Sample records for assisted reproduction treatment

  1. Legal regulation of assisted reproduction treatment in Russia.

    PubMed

    Svitnev, Konstantin

    2010-06-01

    Russia remains one of the countries with a most favourable approach towards human reproduction in Europe, allowing almost everybody wanting to have a child of their own through assisted reproduction treatment to fulfill their dream. The legal situation around assisted reproduction treatment in Russia is very favourable; surrogacy, gamete and embryo donation are permitted, even on a commercial level. Gestational surrogacy is an option for heterosexual couples and single women, although a court decision might be needed to register a 'surrogate' child born to a couple who are not officially married or a single woman. However, it is not explicitly allowed nor prohibited for single men. Copyright 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  2. Accuracy of self-reported survey data on assisted reproductive technology treatment parameters and reproductive history.

    PubMed

    Stern, Judy E; McLain, Alexander C; Buck Louis, Germaine M; Luke, Barbara; Yeung, Edwina H

    2016-08-01

    It is unknown whether data obtained from maternal self-report for assisted reproductive technology treatment parameters and reproductive history are accurate for use in research studies. We evaluated the accuracy of self-reported in assisted reproductive technology treatment and reproductive history from the Upstate KIDS study in comparison with clinical data reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. Upstate KIDS maternal questionnaire data from deliveries between 2008 and 2010 were linked to data reported to Society for Assisted Reproductive Technology Clinic Outcome Reporting System. The 617 index deliveries were compared as to treatment type (frozen embryo transfer and donor egg or sperm) and use of intracytoplasmic sperm injection and assisted hatching. Use of injectable medications, self-report for assisted reproductive technology, or frozen embryo transfer prior to the index deliveries were also compared. We report agreement in which both sources had yes or both no and sensitivity of maternal report using Society for Assisted Reproductive Technology Clinic Outcome Reporting System as the gold standard. Significance was determined using χ(2) at P < 0.05. Universal agreement was not reached on any parameter but was best for treatment type of frozen embryo transfer (agreement, 96%; sensitivity, 93%) and use of donor eggs (agreement, 97%; sensitivity, 82%) or sperm (agreement, 98%; sensitivity, 82%). Use of intracytoplasmic sperm injection (agreement, 78%: sensitivity, 78%) and assisted hatching (agreement, 57%; sensitivity, 38%) agreed less well with self-reported use (P < .0001). In vitro fertilization (agreement, 82%) and frozen embryo transfer (agreement, 90%) prior to the index delivery were more consistently reported than was use of injectable medication (agreement, 76%) (P < .0001). Women accurately report in vitro fertilization treatment but are less accurate about procedures handled in the

  3. The effect of assisted reproduction treatment on mental health in fertile women.

    PubMed

    Zivaridelavar, Maryam; Kazemi, Ashraf; Kheirabadi, Gholam Reza

    2016-01-01

    The process of assisted reproductive treatment is a stressful situation in the treatment of infertile couples and it would harm the mental health of women. Fertile women who started infertility treatment due to male factor infertility have reported to experience less stress and depression than other women before the assisted reproductive process but considering the cultural and social factors and also the etiology of the assisted reproductive process, it could affect the metal health of these women. Therefore, this study was conducted to evaluate the mental health of fertile women who undergo assisted reproductive treatment due to male factor infertility. This study was a prospective study on 70 fertile women who underwent assisted reproductive treatment due to male factor infertility. The exclusion criterion was to stop super ovulation induction. To assess mental health, anxiety and depression dimensions of the general health questionnaire were used. Before starting ovulation induction and after oocyte harvesting, the general health questionnaire was filled by women who were under treatment. Data were analyzed using multi-variable linear regression, paired t-test, and Chi-square. The results showed that the mean score of depression and anxiety before ovulation induction and after oocyte harvesting were not significantly different; but the rate of mental health disorder in the depression dimension was significantly decreased after oocytes harvesting (31.7% vs. 39.7%). Also, there was a significant relation between the level of anxiety and depression before ovulation induction and after oocyte harvesting (P < 0.05). The anxiety level after oocyte harvesting had a positive and significant correlation with the economic situation (P < 0.05). This study revealed that the process of assisted reproductive treatment does not affect the mental health in fertile women independently, but these women start assisted reproductive process with high levels of depression and

  4. Assisted Reproductive Technology (ART)

    MedlinePlus

    ... Share Facebook Twitter Pinterest Email Print Assisted Reproductive Technology (ART) ART refers to treatments and procedures that ... American Society for Reproductive Medicine. (2015). Assisted reproductive technologies: A guide for patients . Retrieved May 31, 2016, ...

  5. 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. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Identification of Reproductive Education Needs of Infertile Clients Undergoing Assisted Reproduction Treatment Using Assessments of Their Knowledge and Attitude

    PubMed Central

    Ezabadi, Zahra; Mollaahmadi, Fahimeh; Mohammadi, Maryam; Omani Samani, Reza; Vesali, Samira

    2017-01-01

    Background In order to empower infertile individuals and provide high quality patient-centered infertility care, it is necessary to recognize and meet infertile individuals’ educational needs. This study aims to examine infertility patients’ knowledge and subsequently their education needs given their attitudinal approach to infertility education in terms of patients who undergo assisted reproduction treatment. Materials and Methods This descriptive study enrolled 150 subjects by conveni- ence sampling of all patients who received their first assisted reproductive treatment between July and September 2015 at a referral fertility clinic, Royan Institute, Tehran, Iran. We used a questionnaire that measured fertility and infertility information (8 questions) as well as attitude toward education on the causes and treatment of infertility (5 questions). Chi-square, independent sample t test, and one way ANOVA analyses were conducted to examine differences by sex. P<0.05 was considered statistically significant. Results Total mean knowledge was 3.08 ± 0.99. Clients’ responses indicated that the highest mean knowledge scores related to knowledge of factors that affected pregnancy (3.97 ± 1.11) and infertility treatment (3.97 ± 1.16). The lowest mean knowledge scores related to knowledge of the natural reproductive cycle (2.96 ± 1.12) and anatomy of the genital organs (2.94 ± 1.16). Most females (92.1%) and males (83.3%) were of the opinion that infertility education programs should include causes of infertility and types of treatment associated with diagnostic and laboratory procedures. No statistically significant difference existed between male and female participants (P=0.245). Conclusion Most participants in this study expressed awareness of factors that affect pregnancy and infertility treatment. It is imperative to educate and empower infertile individuals who seek reproduction treatment in terms of infertility causes and types of treatment, as well as

  7. Infertilitism: unjustified discrimination of assisted reproduction patients.

    PubMed

    Tonkens, Ryan

    2018-05-04

    Current law in Victoria, Australia requires that all prospective assisted reproduction patients provide a criminal background check and child protection order check prior to being eligible for treatment. These presumptions against treatment stipulated in the Assisted Reproductive Treatment Act ( http://www.legislation.vic.gov.au/domino/web_notes/ldms/pubstatbook.nsf/f932b66241ecf1b7ca256e92000e23be/3ADFC9FBA2C0F526CA25751C0020E494/$FILE/08-076a.pdf , 2008) are discriminatory against all people that are infertile. Requiring assistance in founding a family says nothing about whether someone will be a minimally decent parent to their (future) child. The most plausible justifications for this differential treatment of family builders that require assistance are unsound. The wellbeing of the resulting child is something that the prospective patient(s) should be presumed to have at heart, as this is the default assumption with other kinds of family builders that do not require assistance. That assisted reproduction treatment is publicly funded does not mean that the state is thereby justified in putting moral conditions on access to treatment. As we should not accept discriminatory laws, especially about practices that are of fundamental importance to the lives of citizens, the presumptions against treatment stipulated in ARTA should be eradicated.

  8. Male and female alcohol consumption and live birth after assisted reproductive technology treatment: a nationwide register-based cohort study.

    PubMed

    Vittrup, Ida; Petersen, Gitte Lindved; Kamper-Jørgensen, Mads; Pinborg, Anja; Schmidt, Lone

    2017-08-01

    The objective was to assess the potential association between female and male alcohol consumption and probability of achieving a live birth after assisted reproductive treatment. From a nationwide Danish register-based cohort information on alcohol consumption at assisted reproductive treatment initiation was linked to information on births and abortions. From 1 January 2006 to 30 September 2010, 12,981 women and their partners went through 29,834 treatment cycles. Of these, 22.4% and 20.4% led to a live birth for female abstainers and heavy consumers (>7 drinks/week), respectively. Concerning men, 22.6% and 20.2% of cycles resulted in a live birth for abstainers and heavy consumers (>14 drinks/week), respectively. No statistically significant associations between alcohol consumption and live birth were observed. Adjusted odds ratios from trend analyses were 1.00 (95% confidence interval (CI) 0.99-1.01) and 0.99 (95% CI 0.97-1.01) for every one-unit increase in female and male weekly alcohol consumption at assisted reproductive treatment initiation, respectively. In conclusion, this study did not show significant associations between male or female alcohol consumption and odds of live birth after assisted reproductive treatment. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  9. 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.

  10. 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. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  11. From esterilología to reproductive biology: The story of the Mexican assisted reproduction business.

    PubMed

    González-Santos, Sandra P

    2016-06-01

    This paper provides the first overview of how assisted reproduction emerged and developed in Mexico. In doing so it addresses two broad points: when and how treatments using assisted reproductive technology became common practice within reproductive medicine; and how the Mexican assisted reproduction industry emerged. The paper begins in 1949, when the first medical association dedicated to esterilología - the biomedical area focused on the study of infertility - was established, thus providing the epistemic and professional ground upon which assisted reproductive technology would later thrive. The paper then traces the way in which this biomedical industry developed, from individual doctors in their practices to networks of clinics and from a clinical practice to a reproductive industry. It also describes the different ways in which the professional community and the government have worked towards developing a regulatory frame for the practice of assisted reproduction. The paper is informed by ethnographic work conducted at clinics, conferences, online forums and websites, as well as by analysis of the contemporary national media, government documents and national medical journals from the early mid-twentieth century to the those published today.

  12. Responsive regulation of cross-border assisted reproduction.

    PubMed

    Millbank, Jenni

    2015-12-01

    This article considers the question: how might Australian regulators constructively respond to the dynamic and complex challenges posed by cross-border assisted reproduction? To begin, the article summarises the available international scholarship and outlines what little we know about Australian cross-border reproductive travel. Of the three generally proposed responses to cross-border reproductive care (prohibition, harm minimisation and harmonisation), the article summarily rejects the first approach, and instead discusses a mixture of the latter two. The article proposes the beginnings of an immediate policy response aimed not at stopping cross-border practices per se, but rather at understanding and reducing the risks associated with them, as well as flagging the pursuit of more ambitious meta-goals such as developing more equitable and accessible treatment frameworks for assisted reproductive technology and encouraging domestic self-sufficiency in reproduction.

  13. The role of steroid hormone supplementation in non-assisted reproductive technology treatments for unexplained infertility.

    PubMed

    Quaas, Alexander M; Hansen, Karl R

    2016-12-01

    Fertility treatment strategies are evolving, with a more rapid transition to assisted reproductive technology (ART) treatments after unsuccessful non-ART treatments. This trend increases the potential importance of adjuvant treatments in non-ART cycles, such as steroid hormone supplementation. It has been established that success rates of ART treatments are increased with the use of luteal support with progesterone. In the setting of non-ART cycles, however, the evidence is less clear, and clinical practices vary widely between providers and clinics. In this review, we aimed to provide an overview of the current evidence for the use of steroid hormone supplementation, including progesterone for luteal support, estrogens, androgens, and mineralocorticoids, in the setting of non-ART treatments for ovulatory women. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. [Assisted Reproduction and Preimplantation Genetic Diagnosis in Patients Susceptible to Breast Cancer].

    PubMed

    Veselá, K; Kocur, T; Horák, J; Horňák, M; Oráčová, E; Hromadová, L; Veselý, J; Trávník, P

    2016-01-01

    Assisted reproduction, as well as pregnancy itself, in patients with breast cancer or other hereditary type of cancer, is a widely discussed topic. In the past, patients treated for breast cancer were rarely involved in the discussion about reproductive possibilities or infertility treatment. However, current knowledge suggests, that breast cancer is neither a contraindication to pregnancy, nor to assisted reproduction techniques. On the contrary, assisted reproduction and preimplantation genetic diagnosis methods might prevent the transmission of genetic risks to the fetus. In this review we summarize data concerning pregnancy risks in patients with increased risk of breast cancer. In addition, we introduce current possibilities and approaches to fertility preservation prior to assisted reproduction treatment as well as novel methods improving the safety of fertility treatment. In the second part of this review, we focus on karyomapping--an advanced molecular genetic tool for elimination of germinal mutations in patients with predisposition to cancer. Moreover, the rapid development of preimplantation genetic diagnosis methods contributes to detection of both chromosomal aneuploidy and causal mutations in a relatively short time-span.

  15. 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.

  16. Assisted Reproductive Technology: MedlinePlus Health Topic

    MedlinePlus

    ... into the woman's body. Learn More Assisted Reproductive Technologies (American Society for Reproductive Medicine) - PDF Also in Spanish Assisted ... for Gay Men and Lesbians Seeking Assisted Reproductive Technologies (ART) (American Society for Reproductive Medicine) - PDF Also in Spanish Fertility ...

  17. Assisted reproductive technology with donor sperm: national trends and perinatal outcomes.

    PubMed

    Gerkowicz, Sabrina A; Crawford, Sara B; Hipp, Heather S; Boulet, Sheree L; Kissin, Dmitry M; Kawwass, Jennifer F

    2018-04-01

    Information regarding the use of donor sperm in assisted reproductive technology, as well as subsequent treatment and perinatal outcomes, remains limited. Outcome data would aid patient counseling and clinical decision making. The objectives of the study were to report national trends in donor sperm utilization and live birth rates of donor sperm-assisted reproductive technology cycles in the United States and to compare assisted reproductive technology treatment and perinatal outcomes between cycles using donor and nondonor sperm. We hypothesize these outcomes to be comparable between donor and nondonor sperm cycles. This was a retrospective cohort study using data from all US fertility centers reporting to the Centers for Disease Control and Prevention's National Assisted Reproductive Technology Surveillance System, accounting for ∼98% of assisted reproductive technology cycles (definition excludes intrauterine insemination). The number and percentage of assisted reproductive technology cycles using donor sperm and rates of pregnancy, live birth, preterm birth (<37 weeks), and low birthweight (<2500 g) were the primary outcomes measured. Treatments assessed include use of donor vs nondonor sperm. The trends analysis included all banking and fresh assisted reproductive technology cycles using donor and autologous oocytes performed between 1996 and 2014 (n = 1,710,034). The outcomes analysis was restricted to include only fresh autologous cycles performed between 2010 and 2014 (n = 437,569) to focus on cycles with a potential outcome and cycles reflective of current practice, thereby improving the clinical relevance. Cycles canceled prior to retrieval were excluded. Statistical analysis included linear regression to explore polynomial trends and log-binomial regression to estimate relative risk for outcomes among cycles using donor and nondonor sperm. Of all banking and fresh donor and autologous oocyte assisted reproductive technology cycles performed between

  18. 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 ...

  19. Role of varicocele treatment in assisted reproductive technologies.

    PubMed

    Sönmez, Mehmet G; Haliloğlu, Ahmet H

    2018-03-01

    In this review, we investigate the advantage of varicocele repair prior to assisted reproductive technologies (ART) for infertile couples and provide cost analysis information. We searched the following electronic databases: PubMed, Medline, Excerpta Medica Database (Embase), Cumulative Index to Nursing and Allied Health Literature (CINAHL). The following search strategy was modified for the various databases and search engines: 'varicocele', 'varicocelectomy', 'varicocele repair', 'ART', ' in vitro fertilisation (IVF)', 'intracytoplasmic sperm injection (ICSI)'. A total of 49 articles, including six meta-analyses, 32 systematic reviews, and 11 original articles, were included in the analysis. Bypassing potentially reversible male subfertility factors using ART is currently common practice. However, varicocele may be present in 35% of men with primary infertility and 80% of men with secondary infertility. Varicocele repair has been shown to be an effective treatment for infertile men with clinical varicocele, thus should play an important role in the treatment of such patients due to the foetal/genetic risks and high costs that are associated with increased ART use. Varicocele repair is a cost-effective treatment method that can improve semen parameters, pregnancy rates, and live-birth rates in most infertile men with clinical varicocele. By improving semen parameters and sperm structure, varicocele repair can decrease or even eliminate ART requirement.

  20. 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

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

    PubMed

    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

    2015-03-01

    To study the relation of dietary phytoestrogens intake and clinical outcomes of women undergoing infertility treatment with the use of assisted reproductive technology (ART). Prospective cohort study. Fertility center. A total of 315 women who collectively underwent 520 ART cycles from 2007 to 2013. None. Implantation, clinical pregnancy, and live birth rates per initiated cycle. Soy isoflavones intake was positively related to live birth rates in ART. Compared with 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 isoflavones 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. Dietary soy intake was positively related to the probability of having a live birth during infertility treatment with ART. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Modern approaches to the treatment of human infertility through assisted reproduction.

    PubMed

    Fernández Pelegrina, R; Kessler, A G; Rawlins, R G

    1991-08-01

    Medical statistics from the United States show approximately 15 percent of all couples of reproductive age are unable to conceive naturally. In recent years, the numbers of couples with reproductive problems has increased, principally due to changes in life style and delayed childbearing. Only 13 years after the birth of the first "test tube baby", advances in the field of human reproduction have created a wide range of alternatives to help infertile couples conceive a healthy infant. Together, these techniques are called Assisted Reproductive Technology (ART) and include: in vitro fertilization (IVF), intratubal transfer of gametes (GIFT), intratubal transfer of zygotes (ZIFT), tubal transfer of preimplantation embryos (TET), gamete or embryo donation, cryopreservtion, and micromanipulation. The application of these techniques is presented here. While much remains to be learned, the ability to fertilize ova in vitro and sustain early embryonic life outside the body is now a reality. Contrary to the idea that these techniques create life in vitro, they simply remove barriers caused by different forms of infertility which impede the creation of life. More than 30,000 infants have now been produced world-wide through ART. In the future, new developments in the field of assisted reproduction promise to bring new hope to the growing numbers of infertile couples around the world.

  3. 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. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Multiple births associated with assisted human reproduction in Canada.

    PubMed

    Cook, Jocelynn L; Geran, Leslie; Rotermann, Michelle

    2011-06-01

    Assisted human reproduction has been associated with increased rates of multiple births. Data suggest that twins and higher order multiple pregnancies are at risk for pre- and postnatal health complications that contribute to stress on both the family and the Canadian health care system. No published Canadian data estimate the contribution of assisted human reproduction to multiple birth rates. This study was designed to determine the contributions of age and assisted human reproduction to multiple birth rates in Canada. We performed analyses of existing Canadian databases, using a mathematical model from the Centers for Disease Control and Prevention. More specifically, data from the Canadian Vital Statistics: Births and Stillbirths database were combined with data from the Canadian Assisted Reproductive Technologies Register collected by the Canadian Fertility and Andrology Society. Datasets were standardized to age distributions of mothers in 1978. RESULTS suggest that in vitro fertilization, ovulation induction, and age each contribute more to the rates of triplets than to twins. As expected, the contribution of natural factors was higher to twins than to triplets. These are the first Canadian data analyzed to separate and measure the contributions of age and assisted reproductive technologies to multiple birth rates. Our findings are important for guiding physician and patient education and informing the development of treatment protocols that will result in lower-risk pregnancies and improved long-term health for women and their offspring.

  5. Cumulative birth rates with linked assisted reproductive technology cycles.

    PubMed

    Luke, Barbara; Brown, Morton B; Wantman, Ethan; Lederman, Avi; Gibbons, William; Schattman, Glenn L; Lobo, Rogerio A; Leach, Richard E; Stern, Judy E

    2012-06-28

    Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure. We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment. The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used. Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are

  6. Changing direction: the struggle of regulating assisted reproductive technology in Austria.

    PubMed

    Griessler, Erich; Hager, Mariella

    2016-12-01

    From 1992 until 2015, Austria had a very restrictive Reproductive Medicine Law (FMedG, 1992) that prohibited a number of treatments such as egg donation, preimplantation genetic diagnosis (PGD), heterologous sperm donation for IVF/intracytoplasmic sperm injection (ICSI) as well as general access to assisted reproductive technology for same-sex couples. As one consequence of this rather prohibitive law, Austrian physicians active in the area of assisted reproductive technology co-operated with, or had daughter institutes in, countries with less restrictive legislation such as the Czech Republic and Slovakia, which are only a few hours' drive away. For a long time, liberalisation of the Reproductive Medicine Law was blocked by the fierce and seemingly unresolvable struggle between the restrictive conservative party (ÖVP) and the permissive social democrats' party (SPÖ). In 2014 the impasse, which had lasted for decades, was finally resolved in favour of a more liberal Reproductive Medicine Law that permits egg donation, PGD in some cases and heterologous sperm donation for IVF/ICSI and lesbian couples. Assisted reproductive technology treatments for single women and surrogate motherhood remain prohibited. The new Reproductive Medicine Law was heavily opposed by the Catholic Church, by some conservatives and by disability associations. By applying the concept of political culture, this paper explains why a liberalisation of the Reproductive Medicine Law was blocked for decades, and how the sudden policy change came about.

  7. Ethics, informed consent, and assisted reproduction.

    PubMed

    Macklin, R

    1995-09-01

    Informed consent to treatment is an ethical requirement often misunderstood or not fully appreciated by physicians. The purpose of obtaining informed consent is to ensure that patients know what doctors propose to do and freely grant their permission. Although the purpose of informed consent and the standards by which it is to be employed are the same in all areas of medical practice, special problems arise in assisted reproduction. Voluntary, informed consent is an instance of a reproductive right that should be recognized by the international medical community, and not limited to Western and European countries.

  8. Nordic couples' decision-making processes during assisted reproduction treatments.

    PubMed

    Sol Olafsdottir, Helga; Wikland, Matts; Möller, Anders

    2013-06-01

    To study couples' perceptions of their decision-making process during the first three years of infertility treatments. This study is a part of a larger project studying the decision-making processes of 22 infertile heterosexual couples, recruited from fertility clinics in all five Nordic countries, over a three year period. A descriptive qualitative method was used. Process of decision-making during assisted reproduction treatments. Seventeen couples had succeeded in becoming parents after approximately three years. Our study suggests that the decision-making process during fertility treatments has three phases: (i) recognizing the decisions to be made, with subcategories; the driving force, mutual project, (ii) gathering knowledge and experience about the options, with subcategories; trust, patient competence, personalized support, and (iii) adapting decisions to possible options, with subcategories; strategic planning, adaption. The core category was "maintaining control in a situation of uncertainty." Two parallel processes affect couples' decision-making process, one within themselves and their relationship, and the other in their contact with the fertility clinic. Couples struggle to make decisions, trusting clinic personnel for guidance, knowledge, and understanding. Nevertheless, couples expressed disappointment with the clinics' reactions to their requests for shared decision-making. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... II (special controls) (design specifications, labeling requirements, and clinical testing). ... Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group of...

  10. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... II (special controls) (design specifications, labeling requirements, and clinical testing). ... Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group of...

  11. 21 CFR 884.6120 - Assisted reproduction accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... II (special controls) (design specifications, labeling requirements, and clinical testing). ... Assisted reproduction accessories. (a) Identification. Assisted reproduction accessories are a group of...

  12. Third-party reproductive assistance around the Mediterranean: comparing Sunni Egypt, Catholic Italy and multisectarian Lebanon.

    PubMed

    Inhorn, Marcia C; Patrizio, Pasquale; Serour, Gamal I

    2010-12-01

    The article examines religious and legal restrictions on third-party reproductive assistance in three Mediterranean countries: Sunni Egypt, Catholic Italy and multisectarian Lebanon. In Egypt, assisted reproduction treatments are permitted, but third parties are banned, as in the rest of the Sunni Islamic world. Italy became similar to Egypt with a 2004 law ending third-party reproductive assistance. In multisectarian Lebanon, however, the Sunni/Catholic ban on third-party reproductive assistance has been lifted, because of Shia rulings emanating from Iran. Today, third-party reproductive assistance is provided in Lebanon to both Muslims and Christians, unlike in neighbouring Egypt and Italy. Such comparisons point to the need for understanding the complex interactions between law, religion, local moralities and reproductive practices for global bioethics. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  13. Cycle 1 as predictor of assisted reproductive technology treatment outcome over multiple cycles: an analysis of linked cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System online database.

    PubMed

    Stern, Judy E; Brown, Morton B; Luke, Barbara; Wantman, Ethan; Lederman, Avi; Hornstein, Mark D

    2011-02-01

    To determine whether the first cycle of assisted reproductive technology (ART) predicts treatment course and outcome. Retrospective study of linked cycles. Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. A total of 6,352 ART patients residing or treated in Massachusetts with first treatment cycle in 2004-2005 using fresh, autologous oocytes and no prior ART. Women were categorized by first cycle as follows: Group I, no retrieval; Group II, retrieval, no transfer; Group III, transfer, no embryo cryopreservation; Group IV, transfer plus cryopreservation; and Group V, all embryos cryopreserved. None. Cumulative live-birth delivery per woman, use of donor eggs, intracytoplasmic sperm injection (ICSI), or frozen embryo transfers (FET). Groups differed in age, baseline FSH level, prior gravidity, diagnosis, and failure to return for Cycle 2. Live-birth delivery per woman for groups I through V for women with no delivery in Cycle I were 32.1%, 35.9%, 40.1%, 53.4%, and 51.3%, respectively. Groups I and II were more likely to subsequently use donor eggs (14.5% and 10.9%). Group II had the highest use of ICSI (73.3%); Group III had the lowest use of FET (8.9%). Course of treatment in the first ART cycle is related to different cumulative live-birth delivery rates and eventual use of donor egg, ICSI, and FET. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Adverse pregnancy and birth outcomes associated with underlying diagnosis with and without assisted reproductive technology treatment.

    PubMed

    Stern, Judy E; Luke, Barbara; Tobias, Michael; Gopal, Daksha; Hornstein, Mark D; Diop, Hafsatou

    2015-06-01

    To compare the risks for adverse pregnancy and birth outcomes by diagnoses with and without assisted reproductive technology (ART) treatment to non-ART pregnancies in fertile women. Historical cohort of Massachusetts vital records linked to ART clinic data from Society for Assisted Reproductive Technology Clinic Outcome Reporting System. Not applicable. Diagnoses included male factor (ART only), endometriosis, ovulation disorders, tubal (ART only), and reproductive inflammatory disorders (non-ART only). Pregnancies resulting in singleton and twin live births from 2004 to 2008 were linked to hospital discharges in women who had ART treatment (n = 3,689), women with no ART treatment in the current pregnancy (n = 4,098), and non-ART pregnancies in fertile women (n = 297,987). None. Risks of gestational diabetes, prenatal hospitalizations, prematurity, low birth weight, and small for gestational age were modeled using multivariate logistic regression with fertile deliveries as the reference group adjusted for maternal age, race/ethnicity, education, chronic hypertension, diabetes mellitus, and plurality (adjusted odds ratios [AORs] and 95% confidence intervals [CIs]). Risk of prenatal hospital admissions was increased for endometriosis (ART: 1.97, 1.38-2.80; non-ART: 3.34, 2.59-4.31), ovulation disorders (ART: 2.31, 1.81-2.96; non-ART: 2.56, 2.05-3.21), tubal factor (ART: 1.51, 1.14-2.01), and reproductive inflammation (non-ART: 2.79, 2.47-3.15). Gestational diabetes was increased for women with ovulation disorders (ART: 2.17, 1.72-2.73; non-ART: 1.94, 1.52-2.48). Preterm delivery (AORs, 1.24-1.93) and low birth weight (AORs, 1.27-1.60) were increased in all groups except in endometriosis with ART. The findings indicate substantial excess perinatal morbidities associated with underlying infertility-related diagnoses in both ART-treated and non-ART-treated women. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. 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... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

  16. 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... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

  17. 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... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

  18. 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... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

  19. 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... Assisted reproduction laser system. (a) Identification. The assisted reproduction laser system is a device that images, targets, and controls the power and pulse duration of a laser beam used to ablate a small...

  20. Age-specific cost and public funding of a live birth following assisted reproductive treatment in Japan.

    PubMed

    Maeda, Eri; Ishihara, Osamu; Saito, Hidekazu; Kuwahara, Akira; Toyokawa, Satoshi; Kobayashi, Yasuki

    2014-05-01

    The aim of this study was to calculate and assess the cost of assisted reproductive technology (ART) treatment cycles and live-birth events in Japan in 2010. We performed a retrospective analysis of 238,185 ART cycles, registered with the national registry of assisted reproductive treatment during 2010. Costs were calculated, using a decision analysis model. The average cost per live birth was ¥1,974,000. This varied from ¥1,155,000 in women aged < 30 years to ¥50,189,000 in women aged ≥ 45, which was 29.6 times higher than that of women aged 35-39 years. This rose sharply in the early 40s and upwards. Public funding per live birth was ¥442,000. This was ¥6,118,000 in women aged ≥ 45, 15.4 times higher than that of the 35-39-year-old age group. The costs and public funding of a live birth after ART treatment rises with age due to the lower success rates in older women. It may provide economic background to improve the current subsidy system for ART and to provide practical knowledge about fertility for the general population. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  1. Assisted reproduction and risk of preterm birth in singletons by infertility diagnoses and treatment modalities: a population-based study.

    PubMed

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

    2017-11-01

    The purpose of this study is to examine the spectrum of infertility diagnoses and assisted reproductive technology (ART) treatments in relation to risk of preterm birth (PTB) in singletons. Population-based assisted reproductive technology surveillance data for 2000-2010 were linked with birth certificates from three states: Florida, Massachusetts, and Michigan, resulting in a sample of 4,370,361 non-ART and 28,430 ART-related singletons. Logistic regression models with robust variance estimators were used to compare PTB risk among singletons conceived with and without ART, the former grouped by parental infertility diagnoses and treatment modalities. Demographic and pregnancy factors were included in adjusted analyses. ART was associated with increased PTB risk across all infertility diagnosis groups and treatment types: for conventional ART, adjusted relative risks ranged from 1.4 (95% CI 1.0, 1.9) for male infertility to 2.4 (95% CI 1.8, 3.3) for tubal ligation. Adding intra-cytoplasmic sperm injection and/or assisted hatching to conventional ART treatment did not alter associated PTB risks. Singletons conceived by mothers without infertility diagnosis and with donor semen had an increased PTB risk relative to non-ART singletons. PTB risk among ART singletons is increased within each treatment type and all underlying infertility diagnosis, including male infertility. Preterm birth in ART singletons may be attributed to parental infertility, ART treatments, or their combination.

  2. Costs of medically assisted reproduction treatment at specialized fertility clinics in the Danish public health care system: results from a 5-year follow-up cohort study.

    PubMed

    Christiansen, Terkel; Erb, Karin; Rizvanovic, Amra; Ziebe, Søren; Mikkelsen Englund, Anne L; Hald, Finn; Boivin, Jacky; Schmidt, Lone

    2014-01-01

    To examine the costs to the public health care system of couples in medically assisted reproduction. Longitudinal cohort study of infertile couples initiating medically assisted reproduction treatment. Specialized public fertility clinics in Denmark. Seven hundred and thirty-nine couples having no child at study entry and with data on kind of treatment and live birth (yes/no) for each treatment attempt at the specialized public fertility clinic. Treatment data for medically assisted reproduction attempts conducted at the public fertility clinics were abstracted from medical records. Flow diagrams were drawn for different standard treatment cycles and direct costs at each stage in the flow charts were measured and valued by a bottom-up procedure. Indirect costs were distributed to each treatment cycle on the basis of number of visits as basis. Costs were adjusted to 2012 prices using a constructed medical price index. Live birth, costs. Total costs per live birth in 2012 prices were estimated to 10,755€. Costs per treated couple - irrespective of whether the treatment was terminated by a live birth or not - were estimated at 6607€. Costs per live birth of women <35 years at treatment initiation were 9338€ and 15,040€ for women ≥35 years. The public costs for live births after conception with medically assisted reproduction treatment are relatively modest. The results can be generalized to public fertility treatment in Denmark and to other public treatment settings with similar limitations in numbers of public treatment cycles offered. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  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. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  4. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... controls) (design specifications, labeling requirements, and clinical testing). .... Assisted reproduction micromanipulators are devices intended to control the position of an assisted reproduction microtool. Assisted reproduction microinjectors are any device intended to control aspiration or...

  5. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... controls) (design specifications, labeling requirements, and clinical testing). .... Assisted reproduction micromanipulators are devices intended to control the position of an assisted reproduction microtool. Assisted reproduction microinjectors are any device intended to control aspiration or...

  6. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... controls) (design specifications, labeling requirements, and clinical testing). .... Assisted reproduction micromanipulators are devices intended to control the position of an assisted reproduction microtool. Assisted reproduction microinjectors are any device intended to control aspiration or...

