

    PubMed

    Oliveira, Sofia Andrade de; Calsavara, Vinícius Fernando; Cortés, Gemma Castillón

    2016-12-01

    Final oocyte maturation with Human Chorionic Gonadotropin (hCG) and ovarian stimulation with Follicle Stimulation Hormone (FSH) combined with Gonadotrophin-releasing Hormone (GnRH) antagonist to block Luteinizing hormone (LH) surge is a standard procedure of in vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI). However, GnRH agonist has been replacing the use of hCG in certain situations, especially in patients at risk of Ovarian Hyperstimulation Syndrome (OHSS). Some studies have also shown advantages in the combined use of GnRH agonist concurrently with hCG in inducing final oocyte maturation, a treatment known as "Dual Trigger". In theory, this method combines the advantages of both induction regimens, and it has brought promising results. The objective of this study is to compare Dual Trigger with the use of hCG alone or the use of GnRH agonist alone. A systematic review of articles on Dual Trigger and a retrospective cohort study comparing the three methods of induction of final oocyte maturation have been conducted. It has been found that Dual Triggering for poor responder patients had a statistically significant increase in the number of retrieved oocytes, mature oocytes, and fertilized embryos in the positive beta hCG rate, implantation rate, and newborn/transferred embryo (TE) rate.

  18. Implication of gender differences in heroin-assisted treatment: results from the German randomized controlled trial.

    PubMed

    Eiroá-Orosa, Francisco José; Verthein, Uwe; Kuhn, Silke; Lindemann, Christina; Karow, Anne; Haasen, Christian; Reimer, Jens

    2010-01-01

    Despite a lower prevalence of opioid dependence among females, drug-related problems and risk factors such as prostitution have a negative effect for women in treatment. This study was conducted with the purpose of analyzing gender differences in the German trial on heroin-assisted treatment (HAT), which compared HAT with methadone maintenance treatment (MMT). Significant baseline gender differences were found, with females showing a greater extent of mental distress. Differences in retention and outcome were significant for male patients, but no differences between treatment options were found for female patients. Ongoing prostitution was found to influence drug use outcomes. Other outcome criteria may need to be stressed when assessing the effect of HAT for women.

  19. Evaluating long-term effects of heroin-assisted treatment: the results of a 6-year follow-up.

    PubMed

    Güttinger, Franziska; Gschwend, Patrick; Schulte, Bernd; Rehm, Jürgen; Uchtenhagen, Ambros

    2003-04-01

    Since January 1994, heroin-assisted treatment for opiate addicts has been available in Switzerland. This is the first report of the long-term effects of this form of treatment. The report examines subjects who entered a study involving medical prescription of opiates (Projekt zur ärztlichen Verschreibung von Betäubungsmitteln; PROVE) in Switzerland between January 1994 and March 1995 (n = 366). Opiates were dispensed in eight treatment centres. A follow-up was conducted 6 years after treatment entry. Two groups were assessed: clients who have continuously been on heroin-assisted treatment since entry into the PROVE study or who re-entered this treatment, and ex-clients who had discontinued heroin-assisted treatment at the time of follow-up. Two kinds of comparisons were conducted. Firstly, conditions at treatment entry were compared to 6-year follow-up outcomes, and secondly, outcomes were compared between clients still on heroin-assisted treatment and those who had been discharged. It was found that 46% of the clients still alive were on heroin-assisted treatment at the time of follow-up. A comparison of the present living conditions showed very little difference between those in treatment and those who had terminated treatment. Compared to the situation at entry, the results of the follow-up showed a significant decrease in the use of illegal substances, illegal income and most other variables concerning social conditions, but they also showed an increase in unemployment and reliance on social benefits. Heroin-assisted treatment is thus efficacious in the long-term course of treatment and is still effective after termination of treatment with respect to living conditions and use of illicit substances.

  20. [Robotic assisted laparoscopic colposacropexy in the treatment of pelvic organ prolapse].