  7. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... controls) (design specifications, labeling requirements, and clinical testing). .... Assisted reproduction micromanipulators are devices intended to control the position of an assisted reproduction microtool. Assisted reproduction microinjectors are any device intended to control aspiration or...

  8. 21 CFR 884.6150 - Assisted reproduction micromanipulators and microinjectors.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... controls) (design specifications, labeling requirements, and clinical testing). .... Assisted reproduction micromanipulators are devices intended to control the position of an assisted reproduction microtool. Assisted reproduction microinjectors are any device intended to control aspiration or...

  9. A practical blueprint to systematically study life-long health consequences of novel medically assisted reproductive treatments

    PubMed Central

    Mulder, Callista L; Serrano, Joana B; Catsburg, Lisa A E; Roseboom, Tessa J; Repping, Sjoerd; van Pelt, Ans M M

    2018-01-01

    Abstract In medicine, safety and efficacy are the two pillars on which the implementation of novel treatments rest. To protect the patient from unnecessary or unsafe treatments, usually, a stringent path of (pre) clinical testing is followed before a treatment is introduced into routine patient care. However, in reproductive medicine several techniques have been clinically introduced without elaborate preclinical studies. Moreover, novel reproductive techniques may harbor safety risks not only for the patients undergoing treatment, but also for the offspring conceived through these techniques. If preclinical (animal) studies were performed, efficacy and functionality the upper hand. When a new medically assisted reproduction (MAR) treatment was proven effective (i.e. if it resulted in live birth) the treatment was often rapidly implemented in the clinic. For IVF, the first study on the long-term health of IVF children was published a decade after its clinical implementation. In more recent years, prospective follow-up studies have been conducted that provided the opportunity to study the health of large groups of children derived from different reproductive techniques. Although such studies have indicated differences between children conceived through MAR and children conceived naturally, results are often difficult to interpret due to the observational nature of these studies (and the associated risk of confounding factors, e.g. subfertility of the parents), differences in definitions of clinical outcome measures, lack of uniformity in assessment protocols and heterogeneity of the underlying reasons for fertility treatment. With more novel MARs waiting at the horizon, there is a need for a framework on how to assess safety of novel reproductive techniques in a preclinical (animal) setting before they are clinically implemented. In this article, we provide a blueprint for preclinical testing of safety and health of offspring generated by novel MARs using a mouse

  10. 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) Identification...

  11. 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) Identification...

  12. Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry.

    PubMed

    2007-06-01

    To summarize the procedures and outcomes of assisted reproductive technologies (ART) that were initiated in the United States in 2001. Data were collected electronically using the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/SART Registry. Three hundred eighty-five clinics submitted data on procedures performed in 2001. Data were collated after November 2002 [corrected] so that the outcomes of all pregnancies would be known. Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. Programs reported initiating 108,130 cycles of ART treatment. Of these, 79,042 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 31.6%; 340 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 21.9%; 661 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 31.0%. The following additional ART procedures were also initiated: 8,147 fresh donor oocyte cycles, with a delivery rate per transfer of 47.3%; 14,509 frozen ET procedures, with a delivery rate per transfer of 23.5%; 3,187 frozen ETs employing donated oocytes or embryos, with a delivery rate per transfer of 27.4%; and 1,366 cycles using a host uterus, with a delivery rate per transfer of 38.7%. In addition, 112 cycles were reported as combinations of more than one treatment type, 8 cycles as research, and 85 as embryo banking. As a result of all procedures, 29,585 deliveries were reported, resulting in 41,168 neonates. In 2001, there were more programs reporting ART treatment and a significant increase in reported cycles compared with 2000.

  13. Assisted reproduction treatment and epigenetic inheritance

    PubMed Central

    van Montfoort, A.P.A.; Hanssen, L.L.P.; de Sutter, P.; Viville, S.; Geraedts, J.P.M.; de Boer, P.

    2012-01-01

    BACKGROUND The subject of epigenetic risk of assisted reproduction treatment (ART), initiated by reports on an increase of children with the Beckwith–Wiedemann imprinting disorder, is very topical. Hence, there is a growing literature, including mouse studies. METHODS In order to gain information on transgenerational epigenetic inheritance and epigenetic effects induced by ART, literature databases were searched for papers on this topic using relevant keywords. RESULTS At the level of genomic imprinting involving CpG methylation, ART-induced epigenetic defects are convincingly observed in mice, especially for placenta, and seem more frequent than in humans. Data generally provide a warning as to the use of ovulation induction and in vitro culture. In human sperm from compromised spermatogenesis, sequence-specific DNA hypomethylation is observed repeatedly. Transmittance of sperm and oocyte DNA methylation defects is possible but, as deduced from the limited data available, largely prevented by selection of gametes for ART and/or non-viability of the resulting embryos. Some evidence indicates that subfertility itself is a risk factor for imprinting diseases. As in mouse, physiological effects from ART are observed in humans. In the human, indications for a broader target for changes in CpG methylation than imprinted DNA sequences alone have been found. In the mouse, a broader range of CpG sequences has not yet been studied. Also, a multigeneration study of systematic ART on epigenetic parameters is lacking. CONCLUSIONS The field of epigenetic inheritance within the lifespan of an individual and between generations (via mitosis and meiosis, respectively) is growing, driven by the expansion of chromatin research. ART can induce epigenetic variation that might be transmitted to the next generation. PMID:22267841

  14. Nuchal translucency in pregnancies conceived after assisted reproduction technology.

    PubMed

    Hui, Pui Wah; Lee, Chin Peng; Tang, Mary Hoi Yin; Ho, Pak Chung

    2006-06-01

    Nuchal translucency is one of the important markers in the first trimester during antenatal screening for fetal Down's syndrome. With the observation of alterations in biochemical markers in pregnancies conceived after assisted reproduction, this review presents current information related to the thickness of nuchal translucency in these pregnancies. Early small studies did not demonstrate any discrepancy in the thickness of nuchal translucency in fetuses from assisted reproduction and from spontaneous pregnancies, but there has been recent evidence to suggest an increased level of nuchal translucency in singletons from various modes of assisted-reproduction technology. Nuchal translucency in twins following assisted reproduction did not, however, show a similar increase. Although the effect of chorionicity was not specifically addressed, nuchal translucency thickness in twins born after assisted reproduction was reported to be comparable to that in spontaneous singletons. It is possible that singletons and twins after assisted reproduction exhibit different antenatal behavior and pregnancy courses. Similar to other biochemical markers of fetal Down's syndrome, nuchal translucency is increased in singletons after assisted-reproduction technology. Further studies on twin pregnancies, in particular dichorionic twins, are necessary before conclusive evidence can be drawn for multiple pregnancies.

  15. [Gross characteristics of placentas from an assisted reproduction program].

    PubMed

    Tabs, Dunja; Vejnović, Tihomir; Lalosević, Dusan; Radunović, Nebojsa

    2006-01-01

    Even though placentas from assisted reproduction programs often differ from placentas of women who conceived naturally, they are rarely examined. The aim of our investigation was to determine some gross characteristics of placentas of women who conceived with assisted reproduction. We examined 30 placentas from an assisted reproduction program (20 from in vitro fertilization and 10 from intrauterine insemination) and 30 placentas of women who conceived naturally. All women were age matched. All the women were at term. The mean weight of placentas from assisted reproduction program was 573 g and of those after natural conception--582.67g. The mean length of the umbilical cords was 64.3cm after assisted reproduction and 66.3cm after natural conception. The mean placenta thickness after assisted reproduction was 2,22 cm and after natural conception 2.28 cm. Eight placentas of the study group had a marginal insertion of the umbilical cord, which lead to a statistically significant difference when compared to placentas of women who conceived naturally: chi-square = 7.07; p>0.01. Marginal cord insertion into the placenta after assisted reproduction is also often described in the literature (as a possible "consequence" of embryo-transfer). There were no statistically significant differences in the mean weight and dimensions of placentas, length of the umbilical cord, gross pathological features of placentas and cords, mean birth weight of babies and placental/fetal ratios between women from assisted reproduction program and those who conceived naturally.

  16. 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. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  17. International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2008, 2009 and 2010.

    PubMed

    Dyer, S; Chambers, G M; de Mouzon, J; Nygren, K G; Zegers-Hochschild, F; Mansour, R; Ishihara, O; Banker, M; Adamson, G D

    2016-07-01

    were, in 2008, 2009 and 2010, 21.8, 20.5 and 20.4%, respectively, with a corresponding triplet rate of 1.3, 1.0 and 1.1%. Fresh IVF and ICSI carried a perinatal mortality rate per 1000 births of 22.8 (2008), 19.2 (2009) and 21.0 (2010), compared with 15.1, 12.8 and 14.6/1000 births following FET in the same periods of observation. The proportion of women aged 40 years or older undergoing non-donor ART increased from 20.8 to 23.2% from 2008 to 2010. The data presented are reliant on the quality and completeness of data submitted by individual countries. This report covers approximately two-thirds of the world ART activity. The ICMART World Reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment continues to increase globally, the wide disparities in access to treatment and embryo transfer practices warrant attention by clinicians and policy makers. The authors declare no conflict of interest and no specific support from any organizations in relation to this manuscript. ICMART acknowledges financial support from the following organizations: American Society for Reproductive Medicine; European Society for Human Reproduction and Embryology; Fertility Society of Australia; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproduccion Asistida; Society for Assisted Reproductive Technology; Government of Canada (Research grant), Ferring Pharmaceuticals (Grant unrelated to World Reports). not applicable. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Assisted reproductive technology in Japan: a summary report of 1992-2014 by the Ethics Committee, Japan Society of Obstetrics and Gynecology.

    PubMed

    Irahara, Minoru; Kuwahara, Akira; Iwasa, Takeshi; Ishikawa, Tomonori; Ishihara, Osamu; Kugu, Koji; Sawa, Rintaro; Banno, Kouji; Saito, Hidekazu

    2017-04-01

    The Japan Society of Obstetrics and Gynecology implemented a registry report system for the clinical practice of assisted reproductive technology in 1986. The aggregated results from 1992 to 2014 are reported herein. The total number of registered treatments was 393 745 cycles, of which 66 550 were pregnancy cycles and 46 008 were cycles with a live birth. Compared to the number of registered treatments in 2008, when the cycle-based registry was newly introduced, there was a 2.07-fold increase in the total number of treatments and a 2.25-fold increase in the number of cycles with a live birth. As the average age of patients who receive assisted reproductive technology has become markedly higher year by year, the most common age of those patients who received assisted reproductive technology in 2014 was 40 years. The total numbers of both assisted reproductive technology treatments and assisted reproductive technology live births are likely to be higher in the future. In addition, the trend toward aging patients seems to be continuing into the future.

  19. Same-sex reproduction: medical treatment options and psychosocial considerations.

    PubMed

    Greenfeld, Dorothy A; Seli, Emre

    2016-06-01

    This review provides an overview of the historical significance of assisted reproduction for gay men and women, discusses current reproductive options for same-sex couples, addresses psychosocial considerations unique to these couples, and reviews the current literature addressing medical and psychosocial aspects of same-sex reproduction. Growing numbers of men and women openly self-identify as gay and lesbian. Accompanying this openness is an increased public acceptance of same-sex relationships and same-sex marriage. The combination of gay/lesbian self-determination and mounting public acceptance of same-sex unions has led these individuals and couples to increasingly seek parenthood through assisted reproduction. Recent studies describe relationship satisfaction in gay couples after assisted reproduction and more positive functioning and less stress associated with parenthood when compared with heterosexual parents. Motivations for parenthood are the same for same-sex couples and heterosexual couples alike. However, achieving the goal of parenthood can be a much greater endeavor medically and psychologically for same-sex couples. Fertility treatment centers increasingly recognize issues unique to gay men and women and are increasingly welcoming.

  20. 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.

  1. Nuchal translucency in dichorionic twins conceived after assisted reproduction.

    PubMed

    Hui, P W; Tang, M H Y; Ng, E H Y; Yeung, W S B; Ho, P C

    2006-06-01

    As opposed to biochemical markers of Down syndrome, nuchal translucency (NT) was once thought to be a more reliable screening marker for high order multiple pregnancies and pregnancies conceived after assisted conception. Recent data suggested that NT in singleton fetuses from assisted reproduction technology (ART) was thicker than those from singleton pregnancies. The present study compared the thickness of NT in dichorionic twins from natural conception and assisted reproduction. A retrospective analysis for comparison of NT thickness on 3319 spontaneous singletons, 19 pairs of spontaneous twins and 27 pairs of assisted reproduction twins was performed. The median NT multiple of median (MoM) of spontaneous singletons was 1.00. For twins, the median NT MoM for pregnancies after assisted reproduction and natural conception were 1.02 and 1.07 respectively. There was no statistical difference in the NT thickness among the three pregnancy groups. Contrary to the observed increase in NT in singleton pregnancies from assisted reproduction, the NT in dichorionic twins was comparable to the spontaneous ones. The mode of conception appears to impose differential influence on singletons and twins. Copyright (c) 2006 John Wiley & Sons, Ltd.

  2. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... embryos for assisted hatching, intracytoplasmic sperm injection (ICSI), or other assisted reproduction methods. (b) Classification. Class II (special controls) (mouse embryo assay information, endotoxin...

  3. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... embryos for assisted hatching, intracytoplasmic sperm injection (ICSI), or other assisted reproduction methods. (b) Classification. Class II (special controls) (mouse embryo assay information, endotoxin...

  4. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... embryos for assisted hatching, intracytoplasmic sperm injection (ICSI), or other assisted reproduction methods. (b) Classification. Class II (special controls) (mouse embryo assay information, endotoxin...

  5. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... embryos for assisted hatching, intracytoplasmic sperm injection (ICSI), or other assisted reproduction methods. (b) Classification. Class II (special controls) (mouse embryo assay information, endotoxin...

  6. 21 CFR 884.6130 - Assisted reproduction microtools.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... embryos for assisted hatching, intracytoplasmic sperm injection (ICSI), or other assisted reproduction methods. (b) Classification. Class II (special controls) (mouse embryo assay information, endotoxin...

  7. Does age of the sperm donor influence live birth outcome in assisted reproduction?

    PubMed

    Ghuman, N K; Mair, E; Pearce, K; Choudhary, M

    2016-03-01

    Does age of the sperm donor have an effect on reproductive outcomes (live birth rate and miscarriage occurrence) of donor insemination or in vitro fertilization treatment using donated sperm? Live birth and miscarriage occurrence in assisted reproduction treatment using donor sperms was not found to be affected by the age of sperm donors up to 45 years old. Literature on the effect of sperm donor age on outcome of medically assisted reproduction is scarce. Most researchers agree that semen parameters deteriorate with increasing paternal age. However, there is no substantial evidence to suggest that this deterioration adversely affects the reproductive outcomes in couples undergoing medically assisted reproduction. This retrospective cohort study analysed 46 078 first donor insemination treatments and fresh in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles using donated sperm from 1991 to 2012. The first fresh donor insemination and IVF/ICSI treatment cycles (46 078 treatment cycles) using donated sperm from the long-term anonymized data registry from 1991 to 2012 of the HFEA, the UK regulator, were analysed by the binary logistic modelling technique for association between sperm donor age and reproductive outcomes (live birth occurrence and miscarriage occurrence). The statistical package SPSS (version 21) was used for analysis and results were considered to be statistically significant if the P-value was <0.05. Of 46 078 women, 84.6% (N = 38 974) underwent donor insemination treatment and the remainder, 15.4% (N = 7104), had IVF/ICSI treatment with donor sperm. The live birth occurrence decreased with increasing female age in both treatment groups; In the donor insemination treatment group, it was 11.1% in 18-34 year old women, 8.3% in 35-37 year old women and 4.7% in 38-50 year old women. The corresponding figures in the IVF/ICSI treatment group were 28.9, 22.0 and 12.9% respectively. In each of these subgroups, no evidence of declining

  8. 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 quality...

  9. 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 quality...

  10. 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 quality...

  11. 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 quality...

  12. 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 quality...

  13. 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. © 2013 John Wiley & Sons Ltd.

  14. [Difference between perinatal mortality in multiple pregnancies obtained spontaneously versus assisted reproduction].

    PubMed

    del Rayo Rivas-Ortiz, Yazmín; Hernández-Herrera, Ricardo Jorge

    2010-06-01

    Recently assisted reproduction techniques are more common, which increases multiple pregnancies and adverse perinatal outcomes. Some authors report increased mortality in multiple pregnancies products obtained by techniques of assisted reproduction vs. conceived spontaneously, although other authors found no significant difference. To evaluate mortality rate of multiple pregnancies comparing those obtained by assisted reproduction vs. spontaneous conception. Retrospective, observational and comparative study. We included pregnant women with 3 or more products that went to the Unidad Médica de Alta Especialidad No. 23, IMSS, in Monterrey, NL (Mexico), between 2002-2008. We compared the number of complicated pregnancies and dead products obtained by a technique of assisted reproduction vs. spontaneous. 68 multiple pregnancies were included. On average, spontaneously conceived fetuses had more weeks of gestation and more birth weight than those achieved by assisted reproduction techniques (p = ns). 20.5% (14/68) of multiple pregnancies had one or more fatal events: 10/40 (25%) by assisted reproduction techniques vs. 4/28 (14%) of spontaneous multiple pregnancies (p = 0.22). 21/134 (16%) of the products conceived by assisted reproduction techniques and 6/88 (7%) of spontaneous (p < 0.03) died. 60% of all multiple pregnancies were obtained by a technique of assisted reproduction and 21% of the cases had one or more fatal events (11% more in pregnancies achieved by assisted reproduction techniques). 12% of the products of multiple pregnancies died (9% more in those obtained by a technique of assisted reproduction).

  15. 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.

  16. The role of adiponectin in reproduction: from polycystic ovary syndrome to assisted reproduction

    PubMed Central

    Michalakis, Konstantinos G.; Segars, James H.

    2011-01-01

    Objective To summarize the effects of the adipokine adiponectin on the reproductive endocrine system, from the hypothalamic-pituitary axis to the gonads and target tissues of the reproductive system. Design A Medline computer search was performed to identify relevant articles. Setting Research institution. Intervention(s) None. Result(s) Adiponectin is a hormone secreted by adipose tissue that acts to reduce insulin resistance and atherogenic damage, but it also exerts actions in other tissues. Adiponectin mediates its actions in the periphery mainly via two receptors, AdipoR1 and AdipoR2. Adiponectin receptors are present in many reproductive tissues, including the central nervous system, ovaries, oviduct, endometrium, and testes. Adiponectin influences gonadotropin release, normal pregnancy, and assisted reproduction outcomes. Conclusion(s) Adiponectin, a beneficial adipokine, represents a major link between obesity and reproduction. Higher levels of adiponectin are associated with improved menstrual function and better outcomes in assisted reproductive cycles. PMID:20561616

  17. Assisted reproductive technologies: a hierarchy of risks for conception, pregnancy outcomes and treatment decisions.

    PubMed

    Davies, M J; Rumbold, A R; Moore, V M

    2017-08-01

    The use of assisted reproductive technologies (ART) for the treatment of infertility has grown exponentially over the last 20 years, and now accounts for 4% of all births in Australia, and over 1 m births annually around the globe. There is consistent reporting of increased risk of adverse perinatal outcomes and birth defects following infertility treatment. However, change in practice has been stymied by critical knowledge gaps with regards to (a) the relative contribution of patient and treatment factors to adverse outcomes, (b) the independent contribution of specific contemporary treatments and treatment combinations to outcomes, (c) the impact of innovations in laboratory and clinical practice on treatment success and observed risk and (d) changes over time in patient characteristics. Here we summarize key findings from the South Australian Birth Cohort, which is a whole-of-population cohort of over 300,000 births from 1986 to 2002. Relative to spontaneous conceptions, singletons from assisted conception were more likely to be stillborn [odds ratio (OR)=1.82; 95% confidence interval (CI) 1.34-2.48], while survivors as a group were comprehensively disadvantaged at birth, including lower birth weight (OR=2109 g; 95% CI 2129-289), very low birth weight (OR=2.74; 95% CI 2.19-3.43), very preterm birth (OR=2.30; 95% CI 1.82-2.90) and neonatal death (OR=2.04; 95% CI 1.27-3.26). Major birth defects, including cardiac, urogenital and musculoskeletal defects are doubled after fresh ICSI cycles, which is a particular concern as ICSI now accounts for 70% of all treatment cycles globally. Future study is needed to provide contemporary, precise evidence to inform patient and clinic decision making, and generate knowledge for future innovation in ART laboratory methods and clinical practice, thereby optimizing treatment and health outcomes while reducing adverse events.

  18. The Use of Proteomics in Assisted Reproduction.

    PubMed

    Kosteria, Ioanna; Anagnostopoulos, Athanasios K; Kanaka-Gantenbein, Christina; Chrousos, George P; Tsangaris, George T

    2017-01-01

    Despite the explosive increase in the use of Assisted Reproductive Technologies (ART) over the last 30 years, their success rates remain suboptimal. Proteomics is a rapidly-evolving technology-driven science that has already been widely applied in the exploration of human reproduction and fertility, providing useful insights into its physiology and leading to the identification of numerous proteins that may be potential biomarkers and/or treatment targets of a successful ART pregnancy. Here we present a brief overview of the techniques used in proteomic analyses and attempt a comprehensive presentation of recent data from mass spectrometry-based proteomic studies in humans, regarding all components of ARTs, including the male and female gamete, the derived zygote and embryo, the endometrium and, finally, the ART offspring both pre- and postnatally. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  19. The place of reconstructive tubal surgery in the era of assisted reproductive techniques.

    PubMed

    Gomel, Victor

    2015-12-01

    Assisted reproductive techniques yield high rates of success for women with tubal factor infertility. Because they are potentially effective for all categories of infertility, for two decades, clinical and basic research in infertility has been focused on IVF techniques and outcomes, rather than developing surgical techniques or training infertility subspecialists in tubal microsurgery. Nonetheless, in comparison with IVF, reconstructive tubal surgery is inexpensive and offers multiple opportunities to attempt conception. Performing laparoscopic salpingostomy prior to IVF in women with good prognosis tubal disease may improve the outcome of subsequent IVF, while offering the potential for spontaneous conception. Tubo-tubal anastomosis for reversal of tubal ligation, performed either by a microsurgical technique through a mini-laparotomy or by laparoscopy, is preferable to IVF in younger women with no other fertility factors, because it offers potentially higher cumulative pregnancy rates. Surgery is the only alternative for women with tubal factor infertility who for personal or other reasons are unable to undergo assisted reproductive techniques. Tubal reconstructive surgery and assisted reproductive techniques must be considered complementary forms of treatment for women with tubal factor infertility, and training in tubal reconstructive surgery should be an integral part of subspecialty training in reproductive endocrinology and infertility. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  20. [Assisted reproductive medicine in Poland, 2011--SPiN PTG report].

    PubMed

    Janicka, Anna; Spaczyński, Robert Z; Kurzawa, Rafał

    2014-07-01

    The aim of this report is to present data concerning results and complications related to infertility treatment using assisted reproductive technology (ART) and insemination (IUI) in Poland in 2011. The report was prepared by the Fertility and Sterility Special Interest Group of the Polish Gynaecological Society (SPiN PTG), based on individual data provided by fertility clinics in Poland. Reporting was voluntary and the provided data was not subject to external control. The report presents the availability and the structure of infertility treatment services, the number of procedures performed, their effectiveness and the most common complications. In 2013, 33 Polish fertility clinics provided information to the SPiN PTG report, presenting data from the year 2011. The total number of reported treatment cycles using ART was 15,340 (incl. 10,011 IVF/ICSI procedures) and 15,627 IUI procedures. The rate of clinical pregnancies in terms of a cycle was 34.2% in case of IVF/ ICSI procedures and 13.4% in case of IUI. The prevalence of multiple births was 20.2% and 8.3% respectively in case of IVF/ICSI and IUI methods. The most frequent complication in the course of treatment using ART was ovarian hyperstimulation syndrome (OHSS). The SPiN PTG report allows to find out the average effectiveness and safety of assisted reproduction technologies and is currently the only proof of responsibility and due diligence of fertility centres in Poland. However due to the lack of a central register of fertility clinics, facultative participation in the report as well as incomplete information on pregnancy and delivery the collected data does not reflect the full spectrum of the Polish reproductive medicine.

  1. 21 CFR 884.6190 - Assisted reproductive microscopes and microscope accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... contrast microscopes, dissecting microscopes and inverted stage microscopes. (b) Classification. Class I... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Assisted reproductive microscopes and microscope... Devices § 884.6190 Assisted reproductive microscopes and microscope accessories. (a) Identification...

  2. Assisted reproductive technology has no association with autism spectrum disorders: The Taiwan Birth Cohort Study.

    PubMed

    Lung, For-Wey; Chiang, Tung-Liang; Lin, Shio-Jean; Lee, Meng-Chih; Shu, Bih-Ching

    2018-04-01

    The use of assisted reproduction technology has increased over the last two decades. Autism spectrum disorders and assisted reproduction technology share many risk factors. However, previous studies on the association between autism spectrum disorders and assisted reproduction technology have shown inconsistent results. The purpose of this study was to investigate the association between assisted reproduction technology and autism spectrum disorder diagnosis in a national birth cohort database. Furthermore, the results from the assisted reproduction technology and autism spectrum disorder propensity score matching exact matched datasets were compared. For this study, the 6- and 66-month Taiwan Birth Cohort Study datasets were used (N = 20,095). In all, 744 families were propensity score matching exact matched and selected as the assisted reproduction technology sample (ratio of assisted reproduction technology to controls: 1:2) and 415 families as the autism spectrum disorder sample (ratio of autism spectrum disorder to controls: 1:4). Using a national birth cohort dataset, controlling for the confounding factors of assisted reproduction technology conception and autism spectrum disorder diagnosis, both assisted reproduction technology and autism spectrum disorder propensity score matching matched datasets showed the same results of no association between assisted reproduction technology and autism spectrum disorder. Further study on the detailed information regarding the processes and methods of assisted reproduction technology may provide us with more information on the association between assisted reproduction technology and autism spectrum disorder.

  3. Assisted reproductive technologies and children's neurodevelopmental outcomes.

    PubMed

    Hediger, Mary L; Bell, Erin M; Druschel, Charlotte M; Buck Louis, Germaine M

    2013-02-01

    Initial reports suggested that children conceived with assisted reproductive technologies (ART) may be at increased risk for a spectrum of developmental disabilities. Evolving evidence suggests that some of the early risks may have been overstated when not taking plurality of birth or gestational age at delivery into consideration, as both are independent risk factors for neurodevelopmental disabilities arising from alterations in structure and function or limitations in activities. Continued research is needed to overcome lingering data gaps in light of the equivocal literature for many neurodevelopmental disabilities relative to ART, increasing utilization of services, and changes in the clinical management of infecund couples such as the adoption of natural cycles or in vitro maturation treatment options. Population-based cohorts with longitudinal assessment of the multifaceted nature of neurodevelopment across critical and sensitive windows is paramount for the development of empirically based guidance for clinical and population health. Copyright © 2013 American Society for Reproductive Medicine. All rights reserved.

  4. [Evolution of assisted reproductive technologies].

    PubMed

    Jouannet, Pierre

    2009-03-01

    When natural conception is impossible and the underlying problem cannot be treated, medical intervention can reproduce the steps necessary for fertilization and early embryo development. The first known medical action in the field of human reproduction took place at the end of the 18th century, in the form of artificial insemination with the husband's semen, thus dissociating sexual intercourse from procreation. A further upheaval occurred at the end of the 19th century, with the use of donor sperm, separating the notions of genetic descent and parenthood. In the second half of the 20th century, medically assisted procreation saw two major technological advances, namely gamete freezing and in vitro fertilization (IVF). The first child conceived with frozen-thawed sperm was born in 1953, and the first IVF baby in 1978. Fertilization by intracytoplasmic sperm injection (ICSI), first developed in 1992, can overcome many causes of male infertility. The convergence of reproductive biology and genetics has now opened up the possibility of screening for chromosome and gene defects in the embryo, prior to implantation. Thus, assisted reproductive technologies (ART) not only serve as a substitute for natural conception but can also avoid the birth of a disabled child While new technologies continue to extend the available options for infertile couples, they also have the potential to help single women and homosexual couples to have children. These practices are currently only accepted in certain countries. Overall, these new medical technologies have contributed to changing our conception of human reproduction, opening up new paradigms of parenthood and raising new challenges for society.

  5. Ethical and legal aspects in medically assisted human reproduction in Romania.

    PubMed

    Ioan, Beatrice; Astarastoae, Vasile

    2008-01-01

    Up to the present, there have not been any specific norms regarding medically assisted human reproduction in Romanian legislation. Due to this situation the general legislation regarding medical assistance (law no. 95/2006, regarding the Reform in Health Care System), the Penal and Civil law and the provisions of the Code of Deontology of the Romanian College of Physicians are applied to the field of medically assisted human reproduction. By analysing the ethical and legal conflicts regarding medically assisted human reproduction in Romania, some characteristics cannot be set apart because they derive from religious, cultural and socio-economic aspects. In this article the authors identify the development stages of medically assisted human reproduction in Romania, beginning from these characteristics and insisting upon the failure of the legal system in this specific field. The authors consider that the law regarding medically assisted human reproduction cannot be effective because it did not take into account the ethical and cultural aspects that might appear. Furthermore, in this framework of the legal process, no public debate involving the representatives of civil society was undertaken although the Council of Europe Oviedo Convention approved by our country according to law no. 17/2001 stipulated exactly this working method.

  6. Use of assisted reproductive technology treatment as reported by mothers in comparison with registry data: the Upstate KIDS Study.

    PubMed

    Buck Louis, Germaine M; Druschel, Charlotte; Bell, Erin; Stern, Judy E; Luke, Barbara; McLain, Alexander; Sundaram, Rajeshwari; Yeung, Edwina

    2015-06-01

    To assess the validity of maternally reported assisted reproductive technologies (ART) use and to identify predictors of reporting errors. Linkage study. Not applicable. A total of 5,034 (27%) mothers enrolled, from whom 4,886 (97%) self-reported information about use of infertility treatment, including ART, for the index birth. None. Four measures of validity (sensitivity, specificity, positive and negative predictive values) and use of net reclassification improvement (NRI) methods to identify predictors associated with concordant/discordant maternal reporting. The Upstate New York Infant Development Screening Program (Update KIDS Study) was linked with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) using a defined algorithm for 2008-2010. The sensitivity, specificity, positive and negative predictive values were high (0.93, 0.99, 0.80, and 1.00, respectively). The validity of maternal report was high, reflecting few differences by participant characteristics except for maternal age dichotomized at 29 years as identified with NRI methods. Maternally reported ART is valid, with little variation across various characteristics. No strong predictors of discordant reporting were found, supporting the utility of population-based research with SART CORS linkage. Published by Elsevier Inc.

  7. [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.

  8. 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

    2017-05-01

    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.

  9. 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.

  10. Reproduction beyond menopause: how old is too old for assisted reproductive technology?

    PubMed Central

    Havemann, Dara L.; Phelps, John Y.

    2010-01-01

    Background Due to the recent media attention on postmenopausal women giving birth, there has been an increased scrutiny on the utility and safety of assisted reproductive technology in postmenopausal women. Objective The purpose of this commentary is to discuss the following: 1) the limitations and complications of ART in women of advanced reproductive age; 2) the balance between the welfare of the mother and that of the child; 3) the double standards of advanced reproductive age; and 4) the importance of financial and social support systems and preconception counseling with advanced reproductive age. Conclusion When providing in-vitro fertilization services to women of advanced reproductive age, special considerations must be given to ensure the welfare of mother and the child and that the principles of beneficence and nonmaleficence are guaranteed. PMID:20454846

  11. Maternal plasma DNA testing for aneuploidy in pregnancies achieved by assisted reproductive technologies.

    PubMed

    Lambert-Messerlian, Geralyn; Kloza, Edward M; Williams, John; Loucky, Jaroslav; O'Brien, Barbara; Wilkins-Haug, Louise; Mahoney, Maurice J; De Biasio, Pierangela; Borrell, Antoni; Ehrich, Mathias; van den Boom, Dirk; Bombard, Allan T; Deciu, Cosmin; Palomaki, Glenn E

    2014-05-01

    We sought to compare measurements of circulating cell-free DNA as well as Down syndrome test results in women with naturally conceived pregnancies with those conceived using assisted reproductive technologies. Data regarding assisted reproductive technologies were readily available from seven enrollment sites participating in an external clinical validation trial of nested case/control design. Measurements of circulating cell-free fetal and total DNA, fetal fraction (ratio of fetal to total DNA), chromosome-specific z-scores, and karyotype results were available for analysis. Analyses were restricted to 632 euploid (5.2% assisted reproductive technologies) and 73 Down syndrome (13.7% assisted reproductive technologies), including 16 twin pregnancies. No differences were found for fetal or total circulating cell-free DNA, or for the fetal fraction in euploid (P = 0.70) or Down syndrome (P = 0.58) pregnancies by method of conception. There appeared to be systematic z-score reductions for chromosomes 21, 18, and 13 in assisted reproductive technologies versus natural euploid pregnancies (P = 0.048, 0.0032, and 0.36, respectively). Assisted reproductive technologies and naturally conceived pregnancies contribute similar levels of circulating cell-free DNA into maternal circulation. Small differences in the z-scores of pregnancies achieved by assisted reproductive technologies were observed and do not appear to be test-related artifacts. However, the findings need confirmation before any consideration of changes to testing and reporting protocols.

  12. Obesity and Outcome of Assisted Reproduction in Patients With Polycystic Ovary Syndrome

    PubMed Central

    Tziomalos, Konstantinos; Dinas, Konstantinos

    2018-01-01

    Assisted reproduction, including in vitro fertilization and intracytoplasmic sperm injection, is increasingly being used for the management of infertility in patients with polycystic ovary syndrome (PCOS). However, there are limited data regarding the association between obesity and the outcome of assisted reproduction in this specific population as well as on the effects of weight loss. The aim of the present review is to summarize the existing evidence on the association between obesity and the outcome of assisted reproduction in patients with PCOS. Accumulating data suggest that obesity is associated with lower pregnancy and live birth rates in patients with PCOS who are undergoing assisted reproduction therapy. However, it remains unclear whether weight loss improves the outcome of this therapy. Notably, recent guidelines state that the health benefits of postponing pregnancy to achieve weight loss must be balanced against the risk of declining fertility with advancing age. Therefore, if weight loss is not achieved within a reasonable time period, assisted reproduction therapy should be offered in adequately selected patients with PCOS, regardless of the presence of obesity. PMID:29670581

  13. [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.

  14. Counseling Issues for Gay Men and Lesbians Seeking Assisted Reproductive Technologies (ART)

    MedlinePlus

    ... with gay men and lesbians seeking assisted reproductive technology (ART) More lesbian, gay, bisexual, and transgender (LGBT) ... choosing to build a family through assisted reproductive technology (ART) have concerns about how to best nurture ...

  15. In vitro maturation of human oocytes for assisted reproduction.

    PubMed

    Jurema, Marcus W; Nogueira, Daniela

    2006-11-01

    To describe and evaluate the current practice of in vitro maturation of oocytes for assisted reproduction. Review of the available and relevant literature regarding in vitro maturation of oocytes. In vitro maturation of human oocytes retrieved from antral ovarian follicles is an emerging procedure quickly being incorporated into the realm of assisted reproductive technologies. This new technology has several potential advantages over traditional controlled ovarian hyperstimulation for IVF, such as reduction of costs by minimizing gonadotropin and GnRH analogue use, elimination of ovarian hyperstimulation syndrome, and simplicity of protocol. In vitro maturation of oocytes for assisted reproduction in human beings still is undergoing refinement but currently is providing efficacy and safety outcome comparable to that of traditional IVF in recent selected studies. Implementing in vitro maturation into an established IVF practice is feasible and requires only a few simple adjustments. Crucial to the advancement and optimization of the technology is a better understanding of how to maximize immature oocyte developmental competence and endometrial receptivity.

  16. Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment.

    PubMed

    Geber, Selmo; Ferreira, Daniela Parreiras; Spyer Prates, Luis Felipe Víctor; Sales, Liana; Sampaio, Marcos

    2002-01-01

    Endometriosis affects 2-50% of women at reproductive age. Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility. Also, the removal of ovarian endometrioma might lead to a reduction in the follicular reserve and response to stimulation. Therefore, the aim of this study was to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. A total of 61 women, with primary infertility and previously having undergone ovarian surgery for endometriosis, who had received 74 IVF/intracytoplasmic sperm injection (ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within#10; the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as a control group. Patients were matched for age and treatment performed. Patients 35 years with previous ovarian surgery needed more ampoules for ovulation induction (P = 0.017) and had fewer follicles and oocytes than women in the control group (P = 0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Although a lower pregnancy rate was observed in patients who had undergone previous ovarian surgery, this difference was not statistically significant (P = 0.424). In

  17. Application of microfluidic technologies to human assisted reproduction.

    PubMed

    Smith, Gary D; Takayama, Shuichi

    2017-04-01

    Microfluidics can be considered both a science and a technology. It is defined as the study of fluid behavior at a sub-microliter level and the investigation into its application to cell biology, chemistry, genetics, molecular biology and medicine. There are at least two characteristics of microfluidics, mechanical and biochemical, which can be influential in the field of mammalian gamete and preimplantation embryo biology. These microfluidic characteristics can assist in basic biological studies on sperm, oocyte and preimplantation embryo structure, function and environment. The mechanical and biochemical characteristics of microfluidics may also have practical and/or technical application(s) to assisted reproductive technologies (ART) in rodents, domestic species, endangered species and humans. This review will consider data in mammals, and when available humans, addressing the potential application(s) of microfluidics to assisted reproduction. There are numerous sequential steps in the clinical assisted reproductive laboratory process that work, yet could be improved. Cause and effect relations of procedural inefficiencies can be difficult to identify and/or remedy. Data will be presented that consider microfluidic applications to sperm isolation, oocyte cumulus complex isolation, oocyte denuding, oocyte mechanical manipulation, conventional insemination, intracytoplasmic sperm injection, embryo culture, embryo analysis and oocyte and embryo cryopreservation. While these studies have progressed in animal models, data with human gametes and embryos are significantly lacking. These data from clinical trials are requisite for making future evidence-based decisions regarding the application of microfluidics in human ART. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.For Permissions, please email: journals.permissions@oup.com.

  18. 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.

  19. Assisted Reproductive Technology Has No Association with Autism Spectrum Disorders: The Taiwan Birth Cohort Study

    ERIC Educational Resources Information Center

    Lung, For-Wey; Chiang, Tung-Liang; Lin, Shio-Jean; Lee, Meng-Chih; Shu, Bih-Ching

    2018-01-01

    The use of assisted reproduction technology has increased over the last two decades. Autism spectrum disorders and assisted reproduction technology share many risk factors. However, previous studies on the association between autism spectrum disorders and assisted reproduction technology have shown inconsistent results. The purpose of this study…

  20. 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.

  1. Application of microfluidic technologies to human assisted reproduction

    PubMed Central

    Takayama, Shuichi

    2017-01-01

    Abstract Microfluidics can be considered both a science and a technology. It is defined as the study of fluid behavior at a sub-microliter level and the investigation into its application to cell biology, chemistry, genetics, molecular biology and medicine. There are at least two characteristics of microfluidics, mechanical and biochemical, which can be influential in the field of mammalian gamete and preimplantation embryo biology. These microfluidic characteristics can assist in basic biological studies on sperm, oocyte and preimplantation embryo structure, function and environment. The mechanical and biochemical characteristics of microfluidics may also have practical and/or technical application(s) to assisted reproductive technologies (ART) in rodents, domestic species, endangered species and humans. This review will consider data in mammals, and when available humans, addressing the potential application(s) of microfluidics to assisted reproduction. There are numerous sequential steps in the clinical assisted reproductive laboratory process that work, yet could be improved. Cause and effect relations of procedural inefficiencies can be difficult to identify and/or remedy. Data will be presented that consider microfluidic applications to sperm isolation, oocyte cumulus complex isolation, oocyte denuding, oocyte mechanical manipulation, conventional insemination, intracytoplasmic sperm injection, embryo culture, embryo analysis and oocyte and embryo cryopreservation. While these studies have progressed in animal models, data with human gametes and embryos are significantly lacking. These data from clinical trials are requisite for making future evidence-based decisions regarding the application of microfluidics in human ART. PMID:28130394

  2. International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2005.

    PubMed

    Zegers-Hochschild, Fernando; Mansour, Ragaa; Ishihara, Osamu; Adamson, G David; de Mouzon, Jacques; Nygren, Karl G; Sullivan, Elizabeth A

    2014-02-01

    To analyze information on assisted reproductive technology (ART) performed worldwide and trends in outcomes over successive years. Cross-sectional survey on access, effectiveness, and safety of ART procedures performed in 53 countries during 2005. A total of 2,973 clinics from national and regional ART registries. Infertile women and men undergoing ART globally. Collection and analysis of international ART data. Number of cycles performed by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Overall, 1,052,363 ART procedures resulted in an estimated 237,315 babies born. The availability of ART varied by country from 15 to 3,982 cycles per million of population. Of all initiated fresh cycles, 62.9% were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 19.6% and for frozen embryo transfer 17.4%, with a cumulative delivery rate of 23.9%. With wide regional variations, single embryo transfer represented 17.5% of cycles, and the proportion of deliveries with twins and triplets from fresh transfers was 23.6% and 1.5%, respectively. Systematic collection and dissemination of international ART data allows patients, health professionals, and policy makers to examine and compare the impact of reproductive strategies or lack of them as markers of reproductive health. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Financial "risk-sharing" or refund programs in assisted reproduction: an Ethics Committee opinion.

    PubMed

    2016-10-01

    Financial "risk-sharing" fee structures in assisted reproduction programs charge patients a higher initial fee but provide reduced fees for subsequent cycles and often a partial or complete refund if treatment fails. This opinion of the ASRM Ethics Committee analyzes the ethical issues raised by these fee structures, including patient selection criteria, conflicts of interest, success rate transparency, and patient informed consent. This document replaces the document of the same name, last published in 2013 (Fertil Steril 2013;100:334-6). Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. Assisted reproduction: what factors interfere in the professional's decisions? Are single women an issue?

    PubMed

    Záchia, Suzana; Knauth, Daniela; Goldim, José R; Chachamovich, Juliana R; Chachamovich, Eduardo; Paz, Ana H; Felberbaum, Ricardo; Crosignani, PierGiorgio; Tarlatzis, Basil C; Passos, Eduardo P

    2011-05-31

    withhold treatment. 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.

  6. The right to an heir in the era of assisted reproduction.

    PubMed

    Benshushan, A; Schenker, J G

    1998-05-01

    The latest remarkable technological advances in assisted reproduction, which enable cryopreservation of spermatozoa, embryos and ovarian tissue, raise difficult and debatable legal, social, ethical and moral issues concerning the right to posthumous reproduction. Furthermore, reports on the attitudes of the general public and of centres licensed for infertility treatment in the United Kingdom found that the majority of women and centres support the idea of posthumous reproduction. In this paper we review the data published on this issue, and after considering the various aspects, we conclude that each case should be discussed and authorized by a multidisciplinary committee that includes physicians, clergy, psychiatrists, psychologists, sociologists and other appropriate parties. In our opinion, the main principles that should guide this committee would allow posthumous reproduction in the context of marriage when a prior consent exists. For unmarried persons, post-mortem donation of gametes should be done only anonymously, if they are in agreement with existing laws concerning infertility treatments in every country and after appropriate consent and proper counselling. Moreover, any case which involves consanguinity or a possibility of incest should be forbidden, both for ethical and genetic reasons. In a case of pre-existing siblings, they should be consulted and their informed consent should be granted in advance so as to avoid legal problems in the inheritance of property.

  7. Male factor infertility and lack of openness about infertility as risk factors for depressive symptoms in males undergoing assisted reproductive technology treatment in Italy.

    PubMed

    Babore, Alessandra; Stuppia, Liborio; Trumello, Carmen; Candelori, Carla; Antonucci, Ivana

    2017-04-01

    To investigate the association between male factor infertility and openness to discussing assisted reproductive technology (ART) treatment with levels of depression among men undergoing infertility treatment. Cross-sectional. Not applicable. Three hundred forty participants (170 men and their partners) undergoing ART treatments. Administration of a set of questionnaires. Depressive symptoms were detected by means of the Zung Depression Self-Rating Scale. Participants' willingness to share their infertility treatment experience with other people was assessed by means of self-report questionnaires. In this study, 51.8% of males chose not to discuss their ART treatments with people other than their partner. In addition, the decision to discuss or not discuss the ART treatments with others was significantly associated with men's depressive symptoms. Male factor infertility was significantly associated with depression when considered together with the decision not to discuss ART treatments with others. A general disposition characterized by a lack of openness with others seemed to be a significant predictor of depression. There is a need for routine fertility care to pay greater attention to men's emotional needs. Before commencing reproductive treatment, male patients may benefit from undergoing routine screening for variables (i.e., male factor infertility and openness to others about ART) that may affect their risk of depression. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Correct coding for laboratory procedures during assisted reproductive technology cycles.

    PubMed

    2016-04-01

    This document provides updated coding information for services related to assisted reproductive technology procedures. This document replaces the 2012 ASRM document of the same name. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Epigenetic Influences During the Periconception Period and Assisted Reproduction.

    PubMed

    Amoako, Akwasi A; Nafee, Tamer M; Ola, Bolarinde

    2017-01-01

    The periconception period starts 6 months before conception and lasts until the tenth week of gestation. In this chapter, we will focus on epigenetic modifications to DNA and gene expression within this period and during assisted reproduction. There are two critical times during the periconception window when significant epigenetic 'reprogramming' occur: one during gametogenesis and another during the pre-implantation embryonic stage. Furthermore, assisted conception treatments, laboratory protocols and culture media can affect the embryo development and birth weights in laboratory animals. There is, however, an ongoing debate as to whether epigenetic changes in humans, causing embryo mal-development, placenta dysfunction and birth defects, result from assisted reproductive technologies or are consequences of pre-existing medical and/or genetic conditions in the parents. The periconception period starts from ovarian folliculogenesis, through resumption of oogenesis, fertilisation, peri-implantation embryo development, embryogenesis until the end of organogenesis. In men, it is the period from spermatogenesis to epididymal sperm storage and fertilisation. Gametes and developing embryos are sensitive to environmental factors during this period, and epigenetic modifications can occur in response to adverse lifestyles and environmental factors. We now know that lifestyle factors such as advanced parentage age, obesity or undernutrition, smoking, excessive alcohol and caffeine intake and recreational drugs used during gamete production and embryogenesis could induce epigenetic alterations, which could impact adversely on pregnancy outcomes and health of the offspring. Furthermore, these can also result in a permanent and irreversible effect in a dose-dependent manner, which can be passed on to the future generations.

  10. Assisted reproductive technology treatment in women with severe eating disorders: a national cohort study.

    PubMed

    Assens, Maria; Ebdrup, Ninna H; Pinborg, Anja; Schmidt, Lone; Hougaard, Charlotte O; Hageman, Ida

    2015-11-01

    This national retrospective cohort study investigates the prevalence of women with severe eating disorders in assisted reproductive technology (ART) treatment compared with an age-matched background population without ART treatment. It assesses the frequency distribution of the first and last eating disorder diagnosis before, during, and after ART treatment, and evaluates differences in obstetric outcomes between women with and without a severe eating disorder. Hospital-diagnosed eating disorders among 42,915 women in the Danish National ART cohort (DANAC), registered during 1994-2009 in the mandatory Psychiatric Central Research Register, were compared with a non-eating disorder ART cohort of 42,644 women and an age-matched background population of 215,290 women without a history of ART treatment for the main outcome measures prevalence of eating disorders, frequency distribution of diagnoses before/during/after ART treatment, as well as ART treatment and obstetric outcomes. In the ART cohort, 271 women (0.63%) had an eating disorder diagnosis compared with 0.73% in the background population (p = 0.025). The prevalence of ovulatory disorder was significantly higher in women with a severe eating disorder compared with the ART cohort without eating disorders. Obstetric outcomes were similar in ART-treated women with and without an eating disorder. Women with severe eating disorders were identified in the ART cohort, although significantly less often than in the age-matched background population. Women with severe eating disorders suffered more often from anovulatory infertility than the ART comparison cohort without this disease. Obstetric outcomes appeared reassuring in the ART cohort with eating disorders. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis.

    PubMed

    Purewal, Satvinder; Chapman, Sarah C E; van den Akker, Olga B A

    2018-06-01

    This meta-analysis investigated whether state anxiety and depression scores during assisted reproductive technology (ART) treatment and changes in state anxiety and depression scores between baseline and during ART treatment are associated with treatment outcome. PubMed, PsycInfo, Embase, ScienceDirect, Web of Science and Scopus were searched and meta-analytic data analysed using random effects models to estimate standardized mean differences. Eleven studies (2202 patients) were included. Women who achieved pregnancy had significantly lower depression scores during treatment than women who did not become pregnant (-0.302; 95% CI: -0.551 to -0.054, z = -2.387, P = 0.017; I 2 = 77.142%, P = 0.001). State anxiety scores were also lower in women who became pregnant (-0.335; 95% CI: -0.582 to -0.087, z = -2.649, P = 0.008; I 2 = 81.339%, P = 0.001). However, changes in state anxiety (d = -0.056; 95% CI: -0.195 to 0.082, z = -0.794; I 2 = 0.00%) and depression scores (d = -0.106; 95% CI: -0.296 to 0.085, z = -1.088; I 2 = 0.00%) from baseline to treatment were not associated with ART outcome. Clinics should aim to promote better psychosocial care to help patients manage the psychological and physical demands of ART treatment, giving realistic expectations. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.

  12. 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. © 2014 John Wiley & Sons Ltd.

  13. Relationship between Dietary Fat Intake, Its Major Food Sources and Assisted Reproduction Parameters

    PubMed Central

    Kazemi, Ashraf; Ramezanzadeh, Fatemeh; Nasr-Esfahani, Mohammad Hosein

    2014-01-01

    Background High dietary fat consumption may alter oocyte development and embryonic development. This prospective study was conducted to determine the relation between dietary fat consumption level, its food sources and the assisted reproduction parameters. Methods A prospective study was conducted on 240 infertile women. In assisted reproduction treatment cycle, fat consumption and major food sources over the previous three months were identified. The number of retrieved oocytes, metaphase ΙΙ stage oocytes numbers, fertilization rate, embryo quality and clinical pregnancy rate were also determined. The data were analyzed using multiple regression, binary logistic regression, chi-square and t-test. The p-value of less than 0.05 was considered significant. Results Total fat intake adjusted for age, body mass index, physical activity and etiology of infertility was positively associated with the number of retrieved oocytes and inversely associated with the high embryo quality rate. An inverse association was observed between sausage and turkey ham intake and the number of retrieved oocytes. Also, oil intake level had an inverse association with good cleavage rate. Conclusion The results revealed that higher levels of fat consumption tend to increase the number of retrieved oocytes and were adversely related to embryonic development. Among food sources of fat, vegetable oil, sausage and turkey ham intake may adversely affect assisted reproduction parameters. PMID:25473630

  14. Decision for disclosure: The experiences of Iranian infertile couples undergoing assisted reproductive donation procedures.

    PubMed

    Hadizadeh-Talasaz, Fatemeh; Roudsari, Robab Latifnejad; Simbar, Masoumeh

    2015-01-01

    Controversy surrounding disclosure among the recipients of assisted reproductive donation procedures is escalating worldwide, but little research has been conducted in this topic. The purpose of this qualitative study was to explore the experiences of infertile couples undergoing assisted reproductive donation procedures. In this exploratory qualitative study, 32 patients (nine couples and 14 women) who were candidates to use donor eggs, donor embryos or surrogacy, and 5 members of infertility treatment team including gynaecologists, midwives and psychologist (total 37) were purposively selected from the Montaserieh Infertility Research Centre at Mashhad, Iran in 2012 and interviewed using a semi-structured in-depth method. Data were analysed using conventional qualitative content analysis with MAXqda software. One overarching theme, entitled 'experiencing uncertainty surrounding the disclosure to others' was identified from the data. This theme contained two subthemes including 'Couples' decisions to not disclose to others' and 'Couples' decisions to disclose to others'. Five categories formed the first subtheme, and the second subtheme emerged from four categories which are discussed in this paper. The main reason for secrecy was concern over societal negative views about assisted reproductive donation procedures. This worry deprived the couples from support from family and friends and as a result requires them to tolerate psychological pressure when using such procedures.

  15. Shifting paradigms in diminished ovarian reserve and advanced reproductive age in assisted reproduction: customization instead of conformity.

    PubMed

    Reed, Beverly G; Babayev, Samir N; Bukulmez, Orhan

    2015-05-01

    As women are increasingly delaying childbearing into their 30s and beyond, diminished ovarian reserve (DOR) and advanced reproductive age (ARA) patients are bound to become a large proportion of all assisted reproductive technology practices. Traditional controlled ovarian stimulation (COS) protocols for DOR and/or ARA have had some limited success, but pregnancy rates are lower and cycle cancellation rates are higher than their younger counterparts with normal ovarian reserve. Though many physicians have a selection of favorite standard protocols that they use, patients with DOR may require closer monitoring and customization of the treatment cycle to address the common problems that come with low ovarian reserve. Frequent issues that surface in women with DOR and/or ARA include poor follicular response, premature luteinizing hormone surge, and poor embryo quality. Limited published evidence exists to guide treatment for DOR. However, use of minimal or mild doses of gonadotropins, avoidance of severe pituitary suppression, and consideration for luteal phase stimulation and a "freeze all" approach are possible customized treatment options that can be considered for such patients who have failed more traditional COS protocols. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. International committee for monitoring assisted reproductive technologies: world report on assisted reproductive technologies, 2007.

    PubMed

    Ishihara, Osamu; Adamson, G David; Dyer, Silke; de Mouzon, Jacques; Nygren, Karl G; Sullivan, Elizabeth A; Zegers-Hochschild, Fernando; Mansour, Ragaa

    2015-02-01

    To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during 2007. Not applicable. Infertile women and men undergoing ART globally. Collection and analysis of international ART data. Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh in vitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged ≥40 years increased to 19.8% from 15.5% in 2006. The international trend toward <3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40 years was a major component of ART services in some regions and countries. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  17. The legal aspects of parental rights in assisted reproductive technology.

    PubMed

    Ciccarelli, John K; Ciccarelli, Janice C

    2005-03-01

    This paper provides an overview of the different legal approaches that are used in various jurisdictions to determine parental rights and obligations of the parties involved in third party assisted reproduction. Additionally, the paper explores the differing legal models that are used depending on the method of surrogacy being utilized. The data demonstrates that a given method of surrogacy may well result in different procedures and outcomes regarding parental rights in different jurisdictions. This suggests the need for a uniform method to resolve parental rights where assisted reproductive technology is involved.

  18. Assisted reproductive technology: perspectives in Halakha (Jewish religious law).

    PubMed

    Schenker, Joseph G

    2008-01-01

    The Jewish religion is characterized by a strict association between faith and practical precepts. In principle, Jewish law has two divisions, the Written and the Oral traditions. The foundation of the Written Law and the origin of authority is the Torah, the first five books of the Scripture. This paper presents the attitude of Jewish religion to assisted reproductive therapeutic procedures such as IVF-embryo transfer, spermatozoa, oocytes, embryo donation, cryopreservation of genetic material, surrogacy, posthumous reproduction, gender preselection and reproductive and therapeutic cloning.

  19. The use of recombinant luteinizing hormone in patients undergoing assisted reproductive techniques with advanced reproductive age: a systematic review and meta-analysis.

    PubMed

    Hill, Micah J; Levens, Eric D; Levy, Gary; Ryan, Mary E; Csokmay, John M; DeCherney, Alan H; Whitcomb, Brian W

    2012-05-01

    To evaluate the effect of recombinant LH in assisted reproduction technology (ART) cycles in patients of advanced reproductive age. A systematic review and meta-analysis. Published randomized controlled clinical trials comparing recombinant LH plus recombinant FSH versus recombinant FSH only in patients of advanced reproductive age. Patients 35 years and older undergoing assisted reproduction. Recombinant LH plus recombinant FSH controlled ovarian hyperstimulation (COH) versus recombinant FSH stimulation only in assisted reproduction cycles. Implantation and clinical pregnancy. Seven trials were identified that met inclusion criteria and comprised 902 assisted reproduction technology cycles. No differences in serum E(2) on the day of hCG administration were reported in any trials. Two trials reported lower oocyte yield and one trial reported lower metaphase II oocyte yield in the recombinant LH-supplemented group. One trial reported higher fertilization rates in the recombinant LH-supplemented group. In a fixed effect model, implantation was higher in the recombinant LH-supplemented group (odds ratio 1.36, 95% confidence interval 1.05-1.78). Similarly, clinical pregnancy was increased in the recombinant LH-supplemented group (odds ratio 1.37, 95% confidence interval 1.03-1.83). The addition of recombinant LH to ART cycles may improve implantation and clinical pregnancy in patients of advanced reproductive age. Copyright © 2012 American Society for Reproductive Medicine. All rights reserved.

  20. Serum 25-hydroxyvitamin D concentrations and treatment outcomes of women undergoing assisted reproduction.

    PubMed

    Abadia, Laura; Gaskins, Audrey J; Chiu, Yu-Han; Williams, Paige L; Keller, Myra; Wright, Diane L; Souter, Irene; Hauser, Russ; Chavarro, Jorge E

    2016-09-01

    Vitamin D deficiency impairs fertility in animal models, but the role of vitamin D in human fertility or treatment of infertility is less clear. We examined the association between circulating 25-hydroxyvitamin D [25(OH)D] concentrations and the outcome in women undergoing assisted reproduction technologies (ARTs). We randomly selected 100 women undergoing infertility treatment with ART enrolled in an ongoing prospective cohort study who underwent 168 treatment cycles. Serum 25(OH)D concentrations were measured in samples collected from women between days 3 and 9 of gonadotropin treatment. Generalized linear mixed models were used to evaluate the association of 25(OH)D concentrations with ART outcomes while adjusting for potential confounders and accounting for repeated treatment cycles per woman. Median (range) serum 25(OH)D concentrations were 86.5 (33.5-155.5) nmol/L. Ninety-one percent of participants consumed multivitamins. Serum 25(OH)D concentrations were positively related to fertilization rate. The adjusted fertilization rate for women in increasing quartiles of serum 25(OH)D were 0.62 (95% CI: 0.51, 0.72), 0.53 (95% CI: 0.43, 0.63), 0.67 (95% CI: 0.56, 0.76), and 0.73 (95% CI: 0.63, 0.80), respectively (P-trend = 0.03). This association persisted when analyses were restricted to women with serum 25(OH)D between 50 and 125 nmol/L when models were further adjusted for season of blood draw and when analyses were restricted to the first treatment cycle. However, 25(OH)D concentrations were unrelated to probability of pregnancy (P-trend = 0.83) or live birth after ART (P-trend = 0.47). Vitamin D may be associated with higher fertilization rates, but this apparent benefit does not translate into higher probability of pregnancy or live birth. This trial was registered at www.clinicaltrials.gov as NCT00011713. © 2016 American Society for Nutrition.

  1. Assisted reproductive technologies and thrombosis.

    PubMed

    Grandone, Elvira; Villani, Michela

    2015-02-01

    In this article, we address issues about thrombotic risk and use of antithrombotic prophylaxis during assisted reproductive technologies (ART) and during pregnancies after ART. Many aspects of these complications remain not completely understood and data about incidence, pathogenesis, duration and magnitude of the risk, role of thrombophilias and thromboprophylaxis in determining first events and recurrences are lacking. The role of known or possible risk factors and the efficacy of antithrombotic prophylaxis will be discussed. © 2015 Elsevier Ltd. All rights reserved.

  2. CDC-reported assisted reproductive technology live-birth rates may mislead the public.

    PubMed

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

    2017-08-01

    The Centre for Disease Control and Prevention (CDC) publicly reports assisted reproductive technology live-birth rates (LBR) for each US fertility clinic under legal mandate. The 2014 CDC report excluded 35,406 of 184,527 (19.2%) autologous assisted reproductive technology cycles that involved embryo or oocyte banking from LBR calculations. This study calculated 2014 total clinic LBR for all patients utilizing autologous oocytes two ways: including all initiated assisted reproductive technology cycles or excluding banking cycles, as done by the CDC. The main limitation of this analysis is the CDC report did not differentiate between cycles involving long-term banking of embryos or oocytes for fertility preservation from cycles involving short-term embryo banking. Twenty-seven of 458 (6%) clinics reported over 40% of autologous cycles involved banking, collectively performing 12% of all US assisted reproductive technology cycles. LBR in these outlier clinics calculated by the CDC method, was higher than the other 94% of clinics (33.1% versus 31.1%). However, recalculated LBR including banking cycles in the outlier clinics was lower than the other 94% of clinics (15.5% versus 26.6%). LBR calculated by the two methods increasingly diverged based on proportion of banking cycles performed by each clinic reaching 4.5-fold, thereby, potentially misleading the public. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  3. 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…

  4. Provision of assisted reproductive technology for single women in China: a new challenge.

    PubMed

    Zhou, Ling Jing

    2004-01-01

    Following the enactment of the Jilin Regulation, single women, for the first time, are allowed to access assisted reproductive services in China. This paper is intended to analyze the arguments over whether single women are entitled to access assisted reproductive services, in relation to Chinese legal, ethical and social characteristics.

  5. [Cost of assisted reproduction technology in a public hospital].

    PubMed

    Navarro Espigares, José Luis; Martínez Navarro, Luis; Castilla Alcalá, José Antonio; Hernández Torres, Elisa

    2006-01-01

    Most studies on the costs of assisted reproductive technologies (ART) identify the total cost of the procedure with the direct cost, without considering important items such as overhead or intermediate costs. The objective of this study was to determine the cost per ART procedure in a public hospital in 2003 and to compare the results with those in the same hospital in 1998. Data from the Human Reproduction Unit of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998 and 2003 were analyzed. Since the total costs of the unit were known, the cost of the distinct ART procedures performed in the hospital was calculated by means of a methodology for cost distribution. Between 1998 and 2003, the activity and costs of the Human Reproduction Unit analyzed evolved differently. Analysis of activity showed that some techniques, such as intracytoplasmic sperm injection, were consolidated while others, such as stimulation without assisted reproduction or intracervical insemination were abandoned. In all procedures, unit costs per cycle and per delivery decreased in the period analyzed. Important changes took place in the structure of costs of ART in the Human Reproduction Unit of the Virgen de las Nieves University Hospital between 1998 and 2003. Some techniques were discontinued, while others gained importance. Technological advances and structural innovations, together with a "learning effect," modified the structure of ART-related costs.