    PubMed

    Moreno Sierra, Jesús; Galante Romo, Isabel; Ortiz Oshiro, Elena; Núñez Mora, Carlos; Silmi Moyano, Angel

    2007-05-01

    Laparoscopic colposacropexy has become a substitute for open surgery in the treatment of pelvic organ prolapse. In the same way, robotic assisted surgery is a new step in the evolution of the procedure. In this paper we intend to show our surgical technique and preliminary results. From November 2006 to date, 10 patients have undergone this procedure at the Hospital Clinico San Carlos. The main indication for the operation was existence of symptomatic pelvic prolapse. Both patients with or without hysterectomy have been operated, without making significant differences between them. Preoperative evaluation workout included: cystogram, urinary tract ultrasound and urodynamics in all cases; urinary tract MRI was performed only in selected cases. All patients underwent surgery under general anesthesia, with at least three robotic trocars (8 mm) and one conventional trocar for the assistant; 2 accessory trocars were necessary in some cases, mainly at the beginning of the series. Most procedures in our series were associated with a transobturator suburethral sling for the treatment of stress urinary incontinence or prevention of its appearance after prolapse repair. Our results are comparable to those reported in other larger series in terms of operative time, hospital stay and early or late complications. Pending an evaluation on the long term with larger series, we can include robot assisted colposacropexy among the therapeutic options for symptomatic pelvic floor prolapse repair.

  1. Measuring Sperm DNA Fragmentation and Clinical Outcomes of Medically Assisted Reproduction: A Systematic Review and Meta-Analysis.

    PubMed

    Cissen, Maartje; Wely, Madelon van; Scholten, Irma; Mansell, Steven; Bruin, Jan Peter de; Mol, Ben Willem; Braat, Didi; Repping, Sjoerd; Hamer, Geert

    2016-01-01

    Sperm DNA fragmentation has been associated with reduced fertilization rates, embryo quality, pregnancy rates and increased miscarriage rates. Various methods exist to test sperm DNA fragmentation such as the sperm chromatin structure assay (SCSA), the sperm chromatin dispersion (SCD) test, the terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labelling (TUNEL) assay and the single cell gel electrophoresis (Comet) assay. We performed a systematic review and meta-analysis to assess the value of measuring sperm DNA fragmentation in predicting chance of ongoing pregnancy with IVF or ICSI. Out of 658 unique studies, 30 had extractable data and were thus included in the meta-analysis. Overall, the sperm DNA fragmentation tests had a reasonable to good sensitivity. A wide variety of other factors may also affect the IVF/ICSI outcome, reflected by limited to very low specificity. The constructed hierarchical summary receiver operating characteristic (HSROC) curve indicated a fair discriminatory capacity of the TUNEL assay (area under the curve (AUC) of 0.71; 95% CI 0.66 to 0.74) and Comet assay (AUC of 0.73; 95% CI 0.19 to 0.97). The SCSA and the SCD test had poor predictive capacity. Importantly, for the TUNEL assay, SCD test and Comet assay, meta-regression showed no differences in predictive value between IVF and ICSI. For the SCSA meta-regression indicated the predictive values for IVF and ICSI were different. The present review suggests that current sperm DNA fragmentation tests have limited capacity to predict the chance of pregnancy in the context of MAR. Furthermore, sperm DNA fragmentation tests have little or no difference in predictive value between IVF and ICSI. At this moment, there is insufficient evidence to recommend the routine use of sperm DNA fragmentation tests in couples undergoing MAR both for the prediction of pregnancy and for the choice of treatment. Given the significant limitations of the evidence and the

  2. Measuring Sperm DNA Fragmentation and Clinical Outcomes of Medically Assisted Reproduction: A Systematic Review and Meta-Analysis

    PubMed Central

    Cissen, Maartje; van Wely, Madelon; Scholten, Irma; Mansell, Steven; de Bruin, Jan Peter; Mol, Ben Willem; Braat, Didi; Repping, Sjoerd; Hamer, Geert