  6. The clinical benefit and safety of current and future assisted reproductive technology.

    PubMed

    Brown, Rachel; Harper, Joyce

    2012-08-01

    Since the first birth by IVF was achieved in 1978, the techniques involved in assisted reproductive technology have grown at an enormous rate. However, new technology has rarely been robustly validated before clinical use and developing scientific understanding of the available techniques has done little to alter their use. Furthermore, there are inconsistencies in the available clinical studies and endpoints. The benefits of some technologies already established for routine use are currently dubious and there are clear ethical concerns with providing them to patients when their scientific basis is not clear. As the uptake of assisted reproductive technology increases and newer technologies continue to push the boundaries of science, it is important to consider the clinical benefits and safety of all assisted reproductive technologies. This review will discuss aspects of some of the more recent techniques, including sperm DNA-damage tests, intracytoplasmic morphologically selected sperm injection, amino acid and metabolomics profiling, preimplantation genetic screening and time-lapse imaging, and those that may have substantial impacts on the field of reproductive medicine in the future including artificial gametes, ovarian transplantation and gene therapy. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  7. Using a Delphi consensus process to develop an acupuncture treatment protocol by consensus for women undergoing Assisted Reproductive Technology (ART) treatment

    PubMed Central

    2012-01-01

    Background Assisted reproductive technologies (ART) are increasingly utilised for resolving difficulties conceiving. These technologies are expensive to both the public purse and the individual consumers. Acupuncture is widely used as an adjunct to ART with indications that it may assist reducing the time to conception and increasing live birth rates. Heterogeneity is high between treatment protocols. The aim of this study was to examine what fertility acupuncturists consider key components of best practice acupuncture during an ART cycle, and to establish an acupuncture protocol by consensus. Methods Fifteen international acupuncturists with extensive experience treating women during ART interventions participated in 3 rounds of Delphi questionnaires. The first round focused on identifying the parameters of acupuncture treatment as adjunct to ART, the second round evaluated statements derived from the earlier round, and the third evaluated specific parameters for a proposed trial protocol. Consensus was defined as greater than 80% agreement. Results Significant agreement was achieved on the parameters of best practice acupuncture, including an acupuncture protocol suitable for future research. Study participants confirmed the importance of needling aspects relating to the dose of acupuncture, the therapeutic relationship, tailoring treatment to the individual, and the role of co-interventions. From two rounds of the Delphi a consensus was achieved on seven treatment parameters for the design of the acupuncture treatment to be used in a clinical trial of acupuncture as an adjunct to ART. The treatment protocol includes the use of the traditional Chinese medicine acupuncture, use of manual acupuncture, a first treatment administered between day 6–8 of the stimulated ART cycle which is individualised to the participant, two treatments will be administered on the day of embryo transfer, and will include points SP8, SP10, LR3, ST29, CV4, and post transfer include: GV

  8. 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

  9. National survey of the current management of endometriomas in women undergoing assisted reproductive treatment.

    PubMed

    Raffi, F; Shaw, R W; Amer, S A

    2012-09-01

    What is the current management of women with ovarian endometriomas undergoing assisted reproductive treatment (ART) in the UK? It appears that the majority of gynaecologists in the UK offer surgery (mostly cystectomy) for endometriomas prior to ART, regardless of the presence of symptoms. The ideal management of endometriomas in women undergoing ART remains controversial and presents a dilemma to reproductive specialists. This was a national cross-sectional survey. A total of 388 gynaecologists completed the questionnaire. All clinicians fully registered with the Royal College of Obstetricians and Gynaecologists were contacted. An 11-item survey was administered electronically using Survey Monkey software. Quantitative data were analysed using descriptive and comparative statistics. The majority of responders were consultants (65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of responders would offer surgery for endometriomas in women undergoing ART, either on the basis of the size (>3-5 cm) of the endometrioma (52%), the presence of symptoms (16%), the presence of multiple/bilateral endometriomas (2%), regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). The remaining 5% of responders would not offer surgery before ART. Excision was the most common surgical modality (68%), followed by ablation (25%). Laparoscopic surgeons were almost twice as likely to 'offer surgery to all patients with endometriomas prior to ART' compared with clinicians performing laparotomy (22 versus 12%, P < 0.001). Our overall response rate, with answers to the questionnaire, was low (15%). However, the response rate amongst reproductive specialists was estimated at 60%. It is possible that there might have been an element of bias towards over-representation of responders who are more concerned about 'normalization' of the pelvic anatomy. Furthermore, our survey relied on self-reporting of practice and it is possible that being

  10. Trends over time in congenital malformations in live-born children conceived after assisted reproductive technology.

    PubMed

    Henningsen, Anna-Karina A; Bergh, Christina; Skjaerven, Rolv; Tiitinen, Aila; Wennerholm, Ulla-Britt; Romundstad, Liv B; Gissler, Mika; Opdahl, Signe; Nyboe Andersen, Anders; Lidegaard, Øjvind; Forman, Julie L; Pinborg, Anja

    2018-07-01

    Children born after assisted reproductive technology, particularly singletons, have been shown to have an increased risk of congenital malformations compared with children born after spontaneous conception. We wished to study whether there has been a change in the past 20 years in the risk of major congenital malformations in children conceived after assisted reproductive technology compared with children spontaneously conceived. Population-based cohort study including 90 201 assisted reproductive technology children and 482 552 children spontaneously conceived, born in Denmark, Finland, Norway and Sweden. Both singletons and twins born after in vitro fertilization, intracytoplasmatic sperm injection and frozen embryo transfer were included. Data on children were taken from when the national Nordic assisted reproductive technology registries were established until 2007. Multiple logistic regression analyses were used to estimate the risks and adjusted odds ratios for congenital malformations in four time periods: 1988-1992, 1993-1997, 1998-2002 and 2003-2007. Only major malformations were included. The absolute risk for singletons of being born with a major malformation was 3.4% among assisted reproductive technology children vs. 2.9% among children spontaneously conceived during the study period. The relative risk of being born with a major congenital malformation between all assisted reproductive technology children and children spontaneously conceived remained similar through all four time periods (p = 0.39). However, we found that over time the number of children diagnosed with a major malformation increased in both groups across all four time periods. When comparing children conceived after assisted reproductive technology and spontaneously conceived, the relative risk of being born with a major congenital malformation did not change during the study period. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Implantation in assisted reproduction: a look at endometrial receptivity.

    PubMed

    Fatemi, H M; Popovic-Todorovic, B

    2013-11-01

    Implantation failure in assisted reproduction is thought to be mainly due to impaired uterine receptivity. With normal uterine anatomy, changes in endocrine profile during ovarian stimulation and medical conditions of the mother (i.e. thrombophilia and abnormal immunological response) could result in a non-receptive endometrium. High oestradiol concentrations during ovarian stimulation lead to premature progesterone elevation, causing endometrial advancement and hampering implantation, which can be overcome by a freeze-all approach and embryo transfer in natural cycles or by milder stimulation protocols. Patients with recurrent implantation failure (RIF) should be tested for inherited and acquired thrombophilias. Each patient should be individually assessed and counselled regarding therapy with low-molecular-weight heparin (LMWH). Empirical treatment with LMWH, aspirin or corticosteroids is not effective for women with RIF who have negative thrombophilic tests. If thrombophilic tests are normal, patients should be tested for immunological causes. If human leukocyte antigen dissimilarity is proven, treatment with intravenous immunoglobulin might be beneficial. Preliminary observational studies using intralipid infusion in the presence of increased natural killer cytotoxic activity are interesting but the proposed rationale is controversial and randomized controlled trials are needed. Hysteroscopy and/or endometrial scratching in the cycle preceding ovarian stimulation should become standard for patients with RIF. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  12. ESHRE Task Force on Ethics and Law 11: Posthumous assisted reproduction.

    PubMed

    Pennings, G; de Wert, G; Shenfield, F; Cohen, J; Devroey, P; Tarlatzis, B

    2006-12-01

    This article analyses the different ethical aspects of posthumous assisted reproduction. Two situations are distinguished: cases in which the gametes or embryos are used by the surviving partner and cases in which the gametes or embryos are made available for third persons. The moral evaluation of the procedure depends on whether the act is restricted to the existing parental project. A major difficulty for the moral evaluation is the inconclusiveness of the empirical data on the psychosocial development of children born after this procedure. The Task Force concluded that posthumous reproduction by a partner is acceptable if the following conditions are met: written consent has been given by the deceased person, the partner received extensive counselling and a minimum waiting period of 1 year is imposed before a treatment can be started. For use by third parties, the usual conditions for gamete and embryo donation apply.

  13. Surrogate losses: Understandings of pregnancy loss and assisted reproduction among surrogate mothers.

    PubMed

    Berend, Zsuzsa

    2010-06-01

    I explore surrogate mothers' narrative construction of pregnancy loss on surrogacy support websites. Communicating via the Internet, women construct the public online world of surrogacy. Drawing on anthropological and sociological literature I investigate the connections between conceptualizations of loss and understandings of technological practices and the consequences of these understandings for assisted reproduction. Surrogate mothers define loss broadly, ranging from failure to conceive to miscarriage and stillbirth; loss means the failure to give a baby to the intended parents. Assisted reproductive technologies contribute to loss by raising expectations of success, by attempting to maximize results through the transfer of multiple fertilized ova, and by early monitoring and testing. However, surrogates collectively understand technology as a positive force and advocate for reproductive technology. Surrogates' resolve to "give the gift of life" makes them vulnerable to failure and loss, yet also informs repeated efforts to bear children for others with technological assistance.

  14. Does assisted reproduction technology, per se, increase the risk of preterm birth?

    PubMed

    Blickstein, I

    2006-12-01

    There is little doubt that all methods of assisted reproduction increase the likelihood of multiple pregnancy and, as a result, increase the likelihood of preterm birth. Data from the East Flanders Prospective Twin Study clearly show that the proportion of spontaneous to iatrogenic twins has changed from 25:1 to 1:1 over the past two decades. Data from the very low birthweight (VLBW) Infant Database of the Israel Neonatal Network showed that 10% of VLBW singletons were a result of assisted reproduction compared with 60% of the VLBW twins and 90% of the VLBW triplets. Irrespective of plurality, an association between preterm birth and assisted reproduction has long been suspected and was related to causes such as iatrogenic preterm birth (in the so-called 'premium' pregnancies), fertility history, past obstetric performance and to underlying medical conditions of the female partner. With more data available, a clearer picture is defined. Two different, recent meta-analyses showed that singleton pregnancies resulting from in vitro fertilisation (IVF) have increased rates of preterm birth at <33 weeks of gestation (OR 2.99; 95% CI 1.54-5.80), at <37 weeks of gestation (OR 1.93; 95% CI 1.36-2.74) and a relative risk of 1.98 (95% CI 1.77-2.22) for preterm birth in singleton pregnancies resulting from in vitro fertilisation embryo transfer/gamete intra fallopian transfer (IVF-ET/GIFT) compared with naturally conceived pregnancies. Since there is no way to predict which pregnant woman is at increased risk of preterm birth, it may be advisable to consider all pregnancies after assisted reproduction as being at risk. In any case, the most appropriate endpoint after assisted reproduction should also include preterm or term birth as measure of success.

  15. 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... or embryos. Variations of microscopes and accessories used for these purposes would include phase...

  16. 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.

  17. Collision of Media Positions on Assisted Reproductive Technologies

    ERIC Educational Resources Information Center

    Emelyanova, T. P.; Vopilova, I. E.

    2016-01-01

    An analysis of the discourse on assisted reproductive technologies (ART) indicates the predominance of conservative representations of the family. The appearance of new technologies does not change the image of a "normal" family, because concepts connected with surrogate mothers and egg donors are minimally present in the discourse. In…

  18. [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.

  19. Long-term fiscal implications of funding assisted reproduction: a generational accounting model for Spain.

    PubMed

    Matorras, R; Villoro, R; González-Domínguez, A; Pérez-Camarero, S; Hidalgo-Vega, A; Polanco, C

    2015-12-01

    The aim of this study was to assess the lifetime economic benefits of assisted reproduction in Spain by calculating the return on this investment. We developed a generational accounting model that simulates the flow of taxes paid by the individual, minus direct government transfers received over the individual's lifetime. The difference between discounted transfers and taxes minus the cost of either IVF or artificial insemination (AI) equals the net fiscal contribution (NFC) of a child conceived through assisted reproduction. We conducted sensitivity analysis to test the robustness of our results under various macroeconomic scenarios. A child conceived through assisted reproduction would contribute €370,482 in net taxes to the Spanish Treasury and would receive €275,972 in transfers over their lifetime. Taking into account that only 75% of assisted reproduction pregnancies are successful, the NFC was estimated at €66,709 for IVF-conceived children and €67,253 for AI-conceived children. The return on investment for each euro invested was €15.98 for IVF and €18.53 for AI. The long-term NFC of a child conceived through assisted reproduction could range from €466,379 to €-9,529 (IVF) and from €466,923 to €-8,985 (AI). The return on investment would vary between €-2.28 and €111.75 (IVF), and €-2.48 and €128.66 (AI) for each euro invested. The break-even point at which the financial position would begin to favour the Spanish Treasury ranges between 29 and 41 years of age. Investment in assisted reproductive techniques may lead to positive discounted future fiscal revenue, notwithstanding its beneficial psychological effect for infertile couples in Spain.

  20. Failures of reproduction: problematising 'success' in assisted reproductive technology.

    PubMed

    Peters, Kathleen; Jackson, Debra; Rudge, Trudy

    2007-06-01

    This paper scrutinises the many ways in which 'success' is portrayed in representing assisted reproductive technology (ART) services and illuminates how these definitions differ from those held by participant couples. A qualitative approach informed by feminist perspectives guided this study and aimed to problematise the concept of 'success' by examining literature from ART clinics, government reports on ART, and by analysing narratives of couples who have accessed ART services. As many ART services have varying definitions of 'success' and as statistics are manipulated to promote further patronage of ART services, the likelihood of 'success' is often overstated. This paper is concerned with the effects this promotion has on the participants. We suggest that this very mobilisation of statistical success changes the ability of those who access ART services to make productive decisions about themselves inside these treatment regimes, as the basis for decision-making is hidden by the way numbers, objectivity and clinical reasoning operate to maintain participation in the program. In such an operation, the powerful mix of hope and technology kept participants enrolled far longer than they originally planned. Moreover, how success rates are manipulated raises ethical issues for all involved: clients, counsellors, and nursing and medical professionals.

  1. Influence of Paternal Age on Assisted Reproduction Outcome

    ClinicalTrials.gov

    2017-04-27

    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

  2. ESHRE Task Force on Ethics and Law 14: equity of access to assisted reproductive technology.

    PubMed

    Pennings, G; de Wert, G; Shenfield, F; Cohen, J; Tarlatzis, B; Devroey, P

    2008-04-01

    Justice and access are among the most urgent questions for medically assisted reproduction. This paper analyses this question not only for people suffering from infertility, but also for people who need assistance to prevent the birth of a child with a specific genetic disorder. Based on the impact of not being able to have a child on the quality of life of a person, the position is defended that infertility treatment should be at least partially reimbursed. Simultaneously, the medical professionals have an obligation towards their patients and the health care system to bring down the costs as far as reasonably possible.

  3. 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. © 2016 Wiley Periodicals, Inc.

  4. Assisted reproductive technology: an overview of Cochrane Reviews.

    PubMed

    Farquhar, Cindy; Rishworth, Josephine R; Brown, Julie; Nelen, Willianne L D M; Marjoribanks, Jane

    2015-07-15

    As many as one in six couples will encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex, and each ART cycle consists of several steps. If one of the steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step of the ART cycle is supported by good evidence from well-designed studies. To summarise the evidence from Cochrane systematic reviews on procedures and treatment options available to couples with subfertility undergoing assisted reproductive technology (ART). Published Cochrane systematic reviews of couples undergoing ART (in vitro fertilisation or intracytoplasmic sperm injection) were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation, for future inclusion.The outcomes of the overview were live birth (primary outcome), clinical pregnancy, multiple pregnancy, miscarriage and ovarian hyperstimulation syndrome (secondary outcomes). Studies of intrauterine insemination and ovulation induction were excluded.Selection of systematic reviews, data extraction and quality assessment were undertaken in duplicate. Review quality was assessed by using the AMSTAR tool. Reviews were organised by their relevance to specific stages in the ART cycle. Their findings were summarised in the text and data for each outcome were reported in 'Additional tables'. Fifty-nine systematic reviews published in The Cochrane Library up to July 2015 were included. All were high quality. Thirty-two reviews identified interventions that were effective (n = 19) or promising (n = 13), 14 reviews identified interventions that were either ineffective (n = 2) or possibly ineffective (n = 12), and 13 reviews were unable to

  5. Assisted reproductive technology: an overview of Cochrane reviews.

    PubMed

    Farquhar, Cindy; Rishworth, Josephine R; Brown, Julie; Nelen, Willianne L D M; Marjoribanks, Jane

    2014-12-23

    As many as one in six couples will encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex, and each ART cycle consists of several steps. If one of the steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step of the ART cycle is supported by good evidence from well-designed studies. To summarise the evidence from Cochrane systematic reviews on procedures and treatment options available to couples with subfertility undergoing assisted reproductive technology (ART). Published Cochrane systematic reviews of couples undergoing ART (in vitro fertilisation or intracytoplasmic sperm injection) were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation, for future inclusion.The outcomes of the overview were live birth (primary outcome), clinical pregnancy, multiple pregnancy, miscarriage and ovarian hyperstimulation syndrome (secondary outcomes). Studies of intrauterine insemination and ovulation induction were excluded.Selection of systematic reviews, data extraction and quality assessment were undertaken in duplicate. Review quality was assessed by using the AMSTAR tool. Reviews were organised by their relevance to specific stages in the ART cycle. Their findings were summarised in the text and data for each outcome were reported in 'Additional tables'. Fifty-eight systematic reviews published in The Cochrane Library were included. All were high quality. Thirty-two reviews identified interventions that were effective (n = 19) or promising (n = 13), 14 reviews identified interventions that were either ineffective (n = 3) or possibly ineffective (n=11), and 12 reviews were unable to draw conclusions

  6. Assisted reproductive technology: an overview of Cochrane Reviews.

    PubMed

    Farquhar, Cindy; Rishworth, Josephine R; Brown, Julie; Nelen, Willianne L D M; Marjoribanks, Jane

    2013-08-22

    As many as one in six couples will encounter problems with fertility, defined as failure to achieve a clinical pregnancy after regular intercourse for 12 months. Increasingly, couples are turning to assisted reproductive technology (ART) for help with conceiving and ultimately giving birth to a healthy live baby of their own. Fertility treatments are complex, and each ART cycle consists of several steps. If one of the steps is incorrectly applied, the stakes are high as conception may not occur. With this in mind, it is important that each step of the ART cycle is supported by good evidence from well-designed studies. To summarise the evidence from Cochrane systematic reviews on procedures and treatment options available to couples with subfertility undergoing assisted reproductive technology (ART). Published Cochrane systematic reviews of couples undergoing ART (in vitro fertilisation or intracytoplasmic sperm injection) were eligible for inclusion in the overview. We also identified Cochrane reviews in preparation, for future inclusion.The outcomes of the overview were live birth (primary outcome), clinical pregnancy, multiple pregnancy, miscarriage and ovarian hyperstimulation syndrome (secondary outcomes). Studies of intrauterine insemination and ovulation induction were excluded.Selection of systematic reviews, data extraction and quality assessment were undertaken in duplicate. Review quality was assessed by using the AMSTAR tool. Reviews were organised by their relevance to specific stages in the ART cycle. Their findings were summarised in the text and data for each outcome were reported in 'Additional tables'. Fifty-four systematic reviews published in The Cochrane Library were included. All were high quality. Thirty reviews identified interventions that were effective (n = 18) or promising (n = 12), 13 reviews identified interventions that were either ineffective (n = 3) or possibly ineffective (n=10), and 11 reviews were unable to draw conclusions due to

  7. What's the message? A content analysis of newspaper articles about assisted reproductive technology from 2005 to 2011.

    PubMed

    King, L; Tulandi, T; Whitley, R; Constantinescu, T; Ells, C; Zelkowitz, P

    2014-06-01

    Infertility and its treatment is the subject of considerable media coverage. In order to evaluate the representation of assisted reproductive technology (ART) in the popular media, we conducted a content analysis of North American newspaper articles. We also explored whether different themes emerged in relation to the implementation of public funding for ART in Quebec, Canada. Print and online newspaper articles from 2005 to 2011 were retrieved using the terms "in-vitro fertilization", "infertility treatment", "assisted reproductive technology", and "IVF treatment". Totally, 719 newspaper articles met inclusion criteria and were coded according to predetermined categories. Risks (63%) and ethical issues (61%) related to ART were most commonly featured. Quebec-based articles were mostly concerned with the politics and financial issues governing ART, and were less likely to report the risks and emotional impact of ART than other North American press. Newspapers tended to emphasize extreme scenarios as well as controversial cases that may not represent the everyday realities of ART. Changes in public policy may also engender shifts in the tone and content of media reports. It is important to establish resources that can inform the public as well as prospective infertility patients about their condition and potential treatment options.

  8. The economic impact of assisted reproductive technology: a review of selected developed countries.

    PubMed

    Chambers, Georgina M; Sullivan, Elizabeth A; Ishihara, Osamu; Chapman, Michael G; Adamson, G David

    2009-06-01

    To compare regulatory and economic aspects of assisted reproductive technologies (ART) in developed countries. Comparative policy and economic analysis. Couples undergoing ART treatment in the United States, Canada, United Kingdom, Scandinavia, Japan, and Australia. Description of regulatory and financing arrangements, cycle costs, cost-effectiveness ratios, total expenditure, utilization, and price elasticity. Regulation and financing of ART share few general characteristics in developed countries. The cost of treatment reflects the costliness of the underlying healthcare system rather than the regulatory or funding environment. The cost (in 2006 United States dollars) of a standard IVF cycle ranged from $12,513 in the United States to $3,956 in Japan. The cost per live birth was highest in the United States and United Kingdom ($41,132 and $40,364, respectively) and lowest in Scandinavia and Japan ($24,485 and $24,329, respectively). The cost of an IVF cycle after government subsidization ranged from 50% of annual disposable income in the United States to 6% in Australia. The cost of ART treatment did not exceed 0.25% of total healthcare expenditure in any country. Australia and Scandinavia were the only country/region to reach levels of utilization approximating demand, with North America meeting only 24% of estimated demand. Demand displayed variable price elasticity. Assisted reproductive technology is expensive from a patient perspective but not from a societal perspective. Only countries with funding arrangements that minimize out-of-pocket expenses met expected demand. Funding mechanisms should maximize efficiency and equity of access while minimizing the potential harm from multiple births.

  9. Assisted reproductive technology: Islamic Sunni perspective.

    PubMed

    Chamsi-Pasha, Hassan; Albar, Mohammed Ali

    2015-06-01

    Islam acknowledges that infertility is a significant hardship. Attempts to cure infertility are not only permissible, but also encouraged in Islam. Over the last three decades, a multitude of advances in assisted reproductive technologies (ARTs) have appeared. This review was carried out to inform readers, who are not familiar with Islamic doctrine, about the Sunni perspective on this topic. Systematic review of the literature. A series of searches was conducted of Medline databases published in English between January 1978 and December 2013 with the following assisted reproduction, infertility, gender selection, ethics, bioethics, and Islam. In Islamic Sunni law, all ARTs are allowed, provided that the source of the sperm, ovum, and uterus comes from a legally married couple during the span of their marriage. All forms of surrogacy are forbidden. A third-party donor is not allowed, whether he or she is providing sperm, eggs, embryos, or a uterus. Frozen preimplantation may be transferred to the wife in a successive cycle provided the marital bondage is not absolved by death or divorce. Gender selection for medical reasons is permitted. It is allowed for limited social reasons by some jurists, provided it does not involve discrimination against either sex. ART is acceptable and commendable in Islamic Sunni law provided it is practiced within the husband and wife dyad during the span of their marital contract. No third party should intrude upon the marital function of procreation. Surrogacy is not accepted by Sunni Islamic authorities.

  10. The effect of paternal age on assisted reproduction outcome.

    PubMed

    Dain, Lena; Auslander, Ron; Dirnfeld, Martha

    2011-01-01

    To summarize the current knowledge about the association between paternal age and assisted reproductive technology (ART) outcomes. In contrast to the extensive investigation of the relationship between maternal age and the success of ART, there are few studies examining the effect of paternal age on ART outcomes. Systematic review of the literature. By means of a PubMed literature search using the phrases "paternal age", "male age", and "assisted reproductive technology", we identified articles that investigated the role of male age in in vitro reproduction techniques. The 10 studies included in this review did not show a clear correlation between advanced paternal age and rates of fertilization, implantation, pregnancy, miscarriage, and live birth. Paternal age was not found to affect embryo quality at the cleavage stage (days 2-3). However, a significant decrease in blastocyst embryo formation was associated with increased paternal age, probably reflecting male genomic activation within the embryo. Except for volume, characteristics of semen such as motility, concentration, and morphology did not decrease with age. There is insufficient evidence to demonstrate an unfavorable effect of paternal age on ART outcomes. Further study with well-defined entry criteria and uniform reporting of outcomes is needed to investigate the subject. Copyright © 2011. Published by Elsevier Inc.

  11. 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…

  12. Protection for Children Born Through Assisted Reproductive Technologies Act, B.E. 2558: The Changing Profile of Surrogacy in Thailand

    PubMed Central

    Stasi, Alessandro

    2017-01-01

    The National Legislative Assembly of Thailand has enacted on February 19, 2015 the Protection for Children Born through Assisted Reproductive Technologies Act (ART Act). Its primary objective aims at protecting children born through assisted reproductive technologies and providing the legal procedures that the intended parents must follow. The focus of this article is to discuss the ongoing issues involving assisted reproduction in Thailand. After reviewing the past legal framework surrounding surrogate motherhood and the downsides of the assisted reproductive technology market in Thailand, the article will discuss the new ART Act and its regulatory framework. It will conclude that although the new law contains some flaws and limitations, it has so far been successful in tackling surrogacy trafficking and preventing reproductive scandals from occurring again. PMID:29386954

  13. Protection for Children Born Through Assisted Reproductive Technologies Act, B.E. 2558: The Changing Profile of Surrogacy in Thailand.

    PubMed

    Stasi, Alessandro

    2017-01-01

    The National Legislative Assembly of Thailand has enacted on February 19, 2015 the Protection for Children Born through Assisted Reproductive Technologies Act (ART Act). Its primary objective aims at protecting children born through assisted reproductive technologies and providing the legal procedures that the intended parents must follow. The focus of this article is to discuss the ongoing issues involving assisted reproduction in Thailand. After reviewing the past legal framework surrounding surrogate motherhood and the downsides of the assisted reproductive technology market in Thailand, the article will discuss the new ART Act and its regulatory framework. It will conclude that although the new law contains some flaws and limitations, it has so far been successful in tackling surrogacy trafficking and preventing reproductive scandals from occurring again.

  14. Introduction: Management of the luteal phase in assisted reproductive technology.

    PubMed

    Griesinger, Georg; Meldrum, David

    2018-05-01

    The increasing utilization of a gonadotropin-releasing hormone agonist ovulation trigger and the widespread use of artificial cycles for the transfer of frozen-thawed or donated embryos has renewed interest in the luteal phase in assisted reproductive technology. The "luteal phase defect" phenomenon is now understood as a continuum: there is less impairment with milder stimulation than with more intense ovarian stimulation, and less impairment after controlled ovarian stimulation and human chorionic gonadotropin ovulation triggering than after gonadotropin-releasing hormone agonist ovulation triggering, the latter being associated with rapid luteolysis. The intensity of the support of luteal phase necessary to achieve optimal outcomes therefore depends on the degree of luteal phase defect encountered in different treatment protocols. Ultimately, the luteal phase of an artificial cycle in which ovulation is suppressed, a corpus luteum is therefore absent, and the establishment of endometrial receptivity completely relies on the orchestrated exogenous administration of sex steroids, is the litmus test situation for the study of the efficacy of different luteal phase support preparations, doses, regimens, and routes of administration. Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Balancing animal welfare and assisted reproduction: ethics of preclinical animal research for testing new reproductive technologies.

    PubMed

    Jans, Verna; Dondorp, Wybo; Goossens, Ellen; Mertes, Heidi; Pennings, Guido; de Wert, Guido

    2018-02-07

    In the field of medically assisted reproduction (MAR), there is a growing emphasis on the importance of introducing new assisted reproductive technologies (ARTs) only after thorough preclinical safety research, including the use of animal models. At the same time, there is international support for the three R's (replace, reduce, refine), and the European Union even aims at the full replacement of animals for research. The apparent tension between these two trends underlines the urgency of an explicit justification of the use of animals for the development and preclinical testing of new ARTs. Considering that the use of animals remains necessary for specific forms of ART research and taking account of different views on the moral importance of helping people to have a genetically related child, we argue that, in principle, the importance of safety research as part of responsible innovation outweighs the limited infringement of animal wellbeing involved in ART research.

  16. Reproducing politics: the politicisation of patients' identities and assisted reproduction in Poland and Sweden.

    PubMed

    Gunnarsson Payne, Jenny; Korolczuk, Elżbieta

    2016-09-01

    This article examines how discourses on assisted reproductive technologies are locally appropriated, translated or contested in the specific cultural and political contexts of Poland and Sweden. The aim is to investigate how two national patients' organisations, namely the Polish association Nasz Bocian and the Swedish organisation Barnlängtan, articulate rights claims in the context of reproductive technologies. To this end, we investigate how these organisations utilise specific context-dependent and affectively laden political vocabularies in order to mobilise politically, and discuss how each of these two groups gives rise to a different set of politicised reproductive identities. In order to trace which political vocabularies the respective organisations utilise to mobilise their respective rights claims, we draw primarily on political discourse theory and concepts of political grammars and empty signifiers. Lastly, we discuss which political reproductive identities emerge as a result of these different versions of political mobilisation around assisted reproductive technologies. © 2016 Foundation for the Sociology of Health & Illness.

  17. Physician attitudes regarding pregnancy, fertility care, and assisted reproductive technologies for HIV-infected individuals and couples.

    PubMed

    Yudin, Mark H; Money, Deborah M; Cheung, Matthew C; Loutfy, Mona R

    2012-01-01

    Family and pregnancy planning are important for HIV-infected individuals and couples. There is a paucity of data regarding physician attitudes with respect to reproduction in this population, but some evidence suggests that attitudes can influence the information, advice, and services they will provide. To determine physician attitudes toward pregnancy, fertility care, and access to assisted reproductive technologies for HIV-infected individuals, and to determine whether attitudes differed based on specific physician characteristics. A survey was sent electronically to obstetrician/gynecologists and infectious disease specialists in Canada. Items were grouped into 5 key domains: physician demographics, physician attitudes toward pregnancy and adoption, physician attitudes toward fertility care, physician attitudes toward assisted reproductive technology, and challenges for an HIV-infected population. Attitudes were determined based on answers to individual questions and also for each domain. Univariate and logistic regression analyses were used to determine the influence of specific physician characteristics on attitudes. Completed surveys were received from 165 physicians. Most had positive attitudes regarding pregnancy or adoption (89%), fertility care (72%), and assisted reproductive technology (79%). In multivariate analyses, having cared for HIV-infected patients was significantly associated with having a positive attitude toward fertility care or assisted reproductive technology. In this national survey of Canadian physicians, most had positive attitudes toward pregnancy, adoption, fertility care, and use of assisted reproductive technology among HIV-infected persons. Physicians who had cared for HIV-infected individuals in the past were more likely to have positive attitudes than those who had not.

  18. Cystic fibrosis screening in assisted reproduction.

    PubMed

    Gazvani, Rafet; Lewis-Jones, Iwan

    2006-06-01

    The purpose of this review is to discuss the incidence of cystic fibrosis in the general population, in ethnically diverse populations and specifically in couples needing assisted reproduction caused by male factor subfertility. We review the current understanding of risks for reproductive couples and discuss ideal screening strategies. In ethnically diverse populations, a large difference in clinical sensitivity and birth prevalence exists between the broad racial/ethnic groups examined. Extensive data clearly demonstrate the cost-effectiveness of cystic fibrosis screening. Testing for cystic fibrosis gene mutations is reliable and, with a 26-mutation panel, nearly 90% of possible severe mutations can be detected. To halve the incidence of cystic fibrosis in the community, by offering genetic testing of the fetus if both partners are carrier positive, may also be possible. Recent guidelines suggest that all couples contemplating pregnancy should be informed of molecular screening for cystic fibrosis carrier status for purposes of genetic counselling. In ethnically diverse populations, ethnic-specific mutations should be included in the mutation panels.

  19. 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…

  20. From 'Mung Ming' to 'Baby Gammy': a local history of assisted reproduction in Thailand.

    PubMed

    Whittaker, Andrea

    2016-06-01

    This paper documents the rapidly changing history of IVF in Thailand since the birth of the first IVF conceived child there in 1987. The paper is based upon extensive Thai and English media material as well as interviews with leading reproductive specialists and is informed by long-term ethnographic research on IVF in Thailand. Assisted reproduction was quickly accepted in Thai society and associated with modernity and nationalist pride in Thai scientific progress. From its early beginnings in state-owned teaching hospitals, assisted reproduction rapidly expanded into the Thai private sector. Although Thai Medical Council guidelines were introduced in 1997, the loose regulatory regime saw the growth of an international trade in assisted reproductive technology services and medical facilitation companies brokering commercial surrogacies. From 2011, various controversies brought the industry into disrepute. These included: the trafficking of Vietnamese women as surrogates; non-medical sex selection and commercial ova donation and commercial surrogacy in breach of Thai Medical Council guidelines; the highly publicised case of a Japanese man commissioning 15 children with multiple surrogates; and the 'Baby Gammy' case involving the abandonment of a twin born with Down Syndrome. These cases exposed the exploitative downside of an assisted reproductive technology market that takes advantage of countries with little or no regulation in place and led Thai society to question the benefits of these technologies, their practitioners and the industry it has created. Since 2015, new legislation restricts clinical practices, limits eligibility for services and bans all commercial ova donation or surrogacy or its facilitation.

  1. 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.

  2. Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology.

    PubMed

    Chiu, Yu-Han; Williams, Paige L; Gillman, Matthew W; Gaskins, Audrey J; Mínguez-Alarcón, Lidia; Souter, Irene; Toth, Thomas L; Ford, Jennifer B; Hauser, Russ; Chavarro, Jorge E

    2018-01-01

    Animal experiments suggest that ingestion of pesticide mixtures at environmentally relevant concentrations decreases the number of live-born offspring. Whether the same is true in humans is unknown. To examine the association of preconception intake of pesticide residues in fruits and vegetables (FVs) with outcomes of infertility treatment with assisted reproductive technologies (ART). This analysis included 325 women who completed a diet assessment and subsequently underwent 541 ART cycles in the Environment and Reproductive Health (EARTH) prospective cohort study (2007-2016) at a fertility center at a teaching hospital. We categorized FVs as having high or low pesticide residues using a validated method based on surveillance data from the US Department of Agriculture. Cluster-weighted generalized estimating equations were used to analyze associations of high- and low-pesticide residue FV intake with ART outcomes. Adjusted probabilities of clinical pregnancy and live birth per treatment cycle. In the 325 participants (mean [SD] age, 35.1 [4.0] y; body mass index, 24.1 [4.3]), mean (SD) intakes of high- and low-pesticide residue FVs were 1.7 (1.0) and 2.8 (1.6) servings/d, respectively. Greater intake of high-pesticide residue FVs was associated with a lower probability of clinical pregnancy and live birth. Compared with women in the lowest quartile of high-pesticide FV intake (<1.0 servings/d), women in the highest quartile (≥2.3 servings/d) had 18% (95% CI, 5%-30%) lower probability of clinical pregnancy and 26% (95% CI, 13%-37%) lower probability of live birth. Intake of low-pesticide residue FVs was not significantly related to ART outcomes. Higher consumption of high-pesticide residue FVs was associated with lower probabilities of pregnancy and live birth following infertility treatment with ART. These data suggest that dietary pesticide exposure within the range of typical human exposure may be associated with adverse reproductive consequences.