    2016-01-01

    Sperm DNA fragmentation has been associated with reduced fertilization rates, embryo quality, pregnancy rates and increased miscarriage rates. Various methods exist to test sperm DNA fragmentation such as the sperm chromatin structure assay (SCSA), the sperm chromatin dispersion (SCD) test, the terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate nick end labelling (TUNEL) assay and the single cell gel electrophoresis (Comet) assay. We performed a systematic review and meta-analysis to assess the value of measuring sperm DNA fragmentation in predicting chance of ongoing pregnancy with IVF or ICSI. Out of 658 unique studies, 30 had extractable data and were thus included in the meta-analysis. Overall, the sperm DNA fragmentation tests had a reasonable to good sensitivity. A wide variety of other factors may also affect the IVF/ICSI outcome, reflected by limited to very low specificity. The constructed hierarchical summary receiver operating characteristic (HSROC) curve indicated a fair discriminatory capacity of the TUNEL assay (area under the curve (AUC) of 0.71; 95% CI 0.66 to 0.74) and Comet assay (AUC of 0.73; 95% CI 0.19 to 0.97). The SCSA and the SCD test had poor predictive capacity. Importantly, for the TUNEL assay, SCD test and Comet assay, meta-regression showed no differences in predictive value between IVF and ICSI. For the SCSA meta-regression indicated the predictive values for IVF and ICSI were different. The present review suggests that current sperm DNA fragmentation tests have limited capacity to predict the chance of pregnancy in the context of MAR. Furthermore, sperm DNA fragmentation tests have little or no difference in predictive value between IVF and ICSI. At this moment, there is insufficient evidence to recommend the routine use of sperm DNA fragmentation tests in couples undergoing MAR both for the prediction of pregnancy and for the choice of treatment. Given the significant limitations of the evidence and the

  3. Seminal traits, suitability for semen preservation and fertility in the native Portuguese horse breeds Puro Sangue Lusitano and Sorraia: Implications for stallion classification and assisted reproduction.

    PubMed

    Gamboa, Sandra; Machado-Faria, Manuel; Ramalho-Santos, João

    2009-07-01

    The Puro Sangue Lusitano (PSL) is the major national breed of horse in Portugal, but no studies exist on its seminal characteristics, or on the possibility of conserving semen for future use. The aim of this study was to evaluate semen parameters, fertility and the aptness to semen preservation in Lusitano Stallions. In order to compare characteristics defined by a single or by multiple semen collections per stallion 152 ejaculates obtained from 152 Lusitano stallions presented at an annual breeding soundness examination as well as data related to 371 ejaculates obtained from 9 PSL were analyzed. These latter samples were also evaluated in terms of their possible use in assisted reproduction and were compared with 113 ejaculates obtained from 4 Sorraia horses, a rare and endangered Portuguese breed. The percentage of motile spermatozoa (PMS) was assessed after collection (AC), after semen dilution (AD) and at 24h of cool-storage. Mean values obtained for sperm motility and morphology and semen pH observed after semen collection differ significantly (P<0.05) between single collection/multiple stallions and multiple collections/limited stallions, and no age related effects were detected. Overall, Lusitano semen quality was comparable to that of related breeds, while Sorraia stallions had very poor semen quality. The response to cool-storage of diluted semen samples differed among stallions and breeds, and the best results for progressive motile sperm cells at 24h were in a range of 35-53% for PSL stallions and were lower for Sorraia stallions. Fertility rates obtained with artificial insemination (AI) averaged at 85% for PSL. With the exception of PMS AC, sperm vitality and semen pH no other seminal trait seemed to influence fertility rates in the Lusitano breed.

  4. Preliminary functional results of endoscope-assisted transoral treatment of displaced bilateral condylar mandible fractures.

    PubMed

    Schoen, R; Fakler, O; Metzger, M C; Weyer, N; Schmelzeisen, R

    2008-02-01

    Temporomandibular joint (TMJ) function was evaluated following endoscope-assisted transoral open reduction and miniplate fixation of displaced bilateral condylar mandibular fractures. The transoral treatment of bilateral condylar fractures was performed in 13 patients from May 2000 to December 2004. Eleven of the 13 patients had additional mandibular fractures. Out of 26 fractures of the condylar process, 11 were located at the condylar neck and 15 were subcondylar. One, 6 and 12 months after surgery TMJ function was evaluated. Anatomic reduction was achieved using an endoscope-assisted transoral approach even when the condylar fragment was displaced medially and in fractures with comminution. Good TMJ function was noted 6 and 12 months after surgery. Mouth opening was measured to be more than 40 mm without deviation. Postoperative range of motion with a satisfying lateral excursion was found. Early rehabilitation and pre-injury TMJ function was achieved following minimally invasive anatomic fracture reduction.

  5. Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms.