  3. [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. Copyright © 2013. Published by Elsevier SAS.

  4. Cross-border reproductive care: a phenomenon expressing the controversial aspects of reproductive technologies.

    PubMed

    Ferraretti, Anna Pia; Pennings, Guido; Gianaroli, Luca; Natali, Francesca; Magli, M Cristina

    2010-02-01

    Cross-border reproductive care, also called reproductive tourism, refers to the travelling of citizens from their country of residence to another country in order to receive fertility treatment through assisted reproductive technology. Several reasons account for cross-border reproductive care: (i) a certain kind of treatment is forbidden by law in the couple's own country or is inaccessible to the couple because of their demographic or social characteristics; (ii) foreign centres report higher success rates compared with those of the centres in the country of residence; (iii) a specific treatment may be locally unavailable because of a lack of expertise or because the treatment is considered experimental or insufficiently safe; and (iv) limited access to the treatment in the couple's home country because of long waiting lists, excessive distance from a centre or high costs. Although cross-border reproductive care can be viewed as a safety valve, the phenomenon is often associated with a high risk of health dangers, frustration and disparities. Solutions to these problematic effects need to be considered in the light of the fact that cross-border reproductive care is a growing phenomenon. 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  5. A survey of the attitudes of infertile and parous women towards the availability of assisted reproductive technology.

    PubMed

    Heikkilä, Katri; Länsimies, Esko; Hippeläinen, Maritta; Heinonen, Seppo

    2004-11-01

    The aim of the study was to assess differences in attitudes towards aspects of assisted reproduction technology between infertile and parous women. Case-control study. University-based tertiary care clinic. Three hundred and ninety-two women with fertility problems and 200 parous controls. A questionnaire was sent out to 392 the members of Childless Support Association and 200 parous women who had at least three infants and had given birth at Kuopio University Hospital. The questionnaire consisted of 46 questions: demographic information, fertility history, different aspects of assisted reproduction technology and prioritisation issues. Attitudes towards assisted reproduction technology. The overall response rate was 46%. Infertile women were highly educated (P < 0.01) and had lower parity (mean 0.83 vs 4.76, P < 0.01) than parous women. We recorded four major differences in attitudes between the two groups (OR >2 or <0.5) including provision of infertility treatment to lesbian (46.9% vs 16.7%) and homosexual couples (28.4% vs 11.4%), the opportunity for homosexual couples to use surrogate mothers (30.6% vs 15.2%) and limitations in the number of infertility treatment cycles (28.4% vs 61.4%). For 11 questions, we recorded minor, but statistically significant, differences. In the prioritisation questions, the women set the order according to their own interests, probably because the women were at fertile age and they had or would like to have a child. Maternity services and screening for cancer in women (Papanicolaou's test and mammography) were at the top of the list. These results reflect a split attitude that was influenced by the wish of infertile women to help childless couples and to be able to recruit suitable sperm/oocyte donors. Parous women were motivated by their concern for children's rights.

  6. What is the most relevant standard of success in assisted reproduction? Defining outcome in ART: a Gordian knot of safety, efficacy and quality.

    PubMed

    Land, Jolande A; Evers, Johannes L H

    2004-05-01

    In the course of the present Debate series, several new outcome measures for assisted reproduction have been proposed to encourage the transfer of fewer embryos, in order to diminish the number of multiple pregnancies. The implementation of these recommendations, however, is hampered by the perception that safety and efficacy are communicating vessels: it is presumed that by decreasing the number of embryos transferred, pregnancy rates will decrease as well. Data from national and international registries, however, do not confirm the assumption of the communicating vessels: pregnancy rates tend to be low in countries in which many embryos are transferred, and the highest pregnancy rates occur where the number of embryos per transfer is low. Only top-level clinics (where treatment efficacy is guaranteed) are able to decrease the number of embryos transferred without compromising their pregnancy rate, and to vouch for safety in this way. Elective single embryo transfer (eSET) can never be mandatory in all patients, but the percentage of eSETs performed by a particular assisted reproduction treatment centre does reflect its quality: the ultimate outcome measure of efficacy ánd safety. Therefore, the eSET rate is the most relevant qualifier of performance in assisted reproduction.

  7. 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.

  8. The effects of competition on assisted reproductive technology outcomes.

    PubMed

    Henne, Melinda B; Bundorf, M Kate

    2010-04-01

    To evaluate the relationship between competition among fertility clinics and assisted reproductive technology (ART) treatment outcomes, particularly multiple births. Using clinic-level data from 1995 to 2001, we examined the relationship between competition and clinic-level ART outcomes and practice patterns. National database registry. Clinics performing ART. The number of clinics within a 20-mile (32.19-km) radius of a given clinic. Clinic-level births, singleton births, and multiple births per ART cycle; multiple births per ART birth; average number of embryos transferred per cycle; and the proportion of cycles for women under age 35 years. The number of competing clinics is not strongly associated with ART birth and multiple birth rates. Relative to clinics with no competitors, the rate of multiple births per cycle is lower (-0.03 percentage points) only for clinics with more than 15 competitors. Embryo transfer practices are not statistically significantly associated with the number of competitors. Clinic-level competition is strongly associated with patient mix. The proportion of cycles for patients under 35 years old is 6.4 percentage points lower for clinics with more than 15 competitors than for those with no competitors. Competition among fertility clinics does not appear to increase rates of multiple births from ART by promoting more aggressive embryo transfer decisions. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.Published by Elsevier Inc.

  9. Transport of equine ovaries for assisted reproduction.

    PubMed

    Ribeiro, B I; Love, L B; Choi, Y H; Hinrichs, K

    2008-10-01

    Use of assisted reproduction to obtain foals from valuable mares post-mortem typically necessitates holding of ovaries during shipment to a laboratory. The present study evaluated whether holding ovaries briefly at a warm ( approximately 30 degrees C) temperature improves meiotic and developmental competence of oocytes, as determined after maturation in vitro and intracytoplasmic sperm injection. Ovaries were packaged in pairs in insulated containers, and held either at 24 or 25-35 degrees C for 4h, followed by cooling. Ovaries in both treatments were held for either a short (mean, 7-7.4h) or long (mean, 20.6-20.7h) duration before oocyte recovery. Control ovaries were collected en masse at the abattoir. The ovary temperature in this treatment slowly decreased to approximately 27 degrees C; oocyte recovery was performed after 3.5-7h total holding. There was no effect of temperature on oocyte meiotic or developmental competence within either treatment time period. Oocytes in the short duration holding group had similar meiotic competence to controls, but had a significantly decreased rate (P<0.05) of blastocyst development. Oocytes in the long duration holding group had decreased (P<0.05) meiotic competence and blastocyst development compared to controls. These findings indicate that storage of equine ovaries for only 7h may decrease blastocyst development, and that longer storage reduces both rate of oocyte maturation and blastocyst development. Further work is needed to determine if there is a critical time before 7h post-mortem by which equine oocytes should be recovered to maximize developmental competence.

  10. The Effect of Auriculotherapy on the Stress and the Outcomes of Assistant Reproductive Technologies in Infertile Women.

    PubMed

    Saffari, Mozhgan; Khashavi, Zahra; Valiani, Mahboubeh

    2018-01-01

    Infertility means failure to achieve pregnancy after one year of regular unprotected sexual intercourse. Infertile women may experience severe stress and depression. Numerous studies have indicated that auriculotherapy could reduce stress. Thus, the aim of the present study was to determine the effect of auriculotherapy on the stress and the outcome assisted reproductive technology in infertile women. The present study was a clinical trial that was conducted on 56 infertile women aged 20-45, who were assigned into two groups of intervention and control, from November 2014 to November 2015. The control group only received the routine treatments, while the intervention group, in addition to their routine treatment, received auriculotherapy for 8-10 sessions during menstrual cycle. Both groups completed Newton's Fertility Problem Inventory in three stages. The datasets collected for the study were analyzed using independent t -test, repeated-measures analysis of variance, and Chi-square test. The mean score of stress in the intervention group decreased significantly, compared to the control group prior to the embryo transfer and pregnancy test stages. Although insignificant, the rate of pregnancy in the intervention group was higher than the control group. There was a significant increase in the rate of clinical pregnancy in the intervention group, compared to the control. The results indicated that auriculotherapy might be effective in reducing stress and improving the outcome of assisted reproductive treatment.

  11. Genome editing and assisted reproduction: curing embryos, society or prospective parents?

    PubMed

    Cavaliere, Giulia

    2018-06-01

    This paper explores the ethics of introducing genome-editing technologies as a new reproductive option. In particular, it focuses on whether genome editing can be considered a morally valuable alternative to preimplantation genetic diagnosis (PGD). Two arguments against the use of genome editing in reproduction are analysed, namely safety concerns and germline modification. These arguments are then contrasted with arguments in favour of genome editing, in particular with the argument of the child's welfare and the argument of parental reproductive autonomy. In addition to these two arguments, genome editing could be considered as a worthy alternative to PGD as it may not be subjected to some of the moral critiques moved against this technology. Even if these arguments offer sound reasons in favour of introducing genome editing as a new reproductive option, I conclude that these benefits should be balanced against other considerations. More specifically, I maintain that concerns regarding the equality of access to assisted reproduction and the allocation of scarce resources should be addressed prior to the adoption of genome editing as a new reproductive option.

  12. Review: Diagnosis and impact of sperm DNA alterations in assisted reproduction.

    PubMed

    Simon, Luke; Emery, Benjamin R; Carrell, Douglas T

    2017-10-01

    Sperm nuclear and chromatin abnormalities are common among infertile men and are known to influence natural reproduction. These abnormalities are also considered detrimental to normal fertilization, embryo development, and successful implantation and pregnancies following assisted reproductive treatment (ART). Abnormalities in the sperm nucleus can be broadly classified into sperm chromosomal abnormalities (aneuploidies) and sperm DNA abnormalities such as abnormal packing, DNA integrity, or DNA fragmentation. For the past 30 years, numerous tests have been developed to quantify these abnormalities in sperm. In this chapter, we review the causes of sperm DNA and chromosomal abnormalities, describe the commonly used tests to evaluate these abnormalities, and finally review the impact of these abnormalities on male fertility and ART outcomes. We also performed a comprehensive meta-analysis and systematic review from the existing literature to summarize the effect of sperm DNA fragmentation on ART outcomes such as fertilization rate, embryo quality, and clinical pregnancies. A review of the literature presented in this chapter suggests that sperm nuclear and chromatin abnormalities are associated with male infertility, and they reduce the probability of a successful pregnancy following ART. Copyright © 2017. Published by Elsevier Ltd.

  13. [Analysis of the demographic profile of patients treated for infertility using assisted reproductive techniques in 2005-2010].

    PubMed

    Milewski, Robert; Milewska, Anna Justyna; Czerniecki, Jan; Leśniewska, Monika; Wołczyński, Sławomir

    2013-07-01

    other ovulation disorders (31.3% vs. 35%). Advances in assisted reproductive techniques led to an increase in the efficacy of infertility treatment. Environmental factors, availability of treatment and level of awareness about womens health proved to have the strongest effect on the distribution of infertility causes between urban and rural areas. Significant efforts should be made, especially in cities, to decrease the average age of women's reproductive decisions and also to shorten the time to the first contact with the specialist after unsuccessful attempts at conception. It is also crucial to initiate the reimbursement of infertility treatment using ART (Assisted Reproductive Technology).

  14. The passage of Florida's Statute on Assisted Reproductive Technology.

    PubMed

    Maun, A R; Williams, R S; Graber, B; Myers, W G

    1994-11-01

    Until 1993, there were no statutes in the United States covering gestational surrogacy contracts, disposition of stored embryos and gametes, parentage of children born from donated gametes and embryos, and the inheritance rights of cryopreserved embryos of deceased donors. In March 1993, the Florida Assisted Reproductive Technology Act was passed to address some of these issues and to minimize the expense and emotional cost of related courtroom proceedings. Authors of the bill believed that motherhood of a newborn in the eyes of the law should be determined by two factors: genetic inheritance and the original intent of the woman to become the parent of record. The bill included the assumption that, in the cases of children born of gestational surrogacy, the commissioning genetic parents would be the "natural parents" of the child. Some of the reasons for legislative success of the statute include: 1) clear need for statutory guidance in cases involving reproductive technology, 2) relevance of the issue to cost containment (ie, judicial costs) in an era of health care reform, 3) careful use of scientific terminology and the support of the medical community, 4) involvement of a skilled legislative team, 5) participation of physician specialists in the development of the bill (ie, practicing gynecologists in assisted reproductive technology programs), 6) participation of the State of Florida legislative staff, and 7) consultation with appropriate lobbying groups (eg, Florida Catholic Conference). The successful legislative process that was followed to achieve passage of this bill can serve as an example for other states to emulate.

  15. Comparison between two forms of vaginally administered progesterone for luteal phase support in assisted reproduction cycles.

    PubMed

    Geber, Selmo; Moreira, Ana Carolina Ferreira; de Paula, Sálua Oliveira Calil; Sampaio, Marcos

    2007-02-01

    The use of progesterone for luteal phase support has been demonstrated to be beneficial in assisted reproduction cycles using gonadotrophin-releasing hormone analogues (GnRHa). Two micronized progesterone preparations are available for vaginal administration: capsules and gel. The objective of this study was to compare the efficacy of these two forms for luteal phase support in assisted reproduction cycles. A total of 244 couples undergoing IVF/intracytoplasmic sperm injection cycles were included in the study and were randomly allocated (sealed envelopes) into two groups: group 1 (122) received vaginal capsules of 200 mg of micronized progesterone (Utrogestan), 3 times daily, and group 2 (122) received micronized progesterone in gel (Crinone 8%), once daily. Both groups received progesterone for 13 days beginning day 1 after oocyte retrieval, continuing until the pregnancy test was performed and until 12 weeks of pregnancy. Groups were compared by clinical data and assisted reproduction results and had similar ages and causes of infertility. Although the pregnancy rate was higher for those receiving progesterone gel than capsules (44.26 and 36.06% respectively), this difference was not statistically significant. The study showed that vaginal progesterone gel and capsules used for luteal phase support in assisted reproduction cycles with long protocol GnRHa result in similar pregnancy rates.

  16. 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. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Relationship between paternal somatic health and assisted reproductive technology outcomes.

    PubMed

    Eisenberg, Michael L; Li, Shufeng; Wise, Lauren A; Lynch, Courtney D; Nakajima, Steven; Meyers, Stuart A; Behr, Barry; Baker, Valerie L

    2016-09-01

    To study the association between paternal medical comorbidities and the outcomes of assisted reproductive technology (ART). Retrospective cohort study. Academic reproductive medicine center. We analyzed fresh ART cycles uszing freshly ejaculated sperm from the male partner of couples undergoing ART cycles from 2004 until 2014. We recorded patient and partner demographic characteristics. The cohort was linked to hospital billing data to obtain information on selected male partners' comorbidities identified using ICD-9-CM codes. None. Fertilization, clinical pregnancy, miscarriage, implantation, and live-birth rates as well as birth weights and gestational ages. In all, we identified 2,690 men who underwent 5,037 fresh ART cycles. Twenty-seven percent of men had at least one medical diagnosis. Men with nervous system diseases had on average lower pregnancy rates (23% vs. 30%) and live-birth rates (15% vs. 23%) than men without nervous system diseases. Lower fertilization rates were also observed among men with respiratory diseases (61% vs. 64%) and musculoskeletal diseases (61% vs. 64%) relative to those without these diseases. In addition, men with diseases of the endocrine system had smaller children (2,970 vs. 3,210 g) than men without such diseases. Finally, men with mental disorders had children born at an earlier gestational age (36.5 vs. 38.0 weeks). The current report identified a possible relationship between a man's health history and IVF outcomes. As these are potentially modifiable factors, further research should determine whether treatment for men's health conditions may improve or impair IVF outcomes. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  18. Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology

    PubMed Central

    Chiu, Yu-Han; Williams, Paige L.; Gillman, Matthew W.; Gaskins, Audrey J.; Mínguez-Alarcón, Lidia; Souter, Irene; Toth, Thomas L.; Ford, Jennifer B.; Hauser, Russ; Chavarro, Jorge E.

    2018-01-01

    IMPORTANCE Animal experiments suggest that ingestion of pesticide mixtures at environmentally relevant concentrations decreases the number of live-born offspring. Whether the same is true in humans is unknown. OBJECTIVE To examine the association of preconception intake of pesticide residues in fruits and vegetables (FVs) with outcomes of infertility treatment with assisted reproductive technologies (ART). DESIGN, SETTING, AND PARTICIPANTS This analysis included 325 women who completed a diet assessment and subsequently underwent 541 ART cycles in the Environment and Reproductive Health (EARTH) prospective cohort study (2007–2016) at a fertility center at a teaching hospital. We categorized FVs as having high or low pesticide residues using a validated method based on surveillance data from the US Department of Agriculture. Cluster-weighted generalized estimating equations were used to analyze associations of high– and low–pesticide residue FV intake with ART outcomes. MAIN OUTCOMES AND MEASURES Adjusted probabilities of clinical pregnancy and live birth per treatment cycle. RESULTS In the 325 participants (mean [SD] age, 35.1 [4.0] y; body mass index, 24.1 [4.3]), mean (SD) intakes of high– and low–pesticide residue FVs were 1.7 (1.0) and 2.8 (1.6) servings/d, respectively. Greater intake of high–pesticide residue FVs was associated with a lower probability of clinical pregnancy and live birth. Compared with women in the lowest quartile of high-pesticide FV intake (<1.0 servings/d), women in the highest quartile (≥ 2.3 servings/d) had 18% (95% CI, 5%–30%) lower probability of clinical pregnancy and 26% (95% CI, 13%–37%) lower probability of live birth. Intake of low–pesticide residue FVs was not significantly related to ART outcomes. CONCLUSIONS AND RELEVANCE Higher consumption of high–pesticide residue FVs was associated with lower probabilities of pregnancy and live birth following infertility treatment with ART. These data suggest that

  19. Diagnostics in assisted human reproduction.

    PubMed

    Montoya, Juan Manuel; Bernal, Alejandra; Borrero, Claudia

    2002-01-01

    The World Health Organization (WHO) estimates that 50-80 x 10(6) couples in the world are infertile, i.e. 7-15% of all couples of reproductive age (15-45 years old). The term infertility refers to couples who have been unable to conceive children for at least 1 year of regular unprotected intercourse. Although the frequency and origin of infertility varies, approximately 40-60% of the aetiology of infertility in the population studied is due to female causes. The introduction of assisted reproduction techniques, which offer couples the best opportunities for pregnancy, has opened a vast field of knowledge in reproductive biology. The medical history must be taken meticulously, with enough time to obtain the largest possible amount of relevant information. It is recommended that both partners be included in the initial work-up. In recent decades, technological progress has been favoured with the development of a great variety of diagnostic tests. Moreover, a very valuable tool helping to solve this problem has gained strength and is available to everybody - so-called 'evidence-based medicine'. There are three categories in infertility diagnostic tests. The first category includes tests showing a well-established correlation with pregnancy, e.g. semen analysis, tubal patency with hysterosalpingography or laparoscopy, and ovulation detection. The second category includes patients whose results are not consistently related to pregnancy. Here, these tests include sperm penetration assay in the zona-free hamster oocyte, post-coital tests, sperm penetration into cervical mucus, and tests to detect anti-sperm antibodies. The third group includes patients whose tests are not correlated with pregnancy. The relevant tests include endometrial biopsy, the presence of varicocele, and Chlamydia detection tests. Tests for infertility are often expensive. Since these patients are usually anxious and eager and will do almost anything to have a child, care must be taken to avoid

  20. Politics, doctors, assisted reproductive technologies & religion: Transgenerational understandings and experiences of single motherhood in Spain.

    PubMed

    Bravo-Moreno, Ana

    2017-10-01

    The aim is to achieve a transgenerational view of single motherhood in Spain, to look at which contexts it arises in, how it changes with the introduction of assisted reproduction, and how the role of religion in Spanish society permeates medical practice and affects the lives of women patients. I examine single motherhood and investigate two interconnected themes: (a) being a mother and being mothered are both permeated with sociocultural, political, religious, economic and psychological significance; (b) Spain led Europe in multiple births due to assisted reproduction, thus ethical conflicts and patient rights are analyzed.

  1. The costs and consequences of assisted reproductive technology: an economic perspective.

    PubMed

    Connolly, Mark P; Hoorens, Stijn; Chambers, Georgina M

    2010-01-01

    Despite the growing use of assisted reproductive technologies (ART) worldwide, there is only a limited understanding of the economics of ART to inform policy about effective, safe and equitable financing of ART treatment. A review was undertaken of key studies regarding the costs and consequences of ART treatment, specifically examining the direct and indirect costs of treatment, economic drivers of utilization and clinical practice and broader economic consequences of ART-conceived children. The direct costs of ART treatment vary substantially between countries, with the USA standing out as the most expensive. The direct costs generally reflect the costliness of the underlying healthcare system. If unsubsidized, direct costs represent a significant economic burden to patients. The level of affordability of ART treatment is an important driver of utilization, treatment choices, embryo transfer practices and ultimately multiple birth rates. The costs associated with caring for multiple-birth ART infants and their mothers are substantial, reflecting the underlying morbidity associated with such pregnancies. Investment analysis of ART treatment and ART-conceived children indicates that appropriate funding of ART services appears to represent sound fiscal policy. The complex interaction between the cost of ART treatment and how treatments are subsidized in different healthcare settings and for different patient groups has far-reaching consequences for ART utilization, clinical practice and infant outcomes. A greater understanding of the economics of ART is needed to inform policy decisions and to ensure the best possible outcomes from ART treatment.

  2. Rethinking radical politics in the context of assisted reproductive technology.

    PubMed

    Parks, Jennifer

    2009-01-01

    Radical feminists have argued for both the radical potential of assisted reproductive technology (ART) and its oppressive and damaging effects for women. This paper will address the question of what constitutes a radical feminist position on ART; I will argue that the very debate over whether ART liberates or oppresses women is misguided, and that instead the issue should be understood dialectically. Reproductive technologies are neither inherently liberating nor entirely oppressive: we can only understand the potential and effects by considering how they are actually taken up within a culture. The internal contradictions, tensions, and inconsistencies within ART and the way it is addressed within the law points to a dialectic that resists a simple reductivist understanding.

  3. Access to assisted reproductive technologies in France: the emergence of the patients' voice.

    PubMed

    Fournier, Véronique; Berthiau, Denis; d'Haussy, Julie; Bataille, Philippe

    2013-02-01

    Is there any ethical justification for limiting the reproductive autonomy and not make assisted reproductive technologies available to certain prospective parents? We present and discuss the results of an interdisciplinary clinical ethics study concerning access to assisted reproductive technologies (ART) in situations which are considered as ethically problematic in France (overage or sick parents, surrogate motherhood). The study focused on the arguments that people in these situations put forward when requesting access to ART. It shows that requester's arguments are based on sound ethical values, and that their legitimacy is at least as strong as that of those used by doctors to question access to ART. Results reveal that the three implicit normative arguments that founded the law in 1994, which are still in force after the bioethics law revision in July 2011-the welfare of the child, the illegitimacy of a "right to a child," and the defense of the so called "social order"-are challenged on several grounds by requesters as reasons for limiting their reproductive autonomy. Although these results are limited to exceptional situations, they are of special interest insofar as they give voice to the requesters' own ethical concerns in the ongoing political debate over access to ART.

  4. 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.

  5. Progesterone and the luteal phase: a requisite to reproduction.

    PubMed

    Mesen, Tolga B; Young, Steven L

    2015-03-01

    Progesterone production from the corpus luteum is critical for natural reproduction. Progesterone supplementation seems to be an important aspect of any assisted reproductive technology treatment. Luteal phase deficiency in natural cycles is a plausible cause of infertility and pregnancy loss, though there is no adequate diagnostic test. This article describes the normal luteal phase of the menstrual cycle, investigates the controversy surrounding luteal phase deficiency, and presents the current literature for progesterone supplementation during assisted reproductive technologies. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Trans people's experiences with assisted reproduction services: a qualitative study.

    PubMed

    James-Abra, S; Tarasoff, L A; Green, D; Epstein, R; Anderson, S; Marvel, S; Steele, L S; Ross, L E

    2015-06-01

    What are the experiences of trans persons (i.e. those whose gender identity does not match the gender assigned to them at birth) who sought or accessed assisted reproduction (AR) services in Ontario, Canada, between 2007 and 2010? The majority of trans persons report negative experiences with AR service providers. Apart from research examining desire to have children among trans people, most of the literature on this topic has debated the ethics of assisting trans persons to become parents. To-date, all of the published research concerning trans persons' experiences with AR services is solely from the perspective of service providers; no studies have examined the experiences of trans people themselves. Secondary qualitative research study of data from nine trans-identified people and their partners (total n = 11) collected as part of a community-based study of access to AR services for sexual and gender minority people between 2010 and 2012. Trans-identified volunteers (and their partners, when applicable) who had used or attempted to access AR services since 2007 from across Ontario, Canada, participated in a 60-90 minute, semi-structured qualitative interview. Qualitative analysis was performed using a descriptive phenomenological approach. Emerging themes were continually checked against the data as part of an iterative process. The data highlight barriers to accessing AR services for trans people. Participant recommendations for improving AR service provision to better meet the needs of this population are presented. These recommendations address the following areas: (i) AR service provider education and training; (ii) service provider and clinic practices and (iii) clinic environment. The majority of study participants were trans people who identified as men and who resided in major urban areas; those living in smaller communities may have different experiences that were not adequately captured in this analysis. While existing literature debates the ethics of

  7. The pluralism problem in cross-border reproductive care.

    PubMed

    Storrow, R F

    2010-12-01

    Outlawing well established forms of assisted reproduction places obstacles in the path of couples who wish to attain their reproductive goals with medical assistance. One effect of restrictive reproductive laws that has received widespread attention is cross-border reproductive travel. In Europe, such travel is permitted by the policy of free movement of persons that is a cornerstone of the democratic and economic stability of the European Union. Cross-border reproductive travel fails to promote moral and political pluralism in democratic states for three primary reasons. First, the opportunity for patients to go abroad for treatment tempers organized resistance to the law and allows government to pass stricter regulations than it otherwise might. Second, cross-border reproductive care has been shown to have deleterious extraterritorial effects that undermine the articulated rationales behind restrictive reproductive laws. Third, laws that generate demand for cross-border reproductive care often fail to satisfy the standard of proportionality that restrictions on human reproduction must meet.

  8. 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.

  9. GnRH antagonist, cetrorelix, for pituitary suppression in modern, patient-friendly assisted reproductive technology.

    PubMed

    Tur-Kaspa, Ilan; Ezcurra, Diego

    2009-10-01

    Gonadotropin-releasing hormone (GnRH) analogues are used routinely to prevent a premature luteinizing hormone (LH) surge in women undergoing assisted reproductive technology (ART) treatments. In contrast to GnRH agonists, antagonists produce rapid and reversible suppression of LH with no initial flare effect. To review the role of cetrorelix, the first GnRH antagonist approved for the prevention of premature LH surges during controlled ovarian stimulation in modern ART. A review of published literature on cetrorelix. Both multiple- and single-dose cetrorelix protocols were shown to be at least as effective as long GnRH agonist regimens for pituitary suppression in Phase II/III clinical trials. Furthermore, cetrorelix co-treatment resulted in similar live birth rates but a shorter duration of gonadotropin stimulation, a lower total gonadotropin dose requirement and lower incidence of ovarian hyperstimulation syndrome compared with long agonist regimens. A single-dose cetrorelix protocol further decreased the number of injections required. Preliminary studies have also produced promising data on the use of cetrorelix in modified ART protocols, such as frozen embryo transfer and donor oocyte recipient cycles. Cetrorelix offers a potential therapeutic alternative to GnRH agonists during controlled ovarian stimulation and has become an integral part of modern, patient-friendly reproductive medicine.

  10. Trends of racial disparities in assisted reproductive technology outcomes in black women compared with white women: Society for Assisted Reproductive Technology 1999 and 2000 vs. 2004-2006.

    PubMed

    Seifer, David B; Zackula, Rosey; Grainger, David A

    2010-02-01

    To determine trends in assisted reproductive technology (ART) in black and white women by comparing Society for Assisted Reproductive Technology (SART) database outcomes for 2004-2006 with previously reported outcomes for 1999 and 2000. Retrospective, cohort study. The SART member clinics that performed at least 50 cycles of IVF and reported race in more than 95% of cycles. Women receiving 158,693 IVF cycles. In vitro fertilization using nondonor embryos. Live birth rate per cycle started. Reporting of race increased from 52% to 60%. The proportion of black, non-Hispanic (BNH) women increased from 4.6% to 6.5%. For BNH women using fresh embryos and no prior ART, significant increasing trends were observed for older age, male factor, uterine factor, diminished ovarian reserve, and ovulation disorders. The BNH women were 2.5 times more likely to have tubal factor for those cycles with no prior ART. The proportion of live births per cycle started increased across all groups over time, although greater increases occurred for white women. There seems to be widening disparities in IVF outcomes between BNH and white women, perhaps attributable to poor prognostic factors among black women. Race continues to be a marker for prognosis for ART outcomes and should be reported. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. 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.

  12. A clinician's personal view of assisted reproductive technology over 35 years.

    PubMed

    Yovich, John L

    2011-12-01

    This invited presentation is intended to cover clinical developments in the evolution of assisted reproductive technology (ART), a process which was attempted during the 1940's and 50's and culminated in the first fruition in 1978. The first in vitro fertilisation (IVF) child ensued following the partnership by a scientist with a focussed ambition (Nobel laureate Robert Edwards) joining with the gynaecologist who introduced laparoscopy to Britain in the late 60's (Patrick Steptoe). My journey commenced in 1976 as a clinician who became immersed in the embryological and endocrinological science, whence most progress in ART emanates, and continued into a medical directorship position from which this personal view is documented. Several clinical advances have been important developments in the understanding and management of sub-fertile patients. However evolution of the various laboratory sciences has been the major key essential to meeting both the immediate as well as the long-term needs for human reproduction. The future requires a much better understanding and control over gametogenesis and a laboratory process which much more closely duplicates intrinsic reproductive physiology, avoiding gamete and embryo exposure to the atmosphere.This invited presentation is intended to cover clinical developments in the evolution of assisted reproductive technology (ART), a process which was attempted during the 1940's and 50's and culminated in the first fruition in 1978. The first in vitro fertilisation (IVF) child ensued following the partnership by a scientist with a focussed ambition (Nobel laureate Robert Edwards) joining with the gynaecologist who introduced laparoscopy to Britain in the late 60's (Patrick Steptoe). My journey commenced in 1976 as a clinician who became immersed in the embryological and endocrinological science, whence most progress in ART emanates, and continued into a medical directorship position from which this personal view is documented. Several

  13. 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

  14. 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…

  15. A philosopher looks at assisted reproduction.

    PubMed

    Steinbock, B

    1995-09-01

    The article first examines the various objections to IVF: religious, health and safety and feminist. It is argued that none of these objections provides good reasons for banning IVF, though certain controls and procedures to protect individuals from harm and exploitation may be appropriate. Next, the article critiques John Robertson's strong conception of procreative liberty, which entails a right to be a surrogate mother or serve as a sperm donor. Roberton's interpretation misconceives the nature and value of the right to reproduce. The righ to reproduce is best interpreted as a right to have one's own children to rear. Where there is no intent or ability to rear, there is no fundamental moral right to reproduce. However, since assisted reproduction is used to enable individuals to have their own children to rear, it should be available to infertile individuals who cannot otherwise reproduce.

  16. User involvement in assisted reproductive technologies: England and Portugal.

    PubMed

    Samorinha, Catarina; Lichon, Mateusz; Silva, Susana; Dent, Mike

    2015-01-01

    The purpose of this paper is to compare user involvement in the case of assisted reproductive technologies in England and Portugal through the concepts of voice, choice and co-production, assessing the implications for user empowerment. This qualitative study draws primarily on policy review and uses exploratory semi-structured interviews with key informants as a way of illustrating points. Data on the following themes was compared: voice (users' representativeness on licensing bodies and channels of communication between users and doctors); choice (funding and accessibility criteria; choice of fertility centres, doctors and level of care); and co-production (criteria through which users actively engage with health professionals in planning the treatment). Inter- and intra-healthcare systems variations between the two countries on choice and co-production were identified. Differences between funding and accessibility, regions, public and private sectors and attitudes towards doctor-patient relationship (paternalistic/partnership) were the key issues. Although consumer choice and indicators of co-production are evident in treatment pathways in both countries, user empowerment is not. This is limited by inequalities in accessibility criteria, dependence on doctors' individual perspectives and lack of genuine and formal hearing of citizens' voice. Enhancing users' involvement claims for individual and organizational cultures reflecting user-centred values. Effective ways to incorporate users' knowledge in shared decision making and co-design are needed to empower patients and to improve the delivery of care.

  17. Live birth rates and safety profile using dydrogesterone for luteal phase support in assisted reproductive techniques

    PubMed Central

    Nadarajah, Ravichandran; Rajesh, Hemashree; Wong, Ker Yi; Faisal, Fazlin; Yu, Su Ling

    2017-01-01

    INTRODUCTION Assisted reproductive techniques (ARTs) result in a deficient luteal phase, requiring the administration of intramuscular, intravaginal or oral exogenous progesterone. Dydrogesterone, an oral retroprogesterone with good bioavailability, has been used in assisted reproductive cycles with outcomes that are comparable to those of vaginal or intramuscular progesterone. However, there are limited reviews on its use for luteal phase support in ARTs, in terms of pregnancy outcomes and associated fetal anomalies. This study aimed to review the live birth rates and associated fetal anomalies of women who were given dydrogesterone for luteal phase support in assisted reproductive cycles at a tertiary hospital in Singapore. METHODS This retrospective descriptive study included 1,050 women who underwent in vitro fertilisation/intracytoplasmic sperm injection at the Centre for Assisted Reproduction of Singapore General Hospital between 2000 and 2011. The women were given dydrogesterone for luteal phase support. The main outcome measures were rates of pregnancy, live birth, miscarriage and fetal anomalies. RESULTS The pregnancy and live birth rates were 34.7% and 27.7%, respectively. Among those who achieved pregnancy, 17.0% miscarried, 0.8% had ectopic pregnancies and 0.3% had molar pregnancies. Fetal anomalies were detected in 1.9% of pregnancies, all of which were terminated by choice. CONCLUSION Since the outcomes of dydrogesterone are comparable to those of intramuscular and vaginal progesterone, it is a reasonable option to provide luteal phase support for women who are uncomfortable with injections or vaginal insertions. Randomised controlled studies are needed to determine the optimal dosage of dydrogesterone for luteal phase support in ARTs. PMID:27090598

  18. 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.

  19. Reproductive health financing in Kenya: an analysis of national commitments, donor assistance, and the resources tracking process.

    PubMed

    Sidze, Estelle M; Pradhan, Jalandhar; Beekink, Erik; Maina, Thomas M; Maina, Beatrice W

    2013-11-01

    Understanding the flow of resources at the country level to reproductive health is essential for effective financing of this key component of health. This paper gives a comprehensive picture of the allocation of resources for reproductive health in Kenya and the challenges faced in the resource-tracking process. Data are drawn from Kenyan budget estimates, reproductive health accounts, and the Resource Flows Project database and compare budgets and spending in 2005-06 with 2009-10. Despite policies and programmes in place since 1994, services for family planning, maternity care and infant and child health face serious challenges. As regards health financing, the government spends less than the average in sub-Saharan Africa, while donor assistance and out-of-pocket expenditure for health are high. Donor assistance to Kenya has increased over the years, but the percentage of funds devoted to reproductive health is lower than it was in 2005. We recommend an increase in the budget and spending for reproductive health in order to achieve MDG targets on maternal mortality and universal access to reproductive health in Kenya. Safety nets for the poor are also needed to reduce the burden of spending by households. Lastly, we recommend the generation of more comprehensive reproductive health accounts on a regular basis. Copyright © 2013 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

  20. [Access to Assisted Reproductive Technologies, surrogacy, same sex couple parenting].

    PubMed

    Belaisch Allart, J

    2012-08-01

    In France, access to Assisted Reproductive Technologies (ART) is strictly controlled. ART is only authorized for medical infertility. The revision of the law of bioethics has not modified access to ART. It is still forbidden to take charge of lesbian couples or gay-male couples, surrogacy is prohibited. The only change is that unmarried couples have no more to prove they live together since 2 years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  1. 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. Copyright © 2015. Published by Elsevier Inc.

  2. Gamete competence assessment by polarizing optics in assisted reproduction.

    PubMed

    Montag, Markus; Köster, Maria; van der Ven, Katrin; van der Ven, Hans

    2011-01-01

    The purpose of this study was first to give an overview of the historical development of polarization microscopy, second to describe the various applications of this technique in assisted reproduction techniques (ART) and third to discuss the potential benefit of polarization microscopy as a predictor for IVF success. The history of polarization microscopy was undertaken by performing a backward search in the scientific literature using Google and internet sites of several Societies for Microscopy and Cell Biology. Studies of polarization microscopy in ART were identified by using a systematic literature search in PubMed and Scopus. A total of 62 articles were identified by the direct search and further relevant articles were found by screening the cited literature in these articles. The topics relevant for assisted reproduction were spindle and zona imaging in combination with IVF success, meiotic cell cycle progression, pharmaceutical studies and cryopreservation. A separate topic was the use of sperm birefringence in ART. The majority of studies are observational studies and were not performed in a randomized manner and there is no direct comparison of techniques using other gamete selection markers. Despite this, most studies show that polarization microscopy may help us to further increase our knowledge on gametes and meiosis. Whether certain applications such as spindle or zona imaging may lead to an increase in IVF success is unclear at present. Publications on the use of polarization microscopy on sperm are still very limited.

  3. Assessing the use of assisted reproductive technology in the United States by non-United States residents.

    PubMed

    Levine, Aaron D; Boulet, Sheree L; Berry, Roberta M; Jamieson, Denise J; Alberta-Sherer, Hillary B; Kissin, Dmitry M

    2017-11-01

    To study cross-border reproductive care (CBRC) by assessing the frequency and nature of assisted reproductive technology (ART) care that non-U.S. residents receive in the United States. Retrospective study of ART cycles reported to the Centers for Disease Control and Prevention's National ART Surveillance System (NASS) from 2006 to 2013. Private and academic ART clinics. Patients who participated in ART cycles in the United States from 2006 to 2013. None. Frequency and trend of ART use in the U.S. by non-U.S. residents, countries of residence for non-U.S. residents, differences by residence status for specific ART treatments received, and the outcomes of these ART cycles. A total of 1,271,775 ART cycles were reported to NASS from 2006 to 2013. The percentage of ART cycles performed for non-U.S. residents increased from 1.2% (n = 1,683) in 2006 to 2.8% (n = 5,381) in 2013 (P<.001), with treatment delivered to residents of 147 countries. Compared with resident cycles, non-U.S. resident cycles had higher use of oocyte donation (10.6% vs. 42.6%), gestational carriers (1.6% vs. 12.4%), and preimplantation genetic diagnosis or screening (5.3% vs. 19.1%). U.S. resident and non-U.S. resident cycles had similar embryo transfer and multiple birth rates. This analysis showed that non-U.S. resident cycles accounted for a growing share of all U.S. ART cycles and made higher use of specialized treatment techniques. This study provides important baseline data on CBRC in the U.S. and may also prove to be useful to organizations interested in improving access to fertility treatments. Copyright © 2017 American Society for Reproductive Medicine. All rights reserved.

  4. Perception of infertility and acceptability of assisted reproduction technology in northern Nigeria.

    PubMed

    Iliyasu, Z; Galadanci, H S; Abubakar, I S; Bashir, F M; Salihu, H M; Aliyu, M H

    2013-01-01

    Infertility is a stigmatized reproductive morbidity with severe psycho-social consequences, especially in developing countries. There has been little exploration of the public view of infertility and acceptance of assisted reproduction in these countries, including Nigeria. To determine the public perception of infertility, its causes and factors associated with acceptability of Assisted Reproductive Technologies (ART) in Kano, Northern Nigeria. Using interviewer administered questionnaires, a cross-section of 600 adults were interviewed about perceived definition, causes and acceptance of ART. Majority of the respondents (n = 577, 99.3%) perceived infertility as a disease. Only 18.1% (n = 105) of the respondents would consider a couple infertile after one year of marriage. Causes of infertility mentioned by participants included paranormal events (n = 535, 92.1%), suprapubic pain (n = 321, 55.2%), induced abortion (n = 187, 32.2%) and sexually transmitted infections (n = 177, 30.5%). A minority of respondents (n = 161,27.7%) of participants mentioned blocked tubes and 24.6% (n = 143) irregular menstrual cycles. Although 36.1% of respondents were aware of ART; only 7.6% were willing to accept it. Being male [adjusted odds ratio (AOR) (95% CI)] 2.1 (1.55.72), childless [AOR (95% CI)] 2.2 (1.35.95), highly educated [AOR (95% CI)] 3.2 (1.326.72) and non-Muslim [AOR (95% CI)] 2.3 (1.23.76) were significant predictors of acceptance ofART. Infertility was correctly perceived as a disease, but there were misconceptions about its causes. The low acceptance of ART was influenced by socio-demographic factors. There is a need for sustained targeted information, education and communication regarding new reproductive technologies for fertility management.

  5. 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. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004.

    PubMed

    Sullivan, Elizabeth; Wang, Yueping; Chapman, Michael; Chambers, Georgina

    2008-07-01

    The aim of this study was to calculate assisted reproductive technology (ART) success rates for fresh autologous and donor cycles in women aged > or = 45 and the resultant cost per live birth. We performed a retrospective population-based study of 2339 ART cycles conducted in Australia, 2002-2004 to women aged > or = 45 years. The cost-outcome study was performed on fresh autologous treatment cycles. There were 1101 fresh autologous cycles initiated in women aged > or = 45, with a pregnancy rate of 1.9 per 100 initiated cycles. There were 21 women who achieved a clinical pregnancy with 15 (71%) ending in early pregnancy loss and 6 in live singleton births. The live birth rate following fresh autologous initiated cycles was 0.5% [95% confidence interval (CI): 0.1-1.0%]. Fresh donor recipients had an higher live birth rate of 19.1% (95% CI: 15.1-23.2) (odds ratio 43.2; 95% CI: 18.6-100.3) compared with women having fresh autologous cycles. The average cost of a live birth following fresh autologous cycles was 753,107 euros. The success rate of fresh autologous treatment for women aged > or = 45 years was < 1%. The very high cost of a live birth reflects a treatment failure rate of > 99%. The ART profession should counsel patients of the reality of the technology before the patients consent to treatment.

  7. 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. Thieme Medical Publishers.

  8. Relationships between human sperm protamines, DNA damage and assisted reproduction outcomes.

    PubMed

    Simon, Luke; Castillo, Judit; Oliva, Rafael; Lewis, Sheena E M

    2011-12-01

    The exchange of histones with protamines in sperm DNA results in sperm chromatin compaction and protection. Variations in sperm protamine expression are associated with male infertility. The aim of this study was to investigate relationships between DNA fragmentation, sperm protamines and assisted reproduction treatment. Semen and spermatozoa prepared by density-gradient centrifugation (DGC) from 73 men undergoing IVF and 24 men undergoing intracytoplasmic sperm injection (ICSI) were included in the study. Nuclear DNA fragmentation was assessed using the alkaline Comet assay and protamines were separated by acid-urea polyacrylamide gels. Sperm DNA fragmentation and protamine content (P1-DNA, P2-DNA, P1+P2-DNA) decreased in spermatozoa after DGC. Abnormally high and low P1/P2 ratios were associated with increased sperm DNA fragmentation. Couples with idiopathic infertility had abnormally high P1/P2 ratios. Fertilization rates and embryo quality decreased as sperm DNA fragmentation or protamines increased. Sperm DNA fragmentation was lower in couples achieving pregnancies after IVF, but not after ICSI. There was no correlation between protamine content (P1-DNA, P2-DNA, P1+P2-DNA) or P1/P2 ratios and IVF or ICSI pregnancies. Increased sperm DNA fragmentation was associated with abnormal protamination and resulted in lower fertilization rates, poorer embryo quality and reduced pregnancy rates. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  9. 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…

  10. Critical appraisal of the Vienna consensus: performance indicators for assisted reproductive technology laboratories.

    PubMed

    Lopez-Regalado, María Luisa; Martínez-Granados, Luis; González-Utor, Antonio; Ortiz, Nereyda; Iglesias, Miriam; Ardoy, Manuel; Castilla, Jose A

    2018-05-24

    The Vienna consensus, based on the recommendations of an expert panel, has identified 19 performance indicators for assisted reproductive technology (ART) laboratories. Two levels of reference values are established for these performance indicators: competence and benchmark. For over 10 years, the Spanish embryology association (ASEBIR) has participated in the definition and design of ART performance indicators, seeking to establish specific guidelines for ART laboratories to enhance quality, safety and patient welfare. Four years ago, ASEBIR took part in an initiative by AENOR, the Spanish Association for Standardization and Certification, to develop a national standard in this field (UNE 17900:2013 System of quality management for assisted reproduction laboratories), extending the former requirements, based on ISO 9001, to include performance indicators. Considering the experience acquired, we discuss various aspects of the Vienna consensus and consider certain discrepancies in performance indicators between the consensus and UNE 179007:2013, and analyse the definitions, methodology and reference values used. Copyright © 2018. Published by Elsevier Ltd.

  11. What Infertility Treatments Are Available?

    MedlinePlus

    ... for Males Fertility Treatments for Females Assisted Reproductive Technology (ART) Treatments for Diseases That Cause Infertility Citations Open Citations American Society for Reproductive Medicine. (2012) Quick facts about infertility . ...

  12. 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.

  13. The association between pre-treatment maternal alcohol and caffeine intake and outcomes of assisted reproduction in a prospectively followed cohort.

    PubMed

    Abadia, L; Chiu, Y-H; Williams, P L; Toth, T L; Souter, I; Hauser, R; Chavarro, J E; Gaskins, A J

    2017-09-01

    confounding by other diet and lifestyle factors cannot be ruled out owing to the observational nature of this study. It is also unclear how generalizable these results are to women who are conceiving without the assistance of ART. Our results provide reassurance that low to moderate intakes of alcohol (e.g. ≤12 g/day) and caffeine (e.g. <200 mg/day) in the year prior to infertility treatment initiation do not have an adverse effect on intermediate or clinical outcomes of ART. The authors are supported by National Institutes of Health (NIH) grants ES022955, R01ES009718, R01ES000002, P30DK46200 and L50-HD085359. No conflicts of interest to declare. NCT00011713. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  14. 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

  15. Regulating assisted reproductive technologies in Victoria: the impact of changing policy concerning the accessibility of in vitro fertilisation for preimplantation tissue-typing.

    PubMed

    Smith, Malcolm K

    2012-06-01

    On 1 January 2010, the Assisted Reproductive Treatment Act 2008 (Vic) came into force. The legislation was the outcome of a detailed review and consultation process undertaken by the Victorian Law Reform Commission. Arguably, the change to the regulatory framework represents a significant shift in policy compared to previous regulatory approaches on this topic in Victoria. This article considers the impact of the new legislation on eligibility for reproductive treatments, focusing on the accessibility of such services for the purpose of creating a "saviour sibling". It also highlights the impact of the Victorian regulatory body's decision to abolish its regulatory policies on preimplantation genetic diagnosis and preimplantation tissue-typing, concluding that the regulatory approach in relation to these latter issues is similar to other Australian jurisdictions where such practices are not addressed by a statutory framework.

  16. Fatty Acid Composition of Human Follicular Fluid Phospholipids and Fertilization Rate in Assisted Reproductive Techniques

    PubMed Central

    Shaaker, Maghsod; Rahimipour, Ali; Nouri, Mohammad; Khanaki, Korosh; Darabi, Masoud; Farzadi, Laya; Shahnazi, Vahideh; Mehdizadeh, Amir

    2012-01-01

    Background: Fatty acids are known to be critically important in multiple biological functions. Phospholipid fatty acids of follicular fluid, an important microenvironment for the development of oocytes, may contribute to the women’s fertility and the efficacy of assisted reproduction techniques. The aim of this study was to investigate the effect of fatty acid composition of follicular fluid phospholipids on women undergoing assisted reproductive techniques. Methods: Follicular fluid samples were obtained from 100 patients, referred to Tabriz Alzahra Hospital. Seventy-nine subjects underwent in vitro fertilization (IVF) and the remaining 21 underwent intracytoplasmic sperm injection (ICSI). Total lipid of follicular fluid was extracted and fatty acids were analyzed by gas-liquid chromatography. Results: Saturated fatty acids (SFA, P = 0.002) and the ratio of SFA to polyunsaturated fatty acids (P = 0.001) were correlated negatively with a number of mature oocytes after age adjustment. Linoleic acid (P = 0.006) was positively correlated, while the level of arachidonic acid was negatively correlated with fertility percentage after adjustment for body mass index, sperm count, sperm motility. Conclusion: Since phospholipids are one of the major components of lipid metabolism, the results of this study highlight the importance of this component in follicular fluid lipid metabolism. Consequently, it is proposed as an index in determination of the rate of success in assisted reproductive techniques such as IVF/ICSI. PMID:23023218

  17. Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children.

    PubMed

    Kissin, D M; Zhang, Y; Boulet, S L; Fountain, C; Bearman, P; Schieve, L; Yeargin-Allsopp, M; Jamieson, D J

    2015-02-01

    Are assisted reproductive technology (ART) treatment factors or infertility diagnoses associated with autism among ART-conceived children? Our study suggests that the incidence of autism diagnosis in ART-conceived children during the first 5 years of life was higher when intracytoplasmic sperm injection (ICSI) was used compared with conventional IVF, and lower when parents had unexplained infertility (among singletons) or tubal factor infertility (among multiples) compared with other types of infertility. Some studies found an increased risk of autism among ART-conceived infants compared with spontaneously-conceived infants. However, few studies, and none in the USA, have examined the associations between types of ART procedures and parental infertility diagnoses with autism among ART-conceived children. Population-based retrospective cohort study using linkages between National ART Surveillance System (NASS) data for 1996-2006, California Birth Certificate data for 1997-2006, and California Department of Developmental Services (DDS) Autism Caseload data for 1997-2011. All live born ART-conceived infants born in California in 1997-2006 (n = 42 383) with 5-year observation period were included in the study. We assessed the annual incidence of autism diagnosis documented in DDS, which includes information on the vast majority of persons with autism in California, and the association of autism diagnosis with ART treatment factors and infertility diagnoses. Among ART-conceived singletons born in California between 1997 and 2006, the incidence of autism diagnosis remained at ∼0.8% (P for trend 0.19) and was lower with parental diagnosis of unexplained infertility (adjusted hazard risk ratio [aHRR]; 95% confidence interval: 0.38; 0.15-0.94) and higher when ICSI was used (aHRR 1.65; 1.08-2.52), when compared with cases without these patient and treatment characteristics. Among ART-conceived multiples, the incidence of autism diagnosis between 1997 and 2006 remained at

  18. The effect of father's age in fertile, subfertile, and assisted reproductive technology pregnancies: a population based cohort study.

    PubMed

    Stern, Judy E; Luke, Barbara; Hornstein, Mark D; Cabral, Howard; Gopal, Daksha; Diop, Hafsatou; Kotelchuck, Milton

    2014-11-01

    To compare ages of mothers and of fathers at delivery in couples who are fertile, subfertile, and subfertile treated with assisted reproductive technology (ART) and to characterize birth outcomes in the ART population according to paternal age. Live birth deliveries in Massachusetts between July, 2004 and December, 2008 were identified from vital records and categorized by maternal fertility status and treatment as ART, subfertile or fertile. The ART births were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database to obtain cycle-specific treatment data. Parental ages were obtained from birth certificates. Age of mothers and fathers were compared using ANOVA for continuous measures and χ (2) for categories. Risks of prematurity (<37 weeks), low birthweight (<2,500 g), and low birthweight z-score (small for gestatational age, SGA) were modeled using logistic regression by categories of paternal age as adjusted odds ratios and 95 % CI. The study population included 9,092 ART, 6,238 subfertile, and 318,816 fertile deliveries. Paternal ages in the ART and subfertile groups were similar and differed significantly from those of the fertile group. Maternal age in the ART and subfertile groups averaged 5-6 years older than their fertile counterparts and fathers averaged 4-5 years older with twice as many being older than 37. The risks for prematurity, low birthweight and SGA did not increase with increasing paternal age. Fathers in ART- treated and subfertile couples are older than in their fertile counterparts. Older paternal age was not assoicated with increased risk for prematurity, low birthweight, or SGA.

  19. 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. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  20. The status of assisted reproductive technology in Korea in 2012.

    PubMed

    Lee, Gyoung Hoon; Song, Hyun Jin; Choi, Young Min; Han, Hyuck Dong

    2017-03-01

    This study was designed to report the status of assisted reproductive technology (ART) therapy in South Korea between January 1, 2012 and December 31, 2012. A localized online survey, originally developed by the International Committee Monitoring Assisted Reproductive Technologies, was first launched and provided to all available ART centers via email in 2015. Fresh embryo transfer (FET) cases were categorized as standard in vitro fertilization, intracytoplasmic sperm injection (ICSI), or half-ICSI. Thawed embryo transfer (TET) and other related procedures, including surgical sperm retrieval, were surveyed. Data from 33,956 ovum pick-up procedures were provided by 75 clinics in 2012. Of the 33,088 cycles in which ovums were retrieved, a complete transfer was performed in 90.5% (29,932 cycles). In addition, 10,079 FET cycles were confirmed to have resulted in clinical pregnancy, representing a pregnancy rate of 30.5% per ovum pick-up and 33.7% per ET. The most common number of embryos transferred in FET was 2 (41.6%), followed by 3 (34.0%), and non-elective single ETs (10.0%). Of the 10,404 TET cycles in which transfer was completed, 3,760 clinical pregnancies (36.1%) were confirmed by ultrasonography. The overall clinical pregnancy rate for FET and TET cycles in 2012 was higher than in 2011 (33.7% vs. 33.2% and 36.1% vs. 31.1%, respectively). The most common number of embryos transferred in FET cycles was 2, unlike in 2011.

  1. 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.

  2. Can the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) be used to accurately report clinic total reproductive potential (TRP)?

    PubMed

    Stern, Judy E; Hickman, Timothy N; Kinzer, Donna; Penzias, Alan S; Ball, G David; Gibbons, William E

    2012-04-01

    To assess whether total reproductive potential (TRP), the chance of a live birth from each fresh cycle (fresh cycle plus frozen transfers), could be calculated from the national Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database and whether information not available in SART CORS resulted in significant changes to the TRP calculation. Retrospective study using SART CORS and clinic data. Three assisted reproductive technology clinics. Women undergoing ART. None. Two- and three-year TRPs for 2005 and 2006 were calculated according to patient age at cycle start by linking fresh to frozen cycles up to first live birth. Clinic records were used to adjust for (remove) frozen cycles that used more than one fresh cycle as a source of embryos and for any embryos donated to other patients or research or shipped to another facility before a live birth. TRP was higher than fresh per-cycle rates for most ages at all clinics, although accuracy was compromised when there were fewer than 20 cycles per category. Two- and 3-year TRPs differed in only 2 of 24 calculations. Adjusted TRPs differed less than three percentage points from unadjusted TRPs when volume was sufficient. Clinic TRP can be calculated from SART CORS. Data suggest that calculations of clinic TRP from the national dataset would be meaningful. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Assisted reproductive technologies: medical safety issues in the older woman.

    PubMed

    Segev, Yakir; Riskin-Mashiah, Shlomit; Lavie, Ofer; Auslender, Ron

    2011-06-01

    Abstract Previous study has shown that in the United States, most maternal deaths and severe obstetric complications due to chronic disease are potentially preventable through improved medical care before conception. Many women who need assisted reproductive technology (ART) because of infertility are older than the average pregnant woman. Risks for such chronic diseases as obesity, diabetes mellitus, chronic hypertension, cardiovascular disease (CVD), and malignancy greatly increase with maternal age. Chronic illness increases the risk of the in vitro fertilization (IVF) procedure and is also associated with increased obstetric risk and even death. The objective of this review is to outline the potential risks for older women who undergo ART procedures and pregnancy and to characterize guidelines for evaluation before enrollment in ART programs. A PubMed search revealed that very few studies have related to pre-ART medical evaluation. Therefore, we suggest a pre-ART medical assessment, comparable to the recommendations of the American Heart Association before noncompetitive physical activity and the American Society of Anesthesiologists before elective surgery. This assessment should include a thorough medical questionnaire and medical examination. Further evaluation and treatment should follow to ensure the safety of ART procedures and of ensuing pregnancies.

  4. Medicinal plants used in Lesotho for treatment of reproductive and post reproductive problems.

    PubMed

    Moteetee, A; Seleteng Kose, L

    2016-12-24

    Reproductive healthcare has been highlighted as a major challenge in Lesotho mainly due to the high prevalence of HIV/AIDS and sexually transmitted infections. As a result other reproductive ailments have not received much attention, particularly because healthcare facilities are already limited and many of them are inaccessible. For these reasons, medicinal plants play a major role in primary healthcare system in the country, in addition the plants are easily accessible, more affordable, and their use forms part of the cultural heritage. However, documentation of medicinal plants used for reproductive ailments is scattered, more importantly the biological and pharmacological properties, as well as toxicity of many of these plants are not yet known. To document the plants used by both male and female Basotho (residing in Lesotho) for the treatment of reproductive ailments, to explore their recorded biological and pharmacological effects as well as their toxicity, and to establish if these plants are used for similar purposes in other southern African cultures. The results stem from published findings of recent interviews of traditional medicinal practitioners in the Maseru District of Lesotho, first author's own experiences and observations from the Qacha's Nek District as well as comprehensive literature survey including numerous books and unpublished data. Electronic databases such as Google, Google Scholar, PubMed, and ScienceDirect were also used to search for the chemical compounds, pharmacological activity, and toxicity of the plants. A total of 87 plant species are reported to be used for the treatment of several reproductive problems such as infertility, complications associated with pregnancy (twelve plants are used to treat conditions such as colic, heartburn, nausea, and constipation), cleansing and/ or toning of the uterus (with a purpose either to induce pregnancy or to get rid of the placenta, for example Withania somnifera and Zantedeschia

  5. Impact of environmental tobacco smoke exposure in women on oxidative stress in the antral follicle and assisted reproduction outcomes.

    PubMed

    Kazemi, Ashraf; Ramezanzadeh, Fatemeh; Esfahani, Mohammad Hosein Nasr; Saboor-Yaraghi, Ali Akbar; Nejat, Saharnaz; Rahimi-Foroshani, Abbas

    2013-08-01

    Cigarette smoke contains many oxidants and may alter the human reproduction by inducing oxidative stress (OS) in both active and passive smokers. This study was designed to evaluate the effect of environmental tobacco smoke (ETS) exposure on oxidative stress in the follicular fluid and the assisted reproduction outcomes. An observational prospective study was carried out on 236 infertile women, who underwent assisted reproduction cycles. The ETS exposure was assessed using self-reported ETS exposure and the cotinine level in follicular fluid. To evaluate the OS in follicular fluid (FF) malon-di-aldehyde (MDA) and total antioxidant capacity (TAC) were measured. The number of retrieved oocytes, rate of metaphase II stage oocytes, fertilization rate, good cleavage rate, and no-fragmented embryo rate were considered as the assisted reproduction outcomes. The results were adjusted for age, body mass index, duration, and etiology of infertility; P-values less than 0.05 were considered significant. The MDA and TAC levels in FF were not related to the self-report number of the weekly ETS exposure and cotinine levels in FF. Also, the number of retrieved oocytes, MII stage oocytes, fertilization rate, good cleavage rate, and no-fragmented embryo rate were not related to the cotinine level and weekly ETS exposure. However, in women whose cotinine levels in FF were lower and equal/above 3.5 ng/ml, the number of retrieved oocytes was higher (12.63 ± .71 vs. 9.28 ± 1.11, P = 0.01). The relationship between the MDA level and cleavage rate (Beta = -18.5, confidence interval-34.9 and-2.1, P < 0.05) was negatively significant and the relationship between the MII stage rate with TAC (Beta = 0.02, confidence interval 0.01 and 0.04, P < 0.05) was positively significant. The ETS exposure may alter the assisted reproduction success by influencing the number of available oocytes. Although, the OS in a follicular environment affect the ability of oocytes to reach the specific cleavage

  6. Impact of environmental tobacco smoke exposure in women on oxidative stress in the antral follicle and assisted reproduction outcomes

    PubMed Central

    Kazemi, Ashraf; Ramezanzadeh, Fatemeh; Esfahani, Mohammad Hosein Nasr; Saboor-Yaraghi, Ali Akbar; Nejat, Saharnaz; Rahimi-Foroshani, Abbas

    2013-01-01

    Background: Cigarette smoke contains many oxidants and may alter the human reproduction by inducing oxidative stress (OS) in both active and passive smokers. This study was designed to evaluate the effect of environmental tobacco smoke (ETS) exposure on oxidative stress in the follicular fluid and the assisted reproduction outcomes. Materials and Methods: An observational prospective study was carried out on 236 infertile women, who underwent assisted reproduction cycles. The ETS exposure was assessed using self-reported ETS exposure and the cotinine level in follicular fluid. To evaluate the OS in follicular fluid (FF) malon-di-aldehyde (MDA) and total antioxidant capacity (TAC) were measured. The number of retrieved oocytes, rate of metaphase II stage oocytes, fertilization rate, good cleavage rate, and no-fragmented embryo rate were considered as the assisted reproduction outcomes. The results were adjusted for age, body mass index, duration, and etiology of infertility; P-values less than 0.05 were considered significant. Results: The MDA and TAC levels in FF were not related to the self-report number of the weekly ETS exposure and cotinine levels in FF. Also, the number of retrieved oocytes, MII stage oocytes, fertilization rate, good cleavage rate, and no-fragmented embryo rate were not related to the cotinine level and weekly ETS exposure. However, in women whose cotinine levels in FF were lower and equal/above 3.5 ng/ml, the number of retrieved oocytes was higher (12.63 ± .71 vs. 9.28 ± 1.11, P = 0.01). The relationship between the MDA level and cleavage rate (Beta = −18.5, confidence interval-34.9 and-2.1, P < 0.05) was negatively significant and the relationship between the MII stage rate with TAC (Beta = 0.02, confidence interval 0.01 and 0.04, P < 0.05) was positively significant. Conclusion: The ETS exposure may alter the assisted reproduction success by influencing the number of available oocytes. Although, the OS in a follicular environment

  7. Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction.

    PubMed

    Craciunas, Laurentiu; Tsampras, Nikolaos; Coomarasamy, Arri; Raine-Fenning, Nick

    2016-05-20

    Subfertility affects 15% of couples and represents the inability to conceive naturally following 12 months of regular unprotected sexual intercourse. Assisted reproduction refers to procedures involving the in vitro handling of both human gametes and represents a key option for many subfertile couples. Most women undergoing assisted reproduction treatment will reach the stage of embryo transfer (ET) but the proportion of embryos that successfully implant following ET has remained small since the mid-1990s. Human chorionic gonadotropin (hCG) is a hormone synthesised and released by the syncytiotrophoblast and has a fundamental role in embryo implantation and the early stages of pregnancy. Intrauterine administration of synthetic or natural hCG via an ET catheter during a mock procedure around the time of ET is a novel approach that has recently been suggested to improve the outcomes of assisted reproduction. To investigate whether the intrauterine administration of hCG around the time of ET improves the clinical outcomes in subfertile women undergoing assisted reproduction. We performed a comprehensive literature search of the Cochrane Gynaecology and Fertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, registers of ongoing trials andreference lists of all included studies and relevant reviews (from inception to 10 November 2015), in consultation with the Cochrane Gynaecology and Fertility Group Trials Search Co-ordinator. We included all randomised controlled trials (RCTs) evaluating intrauterine administration of hCG around the time of ET in this review irrespective of language and country of origin. Two authors independently selected studies, assessed risk of bias, extracted data from studies and attempted to contact the authors where data were missing. We performed statistical analysis using Review Manager 5 in accordance with the Cochrane Handbook for Systematic Reviews of

  8. A journey through people, places, and projects in equine assisted reproduction.

    PubMed

    Hinrichs, Katrin

    2016-07-01

    A research study is a product of not only a question and its pursuit but also the people, places, and facilities available at the time. My work in equine assisted reproduction has progressed from embryo transfer to oocyte maturation, oocyte transfer, intracytoplasmic sperm injection, embryo biopsy, embryo vitrification, and cloning, as a result of collaborations with an array of remarkable people. This is a summary of some of the stories behind the studies. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Low birth weight: is it related to assisted reproductive technology or underlying infertility?