    PubMed

    Zhang, Jifang; Wang, Donghai; Li, Xingang

    2015-12-01

    Recent advances in neuroradiological techniques have increasingly improved the diagnosis rate for very small aneurysms, particularly with the widespread use of three-dimensional cerebral angiography. However, the treatment of very small aneurysms remains a considerable challenge for neurosurgeons. Endovascular coiling has emerged as a potential treatment option for intracranial aneurysms. The aim of the present study was to evaluate the safety and efficacy of Solitaire AB stent-assisted coiling embolization for the treatment of ruptured very small intracranial aneurysms. This retrospective study included nine consecutive patients with ruptured very small intracranial aneurysms (≤3 mm) that underwent Solitaire AB stent-assisted coiling embolization. The aneurysms were located in the ophthalmic branch of the internal carotid artery (n=2), the posterior communicating branch of the internal carotid artery (n=4), the top of the basilar artery (n=1) and the middle cerebral artery (n=2). Solitaire AB stents were successfully implanted in all nine patients. Of the nice individuals, six patients exhibited complete occlusion at Raymond grade I and three patients exhibited occlusion at Raymond grade II. No aneurysm rupture was observed during the surgery. During the follow-up period of 8-13 months, no intracranial hemorrhage occurred. A total of seven patients underwent follow-up digital subtraction angiography at 5-10 months post-intervention. No recurrence of the aneurysms and no stenosis or occlusion of the parent arteries was observed. Therefore, Solitaire AB stent-assisted coil embolization was demonstrated to be a safe and effective treatment for ruptured very small intracranial aneurysms. The long-term efficacy of this technique may be improved by increasing the packing density around the aneurysmal neck and improving the hemodynamics.

  6. Human reproduction: Jewish perspectives.

    PubMed

    Schenker, Joseph G

    2013-11-01

    Developments in science and technology and corresponding clinical applications raise new religious questions, often without clear answers. The role of theology in bioethics is integral to clarify perceived attitudes toward these developments for different religious communities. The Jewish attitude towards procreation is derived from the first commandment of God to Adam to 'Be fruitful and multiply'. Judaism allows the practice of all techniques of assisted reproduction when the oocyte and spermatozoon originate from the wife and husband respectively. This paper presents the attitude of Jewish Law -- Halacha to therapeutic procedures, such as IVF-embryo transfer, spermatozoa, oocytes, embryo donation, cryopreservation of genetic material, surrogacy, posthumous reproduction, gender preselection, reproductive and therapeutic cloning.

  7. Animal-Assisted Therapy for Patients Undergoing Treatment at NIH Clinical Center | NIH MedlinePlus the Magazine

    MedlinePlus

    ... page please turn JavaScript on. Feature: Therapy Dogs Animal-Assisted Therapy for Patients Undergoing Treatment at NIH ... is unlike any other." A self-described "huge animal lover," she coordinates 14 teams of trained and ...

  8. [On the Decision of the European Court of Human Rights. The S.H. and others against Austria. TEDH 2010/56 of April 1, on human assisted reproduction and its incidence on the European legislative arena].

    PubMed

    Vidal Martínez, Jaime

    2011-01-01

    The judgment of ECHR 2010/56 responds positively the appeal on the part of four Austrian citizens (two married couples) against the Austrian state. The applicants complained that the prohibition of sperm and ova donation for in vitro fertilisation as established in the Austrian Law of 1992 amounts to discrimination, against article 14 of the European Convention on Human Rights in conjunction with article 8, which establishes that everyone has the right to respect for his private and family life. After a detailed exposition of the circumstances surrounding this case, the author examines the origin of the practices of artificial insemination and IVF. The author highlights the transcendence of questions linked to extracorporeal fertilisation and human embryology and looks at the European regulation and the doctrine of reproductive rights, paying attention to the widespread use of the abovementioned techniques in the globalised world and the transborder practices in the European territories. The author points out that the current implementation of assisted reproduction techniques and the lack of uniform regulation in the European context might have influenced the above judgment of the ECHR 2010/56, which pronounced that the 1992 Austrian Law of Artificial Reproduction was not in accordance with article 14 of the European Convention on Human Rights, contrary to the judgment passed by the Austrian Constitutional Court eleven years earlier. It was not questioned, and so it was established by the ECHR, that the applicants right to use assisted reproduction techniques is protected by article 8 of the Convention. However, this does not make the estate liable to allow or regulate the abovementioned practices as long as this does not result in discrimination. According to the author, the right to resort to artificial reproduction techniques is contingent and therefore different from the freedom to procreate that is inherent to the human person, and covered under the right of

  9. What Treatment Options Are Available for Male Infertility?

    MedlinePlus

    ... medical procedures to deliver sperm to the woman, fertilization of the egg in a laboratory, and using ... 2 Assistive reproductive technologies, such as in vitro fertilization, can be effective if other treatments do not ...

  10. Long-Term Prophylactic Antibiotic Treatment: Effects on Survival, Immunocompetence and Reproduction Success of Parasemia plantaginis (Lepidoptera: Erebidae).

    PubMed

    Dickel, Franziska; Freitak, Dalial; Mappes, Johanna

    2016-01-01

    Hundreds of insect species are nowadays reared under laboratory conditions. Rearing of insects always implicates the risk of diseases, among which microbial infections are the most frequent and difficult problems. Although there are effective prophylactic treatments, the side effects of applied antibiotics are not well understood. We examined the effect of prophylactic antibiotic treatment on the overwintering success of wood tiger moth (Parasemia plantaginis) larvae, and the postdiapause effect on their life-history traits. Four weeks before hibernation larvae were treated with a widely used antibiotic (fumagillin). We monitored moths' survival and life-history traits during the following 10 mo, and compared them to those of untreated control larvae. Prophylactic antibiotic treatment had no effect on survival but we show effects on some life-history traits by decreasing the developmental time of treated larvae. However, we also revealed relevant negative effects, as antibiotic treated individuals show a decreased number of laid eggs and also furthermore a suppressed immunocompetence. These results implicate, that a prophylactic medication can also lead to negative effects on life-history traits and reproductive success, which should be seriously taken in consideration when applying a prophylactic treatment to laboratory reared insect populations.

  11. Long-Term Prophylactic Antibiotic Treatment: Effects on Survival, Immunocompetence and Reproduction Success of Parasemia plantaginis (Lepidoptera: Erebidae)

    PubMed Central

    Dickel, Franziska; Freitak, Dalial; Mappes, Johanna

    2016-01-01

    Hundreds of insect species are nowadays reared under laboratory conditions. Rearing of insects always implicates the risk of diseases, among which microbial infections are the most frequent and difficult problems. Although there are effective prophylactic treatments, the side effects of applied antibiotics are not well understood. We examined the effect of prophylactic antibiotic treatment on the overwintering success of wood tiger moth (Parasemia plantaginis) larvae, and the postdiapause effect on their life-history traits. Four weeks before hibernation larvae were treated with a widely used antibiotic (fumagillin). We monitored moths’ survival and life-history traits during the following 10 mo, and compared them to those of untreated control larvae. Prophylactic antibiotic treatment had no effect on survival but we show effects on some life-history traits by decreasing the developmental time of treated larvae. However, we also revealed relevant negative effects, as antibiotic treated individuals show a decreased number of laid eggs and also furthermore a suppressed immunocompetence. These results implicate, that a prophylactic medication can also lead to negative effects on life-history traits and reproductive success, which should be seriously taken in consideration when applying a prophylactic treatment to laboratory reared insect populations. PMID:27271967

  12. Heroin-assisted treatment in the Netherlands: History, findings, and international context.

    PubMed

    Blanken, Peter; van den Brink, Wim; Hendriks, Vincent M; Huijsman, Ineke A; Klous, Marjolein G; Rook, Elisabeth J; Wakelin, Jennifer S; Barendrecht, Cas; Beijnen, Jos H; van Ree, Jan M

    2010-04-01

    This monograph describes the history, findings and international context of heroin-assisted treatment (HAT) in the Netherlands. The monograph consists of (1) a short introduction and seven paragraphs describing the following aspects of HAT in the Netherlands: (2) history of HAT studies and implementation of routine HAT in the Netherlands; (3) main findings on efficacy, safety and cost-effectiveness from the two randomized controlled HAT trials in the Netherlands; (4) new findings from a large cohort study on the effectiveness of HAT in routine clinical practice in the Netherlands; (5) unique data on the patient's perspective of HAT; (6) data on the pharmacological and pharmaceutical basis for HAT in the Netherlands; (7) description of the registration process; and (8) account of the international context of HAT. Together, these data show that HAT can now be considered a safe and proven-effective intervention for the treatment of chronic, treatment-resistant heroin dependent patients.

  13. Natural healers: a review of animal assisted therapy and activities as complementary treatment for chronic conditions.