    PubMed

    Kondapalli, Laxmi A; Perales-Puchalt, Alfredo

    2013-02-01

    Since 1978, we have witnessed a successful evolution of assisted reproductive technology (ART), with improvement of the pregnancy rates and a growing demand. However, in recent years, there has been increasing concern regarding its safety due to the potential health impact on its infants. The raise of the developmental origins of adult disease has positioned low birth weight (LBW) as a significant health issue. Although multiple studies have associated ART with LBW, the etiology of this association remains largely unknown. We review the potential association between different components of ART and infertility with LBW, while acknowledging the limitations of interpretation of the existing literature. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  10. Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? the mediating role of the importance of parenthood.

    PubMed

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

    2016-05-01

    The emotional adjustment of couples undergoing assisted reproductive technology (ART) treatments has been widely studied; however, it remains unclear whether infertility history contributes to couples' adjustment. This study examined the impact of infertility history (duration of infertility and number of previous ART treatment cycles) on the emotional adjustment of couples undergoing an ART cycle and the mediating effect of importance of parenthood on that association. In this cross-sectional study, 70 infertile couples (70 women and 70 men) completed self-report questionnaires assessing emotional adjustment and infertility stress during the hormonal stimulation phase of an ART cycle. Path models accounting for the dyadic nature of the data examined the direct and indirect effects (by affecting representations about parenthood and childlessness) of infertility history on emotional adjustment. The number of previous cycles affected men's, but not women's, emotional adjustment by affecting the representations on the importance of parenthood and of childlessness. Duration of infertility had the opposite effect, as couples with longer infertility reported heightened importance of parenthood, which negatively affected their emotional adjustment. Infertility history was associated with emotional adjustment in men and women, although these associations were complex. The results suggest that progression through treatment is harder for those men and women who attribute higher importance to being parents, which is aggravated by longer infertility. What is already known about the subject? Infertility is an unexpected and stressful life event Assisted reproductive treatments (ART) are emotionally demanding What does this study add? The influence of infertility history on adjustment is mediated by the importance of parenthood Men and women are affected by their past history of infertility differently. © 2015 The Authors. British Journal of Health Psychology published by John

  11. The status of assisted reproductive technology in Korea in 2012

    PubMed Central

    Lee, Gyoung Hoon; Song, Hyun Jin; Han, Hyuck Dong

    2017-01-01

    Objective This study was designed to report the status of assisted reproductive technology (ART) therapy in South Korea between January 1, 2012 and December 31, 2012. Methods A localized online survey, originally developed by the International Committee Monitoring Assisted Reproductive Technologies, was first launched and provided to all available ART centers via email in 2015. Fresh embryo transfer (FET) cases were categorized as standard in vitro fertilization, intracytoplasmic sperm injection (ICSI), or half-ICSI. Thawed embryo transfer (TET) and other related procedures, including surgical sperm retrieval, were surveyed. Results Data from 33,956 ovum pick-up procedures were provided by 75 clinics in 2012. Of the 33,088 cycles in which ovums were retrieved, a complete transfer was performed in 90.5% (29,932 cycles). In addition, 10,079 FET cycles were confirmed to have resulted in clinical pregnancy, representing a pregnancy rate of 30.5% per ovum pick-up and 33.7% per ET. The most common number of embryos transferred in FET was 2 (41.6%), followed by 3 (34.0%), and non-elective single ETs (10.0%). Of the 10,404 TET cycles in which transfer was completed, 3,760 clinical pregnancies (36.1%) were confirmed by ultrasonography. Conclusion The overall clinical pregnancy rate for FET and TET cycles in 2012 was higher than in 2011 (33.7% vs. 33.2% and 36.1% vs. 31.1%, respectively). The most common number of embryos transferred in FET cycles was 2, unlike in 2011. PMID:28428944

  12. Personalized ovarian stimulation for assisted reproductive technology: study design considerations to move from hype to added value for patients.

    PubMed

    Mol, Ben W; Bossuyt, Patrick M; Sunkara, Sesh K; Garcia Velasco, Juan A; Venetis, Christos; Sakkas, Denny; Lundin, Kersti; Simón, Carlos; Taylor, Hugh S; Wan, Robert; Longobardi, Salvatore; Cottell, Evelyn; D'Hooghe, Thomas

    2018-06-01

    Although most medical treatments are designed for the average patient with a one-size-fits-all-approach, they may not benefit all. Better understanding of the function of genes, proteins, and metabolite, and of personal and environmental factors has led to a call for personalized medicine. Personalized reproductive medicine is still in its infancy, without clear guidance on treatment aspects that could be personalized and on trial design to evaluate personalized treatment effect and benefit-harm balance. While the rationale for a personalized approach often relies on retrospective analyses of large observational studies or real-world data, solid evidence of superiority of a personalized approach will come from randomized trials comparing outcomes and safety between a personalized and one-size-fits-all strategy. A more efficient, targeted randomized trial design may recruit only patients or couples for which the personalized approach would differ from the previous, standard approach. Multiple monocenter studies using the same study protocol (allowing future meta-analysis) might reduce the major center effect associated with multicenter studies. In certain cases, single-arm observational studies can generate the necessary evidence for a personalized approach. This review describes each of the main segments of patient care in assisted reproductive technologies treatment, addressing which aspects could be personalized, emphasizing current evidence and relevant study design. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Assisted reproduction professionals' awareness and attitudes towards their own IVF cycles.

    PubMed

    Bonetti, T C S; Melamed, R M M; Braga, D P A F; Madaschi, C; Iaconelli, A; Pasqualotto, F F; Borges, E

    2008-12-01

    Professionals involved in assisted reproductive technologies (ART) have in-depth awareness and knowledge of the risks of multiple pregnancies at the conclusion of in vitro fertilization (IVF) treatment. The aim of the study was to investigate ART professionals' attitudes towards the awareness of the risk of infertility, as well as the decision-making process in IVF issues. Seventy ART professionals answered a questionnaire covering demographic data, infertility awareness and attitudes towards IVF. Approximately half (50.8%) of the participants thought that they were not at risk of infertility. However, if they received a diagnosis of infertility, none would accept childlessness and almost all would undergo IVF. In an IVF cycle, the number of high-quality embryos transferred would be around three, but if treatment was extended to a third cycle, a higher percentage of participants would elect to transfer four or more embryos. All participants would prefer to undergo IVF and accept the risk of multiple pregnancy than remaining childless. It was found that less than a third of ART professionals considered triplets to be an unacceptable complication of IVF. Diagnosis of infertility affects all participants psychosocially, supporting the idea that the emotional aspects of wanting a biological child, and decision making about whether to undertake ART, outweigh the medical position regarding the risks and benefits of IVF.

  14. Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis.

    PubMed

    Chu, Justin; Gallos, Ioannis; Tobias, Aurelio; Tan, Bee; Eapen, Abey; Coomarasamy, Arri

    2018-01-01

    heterogeneous in population characteristics and fertility treatment protocols. The findings of this systematic review show that there is an association between vitamin D status and reproductive treatment outcomes achieved in women undergoing ART. Our results show that vitamin D deficiency and insufficiency could be important conditions to treat in women considering ARTs. A randomized controlled trial to investigate the benefits of vitamin D deficiency treatment should be considered to test this hypothesis. No external funding was either sought or obtained for this study. The authors have no competing interests to declare. N/A. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  15. 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

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

    PubMed

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

    2016-03-01

    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. 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. The study was conducted in a fertility center in a teaching hospital. 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. Live birth rates per initiated treatment cycle were measured. 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. Soy food intake may protect against the adverse reproductive effects of BPA. As these findings represent the first report suggesting a

  17. An Ethical Analysis of Assisted Reproduction Providers' Websites in Pakistan.

    PubMed

    Irshad, Ayesha; Werner-Felmayer, Gabriele

    2016-07-01

    Assisted reproductive technologies (ARTs) and reproductive genetic technologies (RGTs) are intertwined and coevolving. These technologies are increasingly used to fulfill socially and culturally framed requests, for example, "family balancing," or to enable postmenopausal women or homosexual couples to have genetically linked children. The areas of ART and RGT are replete with ethical issues, because different social practices and legal regulations, as well as economic inequalities within and among countries, create vulnerable groups and, therefore, the potential for exploitation. This article provides an overview of the ART and RGT landscape in Pakistan and analyzes the available online content addressing Pakistani citizens and international clients. We explored the topic in view of socioeconomic challenges in Pakistan, particularly deeply rooted poverty, lack of education, gender discrimination, and absence of regulation. As online information given by ART and RGT providers is readily available and could easily raise false hopes, make use of discriminatory statements with regard to women, and promote gender selection to meet sociocultural expectations, it should be subjected to quality control.

  18. The ethics of assisted reproduction.

    PubMed

    Chatzinikolaou, Nikolaos

    2010-05-01

    Issues concerning the beginning of life and medical intervention in the onset of human existence are very delicate in their nature; they involve multi-dimensional knowledge, they are difficult to comprehend and sensitive to handle. When pure scientific elements are combined with profound emotions, when the genius of technological discoveries touches upon human dignity and sanctity, when passion for the technological achievement intervenes in basic human rights, then the sense of inadequacy and ignorance becomes intense and critical. Silence seems more sought-after than words, and willingness to learn more prudent than the desire to speak. Fear of the inconceivable consequences and even more so the inability to assess them, experiments with the unknown, the likelihood that basic historical, ethical and social values may change forever, but mainly the replacement of God in His wondrous work of creation--the onset of human life--places the ethics of reproductive technologies on the frontline of contemporary bioethics. This opinion paper does not deal with dangers, insults, fears, threats, "speed limits" or ethical controversies, but rather with the very mystery of life. Although there are no generally accepted replies to the various questions being posed, some thoughts and reservations, which can shed some light upon complicated dilemmas are presented. Firstly, the content of reproductive technologies, the problem of infertility today, the methods of fertility treatment, and of prenatal and pre-implantation testing are described, and then the social impact of IVF, complicated cases, deontological dilemmas and some ethical concerns are discussed. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  19. Supply of and demand for assisted reproductive technologies in the United States: clinic- and population-based data, 1995-2010.

    PubMed

    Stephen, Elizabeth Hervey; Chandra, Anjani; King, Rosalind Berkowitz

    2016-02-01

    To study national-level trends in assisted reproduction technology (ART) treatments and outcomes as well as the characteristics of women who have sought this form of infertility treatment. Population-based study. Not applicable. For CDC: All reporting clinics from 1996-2010. For NSFG: for the logistic analysis, sample comprising 2,325 women aged 22-44 years who have ever used medical help to get pregnant, excluding women who used only miscarriage prevention services. None. CDC data (number of cycles, live birth deliveries, live births, patient diagnoses); and NSFG data (individual use of ART procedures). Between 1995 and 2010, use of ART increased. Parity and age are strong predictors of using ART procedures. The other correlates are higher education, having had tubal surgery, and having a current fertility problem. The two complementary data sets highlight the trends of ART use. An increase in the use of ART services over this time period is seen in both data sources. Nulliparous women aged 35-39 years are the most likely to have ever used ART services. Copyright © 2016 American Society for Reproductive Medicine. All rights reserved.

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

    PubMed

    Harper, Joyce; Geraedts, Joep; Borry, Pascal; Cornel, Martina C; Dondorp, Wybo J; 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

    2014-08-01

    How has the interface between genetics and assisted reproduction technology (ART) evolved since 2005? The interface between ART and genetics has become more entwined as we increase our understanding about the genetics of infertility and we are able to perform more comprehensive genetic testing. 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 ART and published an extended background paper, recommendations and two Editorials. An interdisciplinary workshop was held, involving representatives of both professional societies and experts from the European Union Eurogentest2 Coordination Action Project. In March 2012, a group of experts from the European Society of Human Genetics, the European Society of Human Reproduction and Embryology and the EuroGentest2 Coordination Action Project met to discuss developments at the interface between clinical genetics and ART. As more genetic causes of reproductive failure are now recognized and an increasing number of patients undergo testing of their genome prior to conception, either in regular health care or in the context of direct-to-consumer testing, the need for genetic counselling and PGD may increase. Preimplantation genetic screening (PGS) thus far does not have evidence from RCTs 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 (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

  1. Advanced reproductive age and fertility.

    PubMed

    Liu, Kimberly; Case, Allison

    2011-11-01

    To improve awareness of the natural age-related decline in female and male fertility with respect to natural fertility and assisted reproductive technologies (ART) and provide recommendations for their management, and to review investigations in the assessment of ovarian aging. This guideline reviews options for the assessment of ovarian reserve and fertility treatments using ART with women of advanced reproductive age presenting with infertility. The outcomes measured are the predictive value of ovarian reserve testing and pregnancy rates with natural and assisted fertility. Published literature was retrieved through searches of PubMed or Medline, CINAHL, and The Cochrane Library in June 2010, using appropriate key words (ovarian aging, ovarian reserve, advanced maternal age, advanced paternal age, ART). Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated into the guideline to December 2010. The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table). Primary and specialist health care providers and women will be better informed about ovarian aging and the age-related decline in natural fertility and about options for assisted reproductive technology. 1. Women in their 20s and 30s should be counselled about the age-related risk of infertility when other reproductive health issues, such as sexual health or contraception, are addressed as part of their primary well-woman care. Reproductive-age women should be aware that natural fertility and assisted reproductive technology success (except with egg donation) is significantly lower for women in their late 30s and 40s. (II-2A) 2. Because of the decline in fertility and the

  2. Should HCV discordant couples with a seropositive male partner be treated with assisted reproduction techniques (ART)?

    PubMed

    Savasi, Valeria; Oneta, Monica; Parrilla, Bina; Cetin, Irene

    2013-04-01

    The debate on HCV discordant couples requiring assisted reproduction is still open today, and specific guidelines have not yet been established on whether or not physicians should treat HCV discordant couples who require ART. We studied the results of our reproductive assistance with sperm washing in HCV discordant couples, all treated in a single center, including the serological status of mothers and babies, and the outcome of the pregnancies. Prospective study conducted between January 2008 and December 2010 in our Reproductive Center in Sacco Hospital, University of Milan. Thirty-five HCV serodiscordant infertile couples with an HCV viremic positive male partner were enrolled. All of them completed the immuno-virological and fertility triage, and were treated according to our clinical protocols. Forty-seven superovulation and IUI and 38 second-level ART procedures are reported. The pregnancy rates for IUI and ICSI are similar to those reported by the Italian ART register. All the 85 sperm samples were treated with sperm washing technique to reduce HCV in semen and the possible risk of transmission. We did not observe any preterm delivery or negative perinatal outcome. No mothers or babies are infected by HCV. This is the biggest prospective study conducted in a single center involving HCV discordant infertile couples in an ART program. Although sexual transmission of HCV is very low, in subfertile or infertile couples sperm washing should be used to treat HCV positive semen before ART. We suggest that it is not necessary to perform nested PCR to detect HCV RNA in the final swim-up. Since the presence of HCV in semen implies a possible risk of nosocomial contamination, safety regulations must be strictly applied in assisted reproduction laboratories. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  3. On a Romanian attempt to legislate on medically assisted human reproduction.

    PubMed

    Cutas, Daniela E

    2008-01-01

    The paper presents and briefly analyses some of the provisions of a Romanian legislative proposal which arrived at the Presidency for ratification twice, in slightly different forms, and which was rejected twice: the first time at the Presidency in October 2004, and the second at the Constitutional Court in July 2005. The proposal was finally dropped in February 2006. My intention here is to point to some of the most problematic deficiencies of the legislative document in the hope that this may assist with future debates and regulations on assisted reproduction either in Romania or elsewhere. I have isolated the features to be discussed under two headings: (1) whose are the rights to reproduce, that the document claimed to 'acknowledge, regulate and guarantee' and (2) what is the status of the embryo, the child and the surrogate mother?

  4. Assisted reproductive techniques and risk of exstrophy-epispadias complex: a German case-control study.

    PubMed

    Zwink, Nadine; Jenetzky, Ekkehart; Hirsch, Karin; Reifferscheid, Peter; Schmiedeke, Eberhard; Schmidt, Dominik; Reckin, Sabrina; Obermayr, Florian; Boemers, Thomas M; Stein, Raimund; Reutter, Heiko; Rösch, Wolfgang H; Brenner, Hermann; Ebert, Anne-Karoline

    2013-04-01

    We assessed the risk of exstrophy-epispadias complex in children conceived by in vitro fertilization or intracytoplasmic sperm injection. Data from the German Network for Congenital Uro-REctal malformations were compared to nationwide data from the German In Vitro Fertilization Register and the German Federal Statistical Office. Odds ratios (95% CI) were determined to quantify associations using logistic regression. A total of 123 patients with exstrophy-epispadias complex born in Germany between 1997 and 2011 were recruited through participating departments of pediatric urology and pediatric surgery throughout the country as well as the German self-help organizations Blasenekstrophie/Epispadie e.V. and Kloakenekstrophie. All German live births (10,069,986) between 1997 and 2010 comprised the controls. Overall, 12 subjects (10%) and 129,982 controls (1%) were conceived by in vitro fertilization or intracytoplasmic sperm injection. Conception by assisted reproductive technique was associated with a more than eightfold increased risk of exstrophy-epispadias complex compared to spontaneous conception (OR 8.3, 95% CI 4.6-15.0, p <0.001). Separate analyses showed a significantly increased risk of exstrophy-epispadias complex in children conceived by in vitro fertilization (OR 14.0, 95% CI 6.5-30.0, p <0.0001) or intracytoplasmic sperm injection (OR 5.3, 95% CI 2.2-12.9, p <0.0001). This study provides evidence that assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection are associated with a markedly increased risk of having a child born with exstrophy-epispadias complex. However, it remains unclear whether this finding may be due to assisted reproduction per se and/or underlying infertility/subfertility etiology or parent characteristics. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. Medically assisted reproduction and ethical challenges

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kaeaeriaeinen, Helena; 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. Ismore » 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.« less

  6. Imprinting Disorders and Assisted Reproductive Technology

    PubMed Central

    Owen, Carter M.; Segars, James H.

    2009-01-01

    Worldwide use of assisted reproductive technology (ART) accounts for an estimated 1 to 3% of births. Since 2002, a series of reports have suggested an increased risk of imprinting disorders (Beckwith-Wiedemann syndrome and Angelman syndrome) in children conceived by ART. Definitive conclusions are difficult to substantiate due to the rarity of imprinting disorders and the variability in ART protocols. Despite these limitations, there is biological plausibility for alteration in nongenomic inheritance caused by ART. Animal studies have shown that ART procedures can alter normal imprinting, specifically DNA methylation patterns. Collectively, studies suggest an association between ART and loss of maternal methylation. More recent reports examined a possible association between ART and global hypomethylation of DNA. Three other imprinting disorders (Silver-Russell syndrome, maternal hypomethylation syndrome, and retinoblastoma) have also been implicated, but there is insufficient evidence to establish an association of these syndromes with ART. Based on current evidence, the absolute risk of imprinting disorders after ART remains small and does not warrant routine screening. Large prospective studies are needed to better understand the risks associated with imprinting disorders, imprinting defects, and ART. PMID:19711252

  7. Outcome of assisted reproductive technology (ART) and subsequent self-reported life satisfaction.

    PubMed

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

    2014-01-01

    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. Cohort study. Tertiary hospital. A total of 987 consecutive women who had undergone ART during 1996-2007 were invited and altogether 505 women participated in the study. A postal enquiry with a life satisfaction scale. Self-reported life satisfaction in respect to the time since the last ART. 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. Even if unsuccessful ART outcome is associated with subsequent lower level of life satisfaction, it does not seem to threaten the long-term wellbeing.

  8. 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

  9. The health outcomes of human offspring conceived by assisted reproductive technologies (ART).

    PubMed

    Chen, M; Heilbronn, L K

    2017-08-01

    Concerns have been raised about the health and development of children conceived by assisted reproductive technologies (ART) since 1978. Controversially, ART has been linked with adverse obstetric and perinatal outcomes, an increased risk of birth defects, cancers, and growth and development disorders. Emerging evidence suggests that ART treatment may also predispose individuals to an increased risk of chronic ageing related diseases such as obesity, type 2 diabetes and cardiovascular disease. This review will summarize the available evidence on the short-term and long-term health outcomes of ART singletons, as multiple pregnancies after multiple embryos transfer, are associated with low birth weight and preterm delivery, which can separately increase risk of adverse postnatal outcomes, and impact long-term health. We will also examine the potential factors that may contribute to these health risks, and discuss underlying mechanisms, including epigenetic changes that may occur during the preimplantation period and reprogram development in utero, and adult health, later in life. Lastly, this review will consider the future directions with the view to optimize the long-term health of ART children.

  10. 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…

  11. [Management of assisted reproductive technology (ART) in case of endometriosis related infertility: CNGOF-HAS Endometriosis Guidelines].

    PubMed

    Santulli, P; Collinet, P; Fritel, X; Canis, M; d'Argent, E M; Chauffour, C; Cohen, J; Pouly, J L; Boujenah, J; Poncelet, C; Decanter, C; Borghese, B; Chapron, C

    2018-03-01

    The management of endometriosis related infertility requires a global approach. In this context, the prescription of an anti-gonadotropic hormonal treatment does not increase the rate of non-ART (assisted reproductive technologies) pregnancies and it is not recommended. In case of endometriosis related infertility, the results of IVF management in terms of pregnancy and birth rates are not negatively affected by the existence of endometriosis. Controlled ovarian stimulation during IVF does not increase the risk of endometriosis associated symptoms worsening, nor accelerate the intrinsic progression of endometriosis and does not increase the rate of recurrence. However, in the context of IVF management for women with endometriosis, pre-treatment with GnRH agonist or with oestrogen/progestin contraception improve IVF outcomes. There is currently no evidence of a positive or negative effect of endometriosis surgery on IVF outcomes. Information on the possibilities of preserving fertility should be considered, especially before surgery. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  12. 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

  13. Validation of birth outcomes from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS): population-based analysis from the Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART).

    PubMed

    Stern, Judy E; Gopal, Daksha; Liberman, Rebecca F; Anderka, Marlene; Kotelchuck, Milton; Luke, Barbara

    2016-09-01

    To assess the validity of outcome data reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) compared with data from vital records and the birth defects registry in Massachusetts. Longitudinal cohort. Not applicable. A total of 342,035 live births and fetal deaths from Massachusetts mothers giving birth in the state from July 1, 2004, to December 31, 2008; 9,092 births and fetal deaths were from mothers who had conceived with the use of assisted reproductive technology (ART) and whose cycle data had been reported to the SART CORS. Not applicable. Percentage agreement between maternal race and ethnicity, delivery outcome (live birth or fetal death), plurality (singleton, twin, or triplet+), delivery date, and singleton birth weight reported in the SART CORS versus vital records; sensitivity and specificity for birth defects among singletons as reported in the SART CORS versus the Massachusetts Birth Defects Monitoring Program (BDMP). There was >95% agreement between the SART CORS and vital records for fields of maternal race/ethnicity, live birth/fetal death, and plurality; birth outcome date was within 1 day with 94.9% agreement and birth weight was within 100 g with 89.6% agreement. In contrast, sensitivity for report of any birth defect was 38.6%, with a range of 18.4%-50.0%, for specific birth defect categories. Although most SART CORS outcome fields are accurately reported, birth defect variables showed poor sensitivity compared with the gold standard data from the BDMP. We suggest that reporting of birth defects be discontinued. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies.

    PubMed

    Luke, Barbara

    2017-09-01

    Infertility, defined as the inability to conceive within 1 year of unprotected intercourse, affects an estimated 80 million individuals worldwide, or 10-15% of couples of reproductive age. Assisted reproductive technology includes all infertility treatments to achieve conception; in vitro fertilization is the process by which an oocyte is fertilized by semen outside the body; non-in vitro fertilization assisted reproductive technology treatments include ovulation induction, artificial insemination, and intrauterine insemination. Use of assisted reproductive technology has risen steadily in the United States during the past 2 decades due to several reasons, including childbearing at older maternal ages and increasing insurance coverage. The number of in vitro fertilization cycles in the United States has nearly doubled from 2000 through 2013 and currently 1.7% of all live births in the United States are the result of this technology. Since the birth of the first child from in vitro fertilization >35 years ago, >5 million babies have been born from in vitro fertilization, half within the past 6 years. It is estimated that 1% of singletons, 19% of twins, and 25% of triplet or higher multiples are due to in vitro fertilization, and 4%, 21%, and 52%, respectively, are due to non-in vitro fertilization assisted reproductive technology. Higher plurality at birth results in a >10-fold increase in the risks for prematurity and low birthweight in twins vs singletons (adjusted odds ratio, 11.84; 95% confidence interval, 10.56-13.27 and adjusted odds ratio, 10.68; 95% confidence interval, 9.45-12.08, respectively). The use of donor oocytes is associated with increased risks for pregnancy-induced hypertension (adjusted odds ratio, 1.43; 95% confidence interval, 1.14-1.78) and prematurity (adjusted odds ratio, 1.43; 95% confidence interval, 1.11-1.83). The use of thawed embryos is associated with higher risks for pregnancy-induced hypertension (adjusted odds ratio, 1

  15. Reproductive ageing and conflicting clocks: King Midas' touch.

    PubMed

    Daly, Irenee; Bewley, Susan

    2013-12-01

    The population attempting pregnancy and having babies is ageing. Gynaecological and obstetric complications worsen with age. Maternity services are struggling. Increasing rates of infertility and complications are not matched by the marvels in the laboratory. This paper argues that assisted reproduction treatment has had a damaging social impact. Despite its public acclaim, it helps few and fails many more. The assisted reproduction industry could take a new and revolutionary direction towards empowering men to experience pregnancy, producing babies from artificial gametes, with a final goal being the liberation of both women and men from the burdens and dangers of pregnancy through the development of artificial wombs. Copyright © 2013. Published by Elsevier Ltd.

  16. Reproductive tourism as moral pluralism in motion

    PubMed Central

    Pennings, G

    2002-01-01

    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. PMID:12468650

  17. 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

  18. 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

  19. Utility of antioxidants during assisted reproductive techniques: an evidence based review.

    PubMed

    Agarwal, Ashok; Durairajanayagam, Damayanthi; du Plessis, Stefan S

    2014-11-24

    Assisted reproductive technology (ART) is a common treatment of choice for many couples facing infertility issues, be it due to male or female factor, or idiopathic. Employment of ART techniques, however, come with its own challenges as the in vitro environment is not nearly as ideal as the in vivo environment, where reactive oxygen species (ROS) build-up leading to oxidative stress is kept in check by the endogenous antioxidants system. While physiological amounts of ROS are necessary for normal reproductive function in vivo, in vitro manipulation of gametes and embryos exposes these cells to excessive ROS production either by endogenous or exogenous environmental factors. In this review, we discuss the sources of ROS in an in vitro clinical setting and the influence of oxidative stress on gamete/embryo quality and the outcome of IVF/ICSI. Sources of ROS and different strategies of overcoming the excessive generation of ROS in vitro are also highlighted. Endogenously, the gametes and the developing embryo become sources of ROS. Multiple exogenous factors act as potential sources of ROS, including exposure to visible light, composition of culture media, pH and temperature, oxygen concentration, centrifugation during spermatozoa preparation, ART technique involving handling of gamete/embryo and cryopreservation technique (freeze/thawing process). Finally, the use of antioxidants as agents to minimize ROS generation in the in vitro environment and as oral therapy is highlighted. Both enzymatic and non-enzymatic antioxidants are discussed and the outcome of studies using these antioxidants as oral therapy in the male or female or its use in vitro in media is presented. While results of studies using certain antioxidant agents are promising, the current body of evidence as a whole suggests the need for further well-designed and larger scale randomized controlled studies, as well as research to minimize oxidative stress conditions in the clinical ART setting.

  20. Association of assisted reproductive technology with adverse pregnancy outcomes

    PubMed Central

    Jie, Zhang; Yiling, Ding; Ling, Yu

    2015-01-01

    Background: More and more infertile patients have accepted the assisted reproductive technique (ART) therapy. Concerns have been raised over an increased risk of adverse maternal outcomes in ART populations as compared with natural conception (NC). Objective: The aim was to improve the ART in clinicial work and to reduce the incidence of pregnancy complications in ART group according to analyzing the reasons of high incidence of pregnancy complications in ART group, comparing the incidence of pregnancy complications in different controlled ovarian hyperstimulation (COH) programs and evaluating the effects of ART which attribute to adverse pregnancy outcomes. Materials and Methods: In this prospective population-based cohort study,3216 pregnant women with gestational age ≤12 weeks, regular antenatal examination,and ultrasound identification of intrauterine pregnancy were enrolled from January 2010 to June 2013. According to having ART history, the participantswere divided into two groups: ART group (contains fresh embryo transfer group or frozen-thawed embryo transfer group) and NC group. We compared the incidence of pregnancy complications between different groups and evaluated the factors which could affect the occurrence of these complications. Results: When compared to NC group, significantly increased rates of gestational diabetes mellitus (GDM) (p<0.01), preeclampsia (PE) (p<0.01) and intrahepatic cholestasis of pregnancy (ICP) (p˂0.01) were observed in ART group. There was no significant difference in the incidence of birth defect between the two groups (p=0.07). Multiple pregnancies and Gonadotropin (Gn) were risk factors in GDM, PE, and ICP. The exogenous progesterone treatment had no effect on GDM, PE or ICP. Conclusion: ART increases the risk of adverse maternal complications such as GDM, PE and ICP. The dosages of Gn should be reduced to an extent and the number of embryo implantation should be controlled. Exogenous progesterone treatment is safe

  1. Life after unsuccessful IVF treatment in an assisted reproduction unit: a qualitative analysis of gains through loss among Chinese persons in Hong Kong.

    PubMed

    Lee, Geok Ling; Hui Choi, W H; Chan, Celia H Y; Chan, Cecilia L W; Ng, Ernest H Y

    2009-08-01

    Previous studies examining experiences of infertility focused mainly on the aspect of loss but neglected the possible gains realized through surviving the experience of infertility. The success rate of IVF remains relatively low, and we used the strengths perspective to examine adjustment after unsuccessful treatment. This study aims to provide an in-depth description of the gains perceived by Chinese men and women and how they re-constructed their lives after unsuccessful IVF treatment. Four couples and another six women who experienced unsuccessful IVF treatment were recruited from an assisted reproduction clinic. Data were collected through in-depth interviews, using a grounded theory constructivist approach. Of the 10 women and 4 men interviewed, 9 remained childless, 3 had adopted a child and 2 had conceived naturally. They reported gains on a personal level, interpersonal level and transpersonal level through surviving the experience of infertility. All, regardless of the eventual outcome, reported at least one form of personal gain: in personality or knowledge gain. Interpersonal gains were perceived in relationships with their spouses, children, parents, friends, colleagues and fellow IVF service users. More than half of them reported spiritual growth and a change in identity through integrating their experiences and offering help to others. Despite the small sample size, this study makes a significant contribution by suggesting that while negative feelings provoked by the failure to conceive should be acknowledged, people in this situation should also be enabled to consolidate their negative experiences of IVF constructively, helping them to move on with their lives.

  2. Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System.

    PubMed

    Baker, Valerie L; Luke, Barbara; Brown, Morton B; Alvero, Ruben; Frattarelli, John L; Usadi, Rebecca; Grainger, David A; Armstrong, Alicia Y

    2010-09-01

    To evaluate factors predictive of clinical pregnancy and of pregnancy loss from assisted reproductive technology (ART) using data from the Society for Assisted Reproductive Technology database for 2004-2006. Retrospective cohort. Clinic-based data. The study population included 225,889 fresh embryo transfer cycles using autologous oocytes and partner semen. None. Clinical intrauterine gestation (presence of gestational sac) and live birth (>or=22 weeks gestation and >or=300 g birth weight). Increasing maternal age was significantly associated with a reduced odds of conception and increased fetal loss until 19 weeks gestation, but not with later pregnancy loss. Intracytoplasmic sperm injection (ICSI), assisted hatching, and increasing number of embryos transferred had significant positive effects on the odds of conception and pregnancy continuation through the first trimester, but did not affect the risk of later loss. Blacks, Asians, and Hispanics had significantly lower odds of clinical pregnancy compared with whites. Also compared with whites, Hispanics and Asians had a significantly greater risk of pregnancy loss in the second and third trimesters, and blacks had a significantly greater risk of pregnancy loss in all trimesters. Certain demographic and ART treatment parameters influenced chance of conception and early pregnancy loss, whereas black race and Hispanic ethnicity were also significantly associated with late pregnancy loss in ART-conceived pregnancies. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  3. 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. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  4. Prevention of congenital Chagas disease by Benznidazole treatment in reproductive-age women. An observational study.