    PubMed

    Reed, Reiley; Ferrer, Lilian; Villegas, Natalia

    2012-01-01

    The primary objective of this review is to synthesize the existing literature on the use of animal-assisted therapy and activity (AAT/A) as complementary treatment among people living with chronic disease and to discuss the possible application of this practice among children living with HIV. Relevant databases were searched between March 10 and April 11, 2011, using the words: animal assisted therapy or treatment and chronic conditions or diseases. Thirty-one articles were found and 18 followed the inclusion and exclusion criteria. Research suggests that AAT/A is effective for different patient profiles, particularly children. Interaction with dogs has been found to increase positive behaviors, such as sensitivity and focus, in children with social disabilities. Decreased levels of pain have also been reported among child patients as a result of AAT/A. More research should be done in the area of children living with chronic diseases that require strict adherence to treatment, such as HIV, and on AAT/A's prospective use as an educational tool to teach children about the importance of self-care for their medical conditions.

  14. MDMA-assisted therapy: A new treatment model for social anxiety in autistic adults.

    PubMed

    Danforth, Alicia L; Struble, Christopher M; Yazar-Klosinski, Berra; Grob, Charles S

    2016-01-04

    The first study of 3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy for the treatment of social anxiety in autistic adults commenced in the spring of 2014. The search for psychotherapeutic options for autistic individuals is imperative considering the lack of effective conventional treatments for mental health diagnoses that are common in this population. Serious Adverse Events (SAEs) involving the administration of MDMA in clinical trials have been rare and non-life threatening. To date, MDMA has been administered to over 1133 individuals for research purposes without the occurrence of unexpected drug-related SAEs that require expedited reporting per FDA regulations. Now that safety parameters for limited use of MDMA in clinical settings have been established, a case can be made to further develop MDMA-assisted therapeutic interventions that could support autistic adults in increasing social adaptability among the typically developing population. As in the case with classic hallucinogens and other psychedelic drugs, MDMA catalyzes shifts toward openness and introspection that do not require ongoing administration to achieve lasting benefits. This infrequent dosing mitigates adverse event frequency and improves the risk/benefit ratio of MDMA, which may provide a significant advantage over medications that require daily dosing. Consequently, clinicians could employ new treatment models for social anxiety or similar types of distress administering MDMA on one to several occasions within the context of a supportive and integrative psychotherapy protocol.

  15. Screening for illicit heroin use in patients in a heroin-assisted treatment program.

    PubMed

    Rook, Elisabeth J; Huitema, Alwin D R; van den Brink, Wim; Hillebrand, Michel J X; van Ree, Jan M; Beijnen, Jos H

    2006-01-01

    The aim of this study was to investigate the use of illicit heroin among patients in a heroin-assisted treatment program. In this program, pharmaceutical-grade heroin was administered to heroin-addicted patients. Monitoring of illicit heroin use was considered important for the evaluation of this treatment program. Acetylcodeine and codeine, common adulterants of "street" heroin, were used as markers for illicit heroin. A liquid chromatography method with tandem mass spectrometric detection (LC-MS-MS) was developed, for quantitative analysis of heroin and methadone, their metabolites, and the simultaneous detection of acetylcodeine. One-hundred patients in a heroin-assisted treatment program were screened for acetylcodeine in plasma. Furthermore, patients were interviewed about illicit heroin use, and they were tested for alcohol and cocaine use. In plasma samples of 16% of the patients, acetylcodeine was detected. Overall agreement between self-report and plasma samples was 95% (kappa: 0.81). Patients who tested positive for acetylcodeine had visited the outpatients' clinics significantly less frequently than the patients who tested negative. Alcohol and cocaine use was more common in patients who tested positive for acetylcodeine. Illicit heroin use was observed in a limited percentage of patients. Overall agreement between self-report and markers of illicit heroin use was good.

  16. Recovery from cannabis use disorders: Abstinence versus moderation and treatment-assisted recovery versus natural recovery.

    PubMed

    Stea, Jonathan N; Yakovenko, Igor; Hodgins, David C

    2015-09-01

    The present study of recovery from cannabis use disorders was undertaken with 2 primary objectives that address gaps in the literature. The first objective was to provide an exploratory portrait of the recovery process from cannabis use disorders, comparing individuals who recovered naturally with those who were involved in treatment. The second objective was to explore systematically the similarities and differences between abstinence and moderation recoveries. Adults who have recovered from a cannabis use disorder were recruited in the community (N = 119). The abstinence and treatment-assisted participants exhibited higher levels of lifetime cannabis problem severity than the moderation and natural recovery participants, respectively. As well, cognitive factors were identified as the most useful strategies for recovery (e.g., thinking about benefits and negative consequences of cannabis), followed by behavioral factors (e.g., avoidance of triggers for use and high-risk situations). Findings lend further support to the effectiveness of cognitive, motivational, and behavioral strategies as helpful actions and maintenance factors involved in the recovery process. The findings also generally support the idea that cannabis use disorders lie on a continuum of problem severity, with moderation and natural recoveries more likely to occur at the lower end of the continuum and abstinence and treatment-assisted recoveries more likely to occur at the upper end.

  17. Compression assisted by removable coils as a new treatment for iatrogenic femoral pseudoaneurysms.

    PubMed

    Bellmunt, Sergi; Dilmé, Jaume; Barros, Antonio; Escudero, José Román

    2011-01-01

    To avoid undesirable effects that sometimes result from current treatments for postpuncture femoral pseudoaneurysms, we developed a new technique involving compression assisted by removable coils. Using ultrasound-guided percutaneous puncture, an Inconel coil with synthetic microfibers is inserted in the pseudoaneurysm, leaving a part of the coil above the skin. Short-duration, ultrasound-guided compression is applied, taking advantage of the coil's thrombogenicity. Following occlusion, the coil is removed, leaving no residual foreign material. The technique was effective in the first patient treated and may minimize or obviate the adverse effects associated with current approaches.

  18. Medication Assisted Treatment for Opioid Use Disorders Reporting Requirements. Final rule.

    PubMed

    2016-09-27

    This final rule outlines annual reporting requirements for practitioners who are authorized to treat up to 275 patients with covered medications in an office-based setting. This final rule will require practitioners to provide information on their annual caseload of patients by month, the number of patients provided behavioral health services and referred to behavioral health services, and the features of the practitioner's diversion control plan. These reporting requirements will help the Department of Health and Human Services (HHS) ensure compliance with the requirements of the final rule, "Medication Assisted Treatment for Opioid Use Disorders," published in the Federal Register on July 8, 2016.

  19. "Cycling overseas": care, commodification, and stratification in cross-border reproductive travel.

    PubMed

    Whittaker, Andrea; Speier, Amy

    2010-10-01

    Cross-border reproductive travel involves the movement of patients to undertake assisted reproductive treatment through technologies, such as in vitro fertilization and associated procedures otherwise denied to them due to cost, access, or regulatory restrictions. Based on fieldwork in Thailand, the United States, and the Czech Republic, we explore the commodification of reproductive bodies within this trade and the reduction of the nurturing affective labor of reproduction to exchange value. Second, we examine the intensification and globalization of the stratification of reproduction. These inequalities are illustrated though discussion of the trade in poor women's bodies for surrogacy and ova donation. Even reproductive body parts, ova, sperm, and embryos are stratified-marketed according to place of origin, the characteristics of their donors, and gender.

  20. NAOMI: The trials and tribulations of implementing a heroin assisted treatment study in North America

    PubMed Central

    Gartry, Candice C; Oviedo-Joekes, Eugenia; Laliberté, Nancy; Schechter, Martin T

    2009-01-01

    Background Opioid addiction is a chronic, relapsing disease and remains a major public health challenge. Despite important expansions of access to conventional treatments, there are still significant proportions of affected individuals who remain outside the reach of the current treatment system and who contribute disproportionately to health care and criminal justice costs as well as to public disorder associated with drug addiction. The NAOMI study is a Phase III randomized clinical trial comparing injectable heroin maintenance to oral methadone. The study has ethics board approval at its Montréal and Vancouver sites, as well as from the University of Toronto, the New York Academy of Medicine and Johns Hopkins University. The main objective of the NAOMI Study is to determine whether the closely supervised provision of injectable, pharmaceutical-grade opioid agonist is more effective than methadone alone in recruiting, retaining, and benefiting chronic, opioid-dependent, injection drug users who are resistant to current standard treatment options. Methods The case study submitted chronicles the challenges of getting a heroin assisted treatment trial up and running in North America. It describes: a brief background on opioid addiction; current standard therapies for opioid addiction; why there is/was a need for a heroin assisted treatment trial; a description of heroin assisted treatment; the beginnings of creating the NAOMI study in North America; what is the NAOMI study; the science and politics of the NAOMI study; getting NAOMI started in Canada; various requirements and restrictions in getting the study up and running; recruitment into the study; working with the media; a status report on the study; and a brief conclusion from the authors' perspectives. Results and conclusion As this is a case study, there are no specific results or main findings listed. The case study focuses on: the background of the study; what it took to get the study started in Canada