    PubMed

    Álvarez, María G; Vigliano, Carlos; Lococo, Bruno; Bertocchi, Graciela; Viotti, Rodolfo

    2017-10-01

    Since the decline in new cases of infection by insect/vector, congenital Chagas disease has become more relevant in the transmission of Chagas disease. Treatment with benznidazole significantly reduces the parasitemia, which constitutes an important factor linked to vertical transmission. The objective of this study was to evaluate whether treatment with benznidazole previously administered to women of childbearing age can prevent or reduce the incidence of new cases of congenital Chagas disease. An historical cohort study that included all women in reproductive age (15-45 years) assisted in our center was designed. We included 67 mothers with chronic Chagas disease; 35 women had not been treated prior to pregnancy, 15 had been treated prior to pregnancy and 17 gave birth prior and after treatment with benznidazole. Eight mothers gave birth to 16 children with congenital Chagas disease (8/67, 12%). The prevalence of congenital Chagas was 16/114 (14%) children born to untreated mothers and 0/42 (0%) children born to benznidazole- treated mothers, p=0.01. No significant differences were observed in clinical, serologic, epidemiological or socioeconomic baseline variables between mothers with and without children born with congenital Chagas. A 32% conversion rate to negative serology was observed in benznidazole-treated women after long-term follow up. Antiparasitic treatment administered to women in reproductive age can prevent the occurrence of congenital Chagas disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. History of Assisted Reproductive Technology and Chlamydia Trachomatis Infection in Pregnancy

    PubMed Central

    Kato, Masahiko; Suzuki, Shunji

    2016-01-01

    Background and Methods To identify whether or not a history of assisted reproductive technology (ART) is associated with the low incidence of Chlamydia trachomatis (CT) infection in pregnant women, we reviewed the obstetric records of the Japanese women aged 35 - 42 years. Results The prevalence of CT in the pregnancies without ART was 1.1% (28/2,632) using nucleic acid amplification tests, while it was zero in the pregnancies conceived by ART (0/364, P = 0.049 by the X2 test). Conclusions A history of ART seemed to be a negative risk factor for CT infection in pregnant women. PMID:26858799

  6. History of Assisted Reproductive Technology and Chlamydia Trachomatis Infection in Pregnancy.

    PubMed

    Kato, Masahiko; Suzuki, Shunji

    2016-03-01

    To identify whether or not a history of assisted reproductive technology (ART) is associated with the low incidence of Chlamydia trachomatis (CT) infection in pregnant women, we reviewed the obstetric records of the Japanese women aged 35 - 42 years. The prevalence of CT in the pregnancies without ART was 1.1% (28/2,632) using nucleic acid amplification tests, while it was zero in the pregnancies conceived by ART (0/364, P = 0.049 by the X(2) test). A history of ART seemed to be a negative risk factor for CT infection in pregnant women.

  7. Assisted reproduction techniques in the horse.

    PubMed

    Hinrichs, Katrin

    2012-01-01

    This paper reviews current equine assisted reproduction techniques. Embryo transfer is the most common equine ART, but is still limited by the inability to superovulate mares effectively. Immature oocytes may be recovered by transvaginal ultrasound-guided aspiration of immature follicles, or from ovaries postmortem, and can be effectively matured in vitro. Notably, the in vivo-matured oocyte may be easily recovered from the stimulated preovulatory follicle. Standard IVF is still not repeatable in the horse; however, embryos and foals can be produced by surgical transfer of mature oocytes to the oviducts of inseminated recipient mares or via intracytoplasmic sperm injection (ICSI). Currently, ICSI and in vitro embryo culture are routinely performed by only a few laboratories, but reported blastocyst development rates approach those found after bovine IVF (i.e. 25%-35%). Nuclear transfer can be relatively efficient (up to 26% live foal rate per transferred embryo), but few laboratories are working in this area. Equine blastocysts may be biopsied via micromanipulation, with normal pregnancy rates after biopsy, and accurate genetic analysis. Equine expanded blastocysts may be vitrified after collapsing them via micromanipulation, with normal pregnancy rates after warming and transfer. Many of these recently developed techniques are now in clinical use.

  8. [Benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of infertility patients].

    PubMed

    Li, Xiao-Qin; Sun, Chao-Feng; Guo, Mei

    2017-06-01

    To investigate the benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of the outpatients with infertility. We randomly divided 600 females preliminarily diagnosed with infertility into a control and an experimental group, 288 in the former and 285 in the latter group excluding those whose husbands had azoospermia. For the women patients of the experimental group, we conducted nursing care intervention concerning related knowledge, skills, diet, excise, medication, and psychology, by one-to-one consultation, individualized or group communication, establishing files, telephone follow-up, and wechat guidance. After 3 months of intervention, we compared the compliance of medical visits, effectiveness of cycle management, sense of self-efficiency, satisfaction, and anxiety score between the two groups of patients. In comparison with the controls, the patients of the experimental group showed significantly better knowledge about assisted reproduction and higher effectiveness of self-cycle-management, self-efficiency, and satisfaction (P <0.05), but a markedly lower degree of anxiety (P <0.05). Nursing care service in the assisted reproduction clinic can improve the compliance of medical visits, effectiveness of self-cycle-management, self-efficiency, and satisfaction and reduce the anxiety of the patients.

  9. Extraterritoriality for cross-border reproductive care: should states act against citizens travelling abroad for illegal infertility treatment?

    PubMed

    Van Hoof, Wannes; Pennings, Guido

    2011-11-01

    Since the development of assisted reproduction technologies, there has been discussion on which people should have access to these technologies and which treatments and techniques are morally acceptable. However, national legislation can no longer determine what citizens do. Some countries react to their citizens going abroad to evade restrictions by implementing even more restrictive laws. Turkey has recently become the first state to ban reproductive travel in pursuit of donor gametes. Several states in Australia have enacted or are considering laws that prohibit international commercial surrogacy. This article investigates the consistency and morality of several state reactions to cross-border reproductive care (CBRC), including extraterritorial regulation. The only widespread existing extraterritorial regulation of private life concerns female genital cutting (FGC), sex with children and (largely in the past) abortion. This discussion develops an analogy with these cross-border crimes to evaluate the morality of similar legislation in cases of CBRC. The dissimilarity in these analogies shows that extraterritoriality is a radical position that is generally inappropriate in the case of CBRC. Subsequently, several potential state reactions to CBRC for law evasion are considered. It is concluded that legislation of CBRC should be modest, tolerant and nuanced. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Attitudes towards human reproductive cloning, assisted reproduction and gene selection: a survey of 4600 British twins.

    PubMed

    Prainsack, B; Cherkas, L F; Spector, T D

    2007-08-01

    Surveys have shown opposition to human reproductive cloning (HRC) in many countries. Views of identical (monozygotic, MZ) twins are of particular interest, as they naturally share 100% of their genes. We investigated attitudes of British twins towards HRC in the context of assisted reproduction technologies (ART) and gene selection. About 4651 identical and non-identical (dizygotic, DZ) twins expressed their degree of agreement or disagreement to nine statements relating to ART, gene selection and HRC in a self-completion questionnaire. Most subjects (70% and 78% respectively) did not regard the use of medical technologies to treat infertility as interfering with either nature or God's will, despite believing that infertility is not a disease (54%). Attitudes to gene selection and HRC were context dependent, with more favourable views towards preventing serious diseases than towards enhancing traits. About 44% supported a permanent ban of HRC. MZ twins were significantly more likely to agree that HRC should be allowed for medical purposes, such as saving a sibling's life, than were DZ twins. Increasing religiosity generally correlated with more negative attitudes. Many attitudes are context dependent. More positive views of MZ twins towards HRC could be linked to their experience with being genetically identical.

  11. Fertility in Women of Reproductive Age After Breast Cancer Treatment: Practice Patterns and Outcomes.

    PubMed

    McCray, Devina K S; Simpson, Ashley B; Flyckt, Rebecca; Liu, Yitian; O'Rourke, Colin; Crowe, Joseph P; Grobmyer, Stephen R; Moore, Halle C; Valente, Stephanie A

    2016-10-01

    Breast cancer is the most frequently occurring cancer in women of reproductive age, and systemic treatments may adversely affect childbearing plans. Use of assisted reproductive technologies and therapies for ovarian protection improve fertility prospects. We evaluated whether patients had a documented fertility discussion (FD) with their oncology physician prior to therapy, what options were chosen, and if pregnancy was achieved. A retrospective chart review from 2006 to 2014 was performed to evaluate women aged 40 years and younger who were diagnosed with breast cancer and treated with chemotherapy and/or antihormonal therapy. Patient demographics, treatment regimens, presence or absence of FD, in vitro fertilization (IVF) consultation, gonadotropin-releasing hormone (GnRH) agonist use, and subsequent successful pregnancy were analyzed. Among 303 patients meeting the inclusion criteria, 80 (26 %) had an FD with their physician documented; 71 of these 80 women (89 %) sought further fertility consultation and options. Sixteen (20 %) women were prescribed a GnRH agonist only for ovarian protection during chemotherapy, 50 (63 %) underwent IVF consultation only, and 5 (6 %) had both a GnRH agonist prescribed and an IVF consultation. The overall pregnancy rate was 7 % at a mean of 3 years post breast cancer treatment. Pregnancy after treatment was more common among those pursuing IVF consultation or prescribed a GnRH agonist. In treating young breast cancer patients, it is important to assess fertility desire, discuss treatment risks relating to fertility, and discuss preservation options. Although not every woman in this group desired pregnancy, 71/80 (89 %) women having a documented FD sought further fertility consultation and options.

  12. 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.

  13. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009.

    PubMed

    Zegers-Hochschild, F; Adamson, G D; de Mouzon, J; Ishihara, O; Mansour, R; Nygren, K; Sullivan, E; Vanderpoel, S

    2009-11-01

    Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the World Health Organization headquarters in Geneva, Switzerland, in December 2008. Several months before, three working groups were established as responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures, and outcome measures. Each group reviewed the existing International Committee for Monitoring Assisted Reproductive Technology glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion. A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures, such as cumulative delivery rates and other markers of safety and efficacy in ART. Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional, and international registries.

  14. The process of justifying assisted reproductive technologies in Iran.

    PubMed

    Gooshki, Ehsan Shamsi; Allahbedashti, Neda

    2015-01-01

    Infertility is medically defined as one year of unprotected intercourse that does not result in pregnancy. Infertility is a noticeable medical problem in Iran, and about a quarter of Iranian couples experience primary infertility at some point in their lives. Since having children is a basic social value in Iran, infertility has an adverse effect on the health of the couple and affects their well-being. The various methods of assisting infertile couples raise several ethical questions and touch upon certain sensitive points. Although the present Iranian legislative system, which is based on the Shi'a school of Islam, has legalised some aspects of assisted reproductive technologies (ARTs), given the absence of a general officially ratified act (official pathway), such medical interventions are usually justified through a fatwa system (non-official pathway). Officially registered married couples can access almost all ART methods, including third-party gamete donation, if they use such pathways. The process of justifying ART interventions generally began when in vitro fertilisation was given the nod and later, Ayatollah Khamenei (the political-religious leader of the country) issued a fatwa which permitted gamete donation by third parties. This open juristic approach paved the way for the ratification of the Embryo Donation to Infertile Spouses Act in 2003.

  15. 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.

  16. Pharmacogenetic algorithm for individualized controlled ovarian stimulation (iCOS) in assisted reproductive technology cycles.

    PubMed

    Roque, Matheus; Bianco, Bianca; Christofolini, Denise M; Cordts, Emerson B; Vilarino, Fabia L; Carvalho, Waldemar; Valle, Marcello; Sampaio, Marcos; Geber, Selmo; Esteves, Sandro C; Barbosa, Caio P

    2018-06-14

    Controlled ovarian stimulation (COS) is crucial for optimizing in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) success. Multiple factors influence the ovarian response to COS, making predictions about oocyte yields not so straightforward. As a result, the ovarian response may be poor or suboptimal, or even excessive, all of which have negative consequences for the affected patient. There is a group of patients that present with a suboptimal response to COS despite normal biomarkers of ovarian reserve, such as AFC and AMH. These patients have a lower number of retrieved oocytes than what was expected based on their ovarian reserve, thus showing the inadequacy of using only the traditional ovarian reserve biomarkers to predict the ovarian response. Suboptimal response to COS might be related to ovarian sensitivity to exogenous gonadotropins modulated by genetic factors. The understanding of the gene polymorphisms related to reproductive function can help to improve the clinical management of this patient population and to explain some of the individual patient variability in response to COS. The development of a pharmacogenetic approach concerning COS in the context of assisted reproduction seems attractive as it might help to understand the relationship between genetic variants and ovarian response to exogenous gonadotropins. The patient ́s genetic profile could be used to select the most appropriate gonadotropin type, predict the optimal dosage for each drug, develop a cost-effective treatment plan, maximize the success rates, and lastly, decrease the time-to-pregnancy.

  17. Assessment of sperm DNA in patients submitted the assisted reproduction technology procedures.

    PubMed

    Tsuribe, Patrícia Miyuki; Lima Neto, João Ferreira; Golim, Marjorie de Assis; Dell'Aqua, Camila de Paula Freitas; Issa, João Paulo; Gobbo, Carlos Alberto Monte

    2016-03-01

    This study aimed to produce data on sperm quality while maintaining the integrity of sperm DNA samples taken from patients submitted to in vitro fertilization (IVF) procedures at our center, and determine whether increased levels of histones were associated with sperm DNA damage and decreased fertilization, cleavage, and pregnancy rates. Such findings might shed light on the physiology and outcomes of pregnancy. Semen samples from 27 patients divided into two groups were analyzed. The case group included individuals offered IVF; the control group had subjects with normal spermograms. Sperm DNA structure was assessed through phosphorylated histone H2AX analysis by flow cytometry. The patients with altered sperm parameters had more histones in sperm chromatin than the individuals with normal sperm parameters. Results indicated that increased levels of histone in sperm chromatin do not affect embryo production, but affect the cleavage rate, embryo quality, and might thus reduce pregnancy rates. The integrity of the paternal genome is of paramount importance in the initiation and maintenance of a viable pregnancy in patients treated with assisted reproduction technology procedures. Further studies on sperm diagnostic tests at a nuclear level might improve the treatment offered to infertile couples.

  18. 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…

  19. Birth defects and congenital health risks in children conceived through assisted reproduction technology (ART): a meeting report.

    PubMed

    2014-08-01

    Assisted Reproduction Treatment (ART) is here to stay. This review addresses the parental background of birth defects, before, during and after conception and focuses both on the underlying subfertility and on the question whether ART as a treatment is an additional contributing factor. Searches were performed in Medline and other databases. Summaries were discussed in a Delphi panel set-up by the European Society of Human Reproduction and Embryology (ESHRE). Several birth defects and adult diseases arise during the earliest stages of ovarian development and oocyte differentiation: this is the case of cleft palate disorders in offspring from female rat exposed to Dioxin during fetal life or the polycystic ovary diseases in female offspring (primates) exposed to elevated androgen concentration during fetal life. Human oocytes and embryos often fail to stop the propagation of aneuploid cells but maintain their ability to repair DNA damages including those introduced by the fertilizing sperm. There is a 29 % increased risk of birth defects in the newborns spontaneously conceived by subfertile couples and the risk is further increased (34 %) when conception is achieved by treating infertlity with ART (Danish IVF Registry). Periconceptional conditions are critical for ART babies: their birth weight is in general smaller (Norvegian Registry) but a more prolonged culture time doubled the number of large babies (Finnish Registry). The long-term developmental effects of ART on child and subsequent health as an adult remains a subject worthy of futher monitoring and investigation.

  20. Urinary phthalate metabolite concentrations in relation to history of infertility and use of assisted reproductive technology.

    PubMed

    Alur, Snigdha; Wang, Hongyue; Hoeger, Kathy; Swan, Shanna H; Sathyanarayana, Sheela; Redmon, Bruce J; Nguyen, Ruby; Barrett, Emily S

    2015-11-01

    To examine urinary phthalate metabolite concentrations in pregnant women with planned pregnancies in relation to history of infertility and use of assisted reproductive technology (ART). Phthalate metabolite concentrations were measured in first-trimester urine samples collected from women participating in a prospective pregnancy cohort study. Prenatal clinics. A total of 750 women, of whom 86 had a history of infertility. Forty-one women used ART to conceive. None. Primary outcomes were concentrations of four metabolites of diethylhexyl phthalate (DEHP) and their molar sum (∑DEHP). Multivariable analyses compared phthalate metabolite levels in [1] women reporting a history of infertility vs. those who did not (comparison group); and [2] those who used ART to conceive the index pregnancy vs. women with a history of infertility who did not use ART. Among women with a history of infertility, ∑DEHP was significantly lower in women who conceived after ART compared with those who did not (geometric mean ratio: 0.83; 95% confidence interval 0.71-0.98). Similar significant associations were observed for all of the individual DEHP metabolites. There were no differences in DEHP metabolite concentrations between women with a history of infertility and the comparison group. Women who used ART to conceive had lower first-trimester phthalate metabolite concentrations than women with a history of infertility who did not use ART. Further research is needed to explore whether those pursuing fertility treatments take precautions to avoid exposure to environmental toxins, to improve treatment outcomes. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Genome constraint through sexual reproduction: application of 4D-Genomics in reproductive biology.

    PubMed

    Horne, Steven D; Abdallah, Batoul Y; Stevens, Joshua B; Liu, Guo; Ye, Karen J; Bremer, Steven W; Heng, Henry H Q

    2013-06-01

    Assisted reproductive technologies have been used to achieve pregnancies since the first successful test tube baby was born in 1978. Infertile couples are at an increased risk for multiple miscarriages and the application of current protocols are associated with high first-trimester miscarriage rates. Among the contributing factors of these higher rates is a high incidence of fetal aneuploidy. Numerous studies support that protocols including ovulation-induction, sperm cryostorage, density-gradient centrifugation, and embryo culture can induce genome instability, but the general mechanism is less clear. Application of the genome theory and 4D-Genomics recently led to the establishment of a new paradigm for sexual reproduction; sex primarily constrains genome integrity that defines the biological system rather than just providing genetic diversity at the gene level. We therefore propose that application of assisted reproductive technologies can bypass this sexual reproduction filter as well as potentially induce additional system instability. We have previously demonstrated that a single-cell resolution genomic approach, such as spectral karyotyping to trace stochastic genome level alterations, is effective for pre- and post-natal analysis. We propose that monitoring overall genome alteration at the karyotype level alongside the application of assisted reproductive technologies will improve the efficacy of the techniques while limiting stress-induced genome instability. The development of more single-cell based cytogenomic technologies are needed in order to better understand the system dynamics associated with infertility and the potential impact that assisted reproductive technologies have on genome instability. Importantly, this approach will be useful in studying the potential for diseases to arise as a result of bypassing the filter of sexual reproduction.

  2. Decreased clinical pregnancy and live birth rates after short interval from delivery to subsequent assisted reproductive treatment cycle.

    PubMed

    Quinn, Molly M; Rosen, Mitchell P; Allen, Isabel Elaine; Huddleston, Heather G; Cedars, Marcelle I; Fujimoto, Victor Y

    2018-06-15

    Does the interval from delivery to initiation of a subsequent ART treatment cycle impact clinical pregnancy or live birth rates? An interval from delivery to treatment start of <6 months or ≥24 months is associated with decreased likelihood of clinical pregnancy and live birth. Short interpregnancy intervals are associated with poor obstetric outcomes in the naturally conceiving population prompting birth spacing recommendations of 18-24 months from international organizations. Deferring a subsequent pregnancy attempt means a woman will age in the interval with an attendant decline in her fertility. Retrospective analysis of the Society for Assisted Reproductive Technology Clinical Outcome Reporting System (SARTCORS) cohort containing 61 686 ART cycles from 2004 to 2013. The delivery-to-cycle interval (DCI) was calculated for patients from SARTCORS with a history of live birth from ART who returned to the same clinic for a first subsequent treatment cycle. Generalized linear models were fit to determine the risk of clinical pregnancy and live birth by DCI with subsequent adjustment for factors associated with outcomes of interest. Predicted probabilities of clinical pregnancy and live birth were generated from each model. A DCI of <6 months was associated with a 5.6% reduction in probability of clinical pregnancy (40.1 ± 1.9 versus 45.7 ± 0.6%, P = 0.009) and 6.8% reduction in live birth (31.6 ± 1.7 versus 38.4 ± 0.6%, P = 0.001) per cycle start compared to a DCI of 12 to <18 months. A DCI of ≥24 months was associated with a 5.1% reduction in probability of clinical pregnancy (40.6 ± 0.5 versus 45.7 ± 0.6%, P < 0.001) and 5.7% reduction in live birth (32.7 ± 0.5 versus 38.4 ± 0.6%, P < 0.001) compared to 12 to <18 months. The SART database is reliant upon self-report of many variables of interest including live birth. It remains unclear whether poorer outcomes are a result of residual confounding from factors inherent to the population with a very short

  3. Reproductive Cancer Treatment Hospitalizations of U.S. Women with Intellectual and Developmental Disabilities

    ERIC Educational Resources Information Center

    Parish, Susan L.; Son, Esther; Powell, Robyn M.; Igdalsky, Leah

    2018-01-01

    There is a dearth of existing research on the treatment of reproductive cancers among women with intellectual and developmental disabilities (IDD). This study analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and compared the prevalence of reproductive cancer treatment hospitalization discharges among women with…

  4. Assisted human reproduction--legal rights of the unborn in respect of avoidable damage.

    PubMed

    Adam, G M

    2007-06-01

    The author describes various risks to the foetus arising from assisted reproduction technology (ART). These risks are examined from the legal viewpoint, especially considering the rights of the foetus as interpreted in a number of jurisdictions. He distinguishes between the avoidable and inherent risks to the foetus resulting from ART and the potential hazards of ART relevant to criminal law. The basic internationally accepted conventions on foetal rights are compared relative to decisions in a number of cases heard and decided.

  5. Recent developments in genetics and medically assisted reproduction: from research to clinical applications.

    PubMed

    Harper, J C; Aittomäki, K; Borry, P; Cornel, M C; de Wert, G; Dondorp, W; Geraedts, J; Gianaroli, L; Ketterson, K; Liebaers, I; Lundin, K; Mertes, H; Morris, M; Pennings, G; Sermon, K; Spits, C; Soini, S; van Montfoort, A P A; Veiga, A; Vermeesch, J R; Viville, S; Macek, M

    2018-01-01

    Two leading European professional societies, the European Society of Human Genetics and the European Society for Human Reproduction and Embryology, have worked together since 2004 to evaluate the impact of fast research advances at the interface of assisted reproduction and genetics, including their application into clinical practice. In September 2016, the expert panel met for the third time. The topics discussed highlighted important issues covering the impacts of expanded carrier screening, direct-to-consumer genetic testing, voiding of the presumed anonymity of gamete donors by advanced genetic testing, advances in the research of genetic causes underlying male and female infertility, utilisation of massively parallel sequencing in preimplantation genetic testing and non-invasive prenatal screening, mitochondrial replacement in human oocytes, and additionally, issues related to cross-generational epigenetic inheritance following IVF and germline genome editing. The resulting paper represents a consensus of both professional societies involved.

  6. The impact of endometriosis on the outcome of Assisted Reproductive Technology.

    PubMed

    González-Comadran, Mireia; Schwarze, Juan Enrique; Zegers-Hochschild, Fernando; Souza, Maria do Carmo B; Carreras, Ramon; Checa, Miguel Ángel

    2017-01-24

    Endometriosis has been described to impair fertility through various mechanisms. However, studies evaluating the reproductive outcomes of women undergoing assisted reproductive technologies show controversial results. The aim of this study is to assess whether the reproductive outcome is impaired among women with endometriosis-associated infertility undergoing IVF. A retrospective cohort study was performed, including women undergoing IVF reported by the Red Latinoamericana de Reproduccion Asistida (Redlara) registry, between January 2010 and December 2012. The study group included women with endometriosis-associated infertility, and the control group women with tubal factor, endocrine disorders or unexplained infertility. Women above 40 years, severe male factor and premature ovarian failure were excluded. The reproductive outcomes of between both groups were compared. The primary outcome was live birth. Secondary outcomes included clinical pregnancy, miscarriage, number of oocytes retrieved and number of fertilized oocytes. Outcomes were assessed after the first fresh IVF cycle, and were adjusted for age and number of embryos transferred. A total of 22.416 women were included (3.583 with endometriosis and 18.833 in the control group). Mean age of patients in the endometriosis group and control group was 34.86 (3.47) and 34.61 (3.91) respectively, p = 0.000. The mean number of oocytes retrieved were 8.89 (6.23) and 9.86 (7.02) respectively, p = 0.000. No significant differences were observed between groups in terms of live birth (odds ratio (OR) 1.032, p = 0.556), clinical pregnancy (OR 1.044, p = 0.428) and miscarriage rates (OR 1.049, p = 0.623). Women with endometriosis had significantly lower number of oocytes retrieved (incidence risk ratio (IRR) 0.917, 95% CI 0.895-0.940), however, the number of fertilized oocytes did not differ among the two groups when adjusting for the number of oocytes retrieved (IRR 1.003, p = 0.794). An age

  7. 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

  8. Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology.

    PubMed

    Martin, Angela S; Chang, Jeani; Zhang, Yujia; Kawwass, Jennifer F; Boulet, Sheree L; McKane, Patricia; Bernson, Dana; Kissin, Dmitry M; Jamieson, Denise J

    2017-04-01

    To examine outcomes of singleton pregnancies conceived without assisted reproductive technology (non-ART) compared with singletons conceived with ART by elective single-embryo transfer (eSET), nonelective single-embryo transfer (non-eSET), and double-embryo transfer with the establishment of 1 (DET -1) or ≥2 (DET ≥2) early fetal heartbeats. Retrospective cohort using linked ART surveillance data and vital records from Florida, Massachusetts, Michigan, and Connecticut. Not applicable. Singleton live-born infants. None. Preterm birth (PTB <37 weeks), very preterm birth (VPTB <32 weeks), small for gestational age birth weight (<10th percentile), low birth weight (LBW <2,500 g), very low birth weight (VLBW <1,500 g), 5-minute Apgar score <7, and neonatal intensive care unit (NICU) admission. After controlling for maternal characteristics and employing a weighted propensity score approach, we found that singletons conceived after eSET were less likely to have a 5-minute Apgar <7 (adjusted odds ratio [aOR] 0.33; 95% CI, 0.15-0.69) compared with non-ART singletons. There were no differences among outcomes between non-ART and non-eSET infants. We found that PTB, VPTB, LBW, and VLBW were more likely among DET -1 and DET ≥2 compared with non-ART infants, with the odds being higher for DET ≥2 (PTB aOR 1.58; 95% CI, 1.09-2.29; VPTB aOR 2.46; 95% CI, 1.20-5.04; LBW aOR 2.17; 95% CI, 1.24-3.79; VLBW aOR 3.67; 95% CI, 1.38-9.77). Compared with non-ART singletons, singletons born after eSET and non-eSET did not have increased risks whereas DET -1 and DET ≥2 singletons were more likely to have adverse perinatal outcomes. Copyright © 2017 American Society for Reproductive Medicine. All rights reserved.

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

    PubMed

    Milachich, Tanya; Shterev, Atanas

    2016-08-01

    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.

  10. The role of anticipated decision regret and the patient's best interest in sterilisation and medically assisted reproduction.

    PubMed

    Mertes, Heidi

    2017-05-01

    There is a clear discrepancy in the way those who request medical assistance in pursuit of their reproductive choices are treated. On the one hand, women who request a sterilisation are urged to consider possible future regrets and are sometimes refused treatment in anticipation of such regrets. This is despite the fact that for all age ranges, the majority of women undergoing a sterilisation do not regret the decision. Moreover, women who are voluntarily childless are likely to have a happier and more gratifying life than parents. On the other hand, women who request fertility treatment are not urged to second guess their desire for parenthood. Although the fact that the probability of regret is expected to be higher in the former case than in the latter justifies this difference in treatment to a certain extent, the gap between the two different approaches is wider than it ought to be if we also take future well-being into consideration, instead of focussing exclusively on anticipated decision regret. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. [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.

  12. [A father's motherhood... or a mother's fatherhood? Transgender, assisted reproduction and bioethics].

    PubMed

    Alvarez-Díaz, Jorge Alberto

    2009-01-01

    The presence of a transsexual pregnant male in the mass media has made people reassess if transsexuals should have access to assisted reproduction. The bioethical discussion should focus on the future child best interests. This article describes the story of this transsexual man, legally married to a woman in the state of Oregon in the United States. A brief overview of transsexuality and the specific characteristics of this case, with special considerations towards fertility in transsexual people is included. We suggest reflections on what constitutes motherhood and fatherhood and bioethical considerations brought forth by this groundbreaking event.

  13. Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI).

    PubMed

    Kwan, Irene; Bhattacharya, Siladitya; Kang, Angela; Woolner, Andrea

    2014-08-24

    Traditional monitoring of ovarian hyperstimulation during in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) treatment has included transvaginal ultrasonography (TVUS) plus serum estradiol levels to ensure safe practice by reducing the incidence and severity of ovarian hyperstimulation syndrome (OHSS) whilst achieving the good ovarian response needed for assisted reproduction treatment. The need for combined monitoring (using TVUS and serum estradiol) during ovarian stimulation in assisted reproduction is controversial. It has been suggested that combined monitoring is time consuming, expensive and inconvenient for women and that simplification of IVF and ICSI therapy by using TVUS only should be considered. To assess the effect of monitoring controlled ovarian hyperstimulation (COH) in IVF and ICSI cycles in subfertile couples with TVUS only versus TVUS plus serum estradiol concentration, with respect to rates of live birth, pregnancy and OHSS. We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO, the National Research Register, and web-based trial registers such as Current Controlled Trials. The last search was conducted in May 2014. There was no language restriction applied. All references in the identified trials and background papers were checked and authors were contacted to identify relevant published and unpublished data. Only randomised controlled trials that compared monitoring with TVUS only versus TVUS plus serum estradiol concentrations in women undergoing COH for IVF and ICSI treatment were included. Three review authors independently selected the studies, extracted data and assessed risk of bias. They resolved disagreements by discussion with the rest of the authors. Outcomes data were pooled and summary statistics were presented when appropriate. The quality of the evidence was rated

  14. The effect of legislation on outcomes of assisted reproduction technology: lessons from the 2004 Italian law.

    PubMed

    La Sala, Giovanni Battista; Villani, Maria Teresa; Nicoli, Alessia; Valli, Barbara; Iannotti, Francesca; Blickstein, Isaac

    2008-04-01

    To evaluate the effect of the 2004 Italian regulations (insemination of assisted reproduction treatment (ART). Case-control study. The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Women undergoing ART for the first time. Comparing outcomes of ART between 2 years before (n = 900) and after (n = 936) the law's implementation (March 10, 2004). Rates of fertilization, pregnancy, "take-home baby," and multiple pregnancies. During the pre-law period, statistically significantly more patients reached embryo transfer (odds ratio 1.9; 95% CI, 1.5, 2.5), and embryo transfer rate per cycle was statistically significantly higher (3.1 +/- 1.7 vs. 2.2 +/- 0.7), but the overall transfer of good embryos was lower (OR 0.6; 95% CI, 0.5, 0.8). The pregnancy rates per aspiration cycle were similar between the periods, but the pregnancy rate per embryo transfer and birth rate with at least one liveborn baby per embryo transfer were statistically significantly lower in the pre-law period (OR 0.7; 95% CI, 0.5, 0.9). The multiple births rate was not different between the two periods. In contrast to prior pessimistic expectations, the obligation to transfer all available embryos produced from

  15. Assisted reproductive technology use and outcomes among women with a history of cancer.

    PubMed

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

    2016-01-01

    How do the assisted reproductive technology (ART) outcomes of women presenting for ART after cancer diagnosis compare to women without cancer? The likelihood of a live birth after ART among women with prior cancer using autologous oocytes is reduced and varies by cancer diagnosis but is similar to women without cancer when donor oocytes are used. Premenopausal patients faced with a cancer diagnosis frequently present for fertility preservation. Population-based cohort study of women treated with ART in NY, TX and IL, USA. Women with their first ART treatment between 2004 and 2009 were identified from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database and linked to their respective State Cancer Registries based on name, date of birth and social security number. Years were rounded, i.e. year 1 = 6-18 months before treatment. This study used reports of cancer from 5 years, 6 months prior to treatment until 6 months after first ART treatment. Women who only presented for embryo banking were omitted from the analysis. The likelihood of pregnancy and of live birth with ART using autologous oocytes was modeled using logistic regression, with women without prior cancer as the reference group, adjusted for woman's age, parity, cumulative FSH dosage, infertility diagnosis, number of diagnoses, number of ART cycles, State of residency and year of ART treatment. Results of the modeling are reported as adjusted odds ratios (AORs) and (95% confidence intervals). The study population included 53 426 women; 441 women were diagnosed with cancer within 5 years prior to ART cycle start. Mean (±SD) age at cancer diagnosis was 33.4 ± 5.7 years; age at start of ART treatment was 34.9 ± 5.8 for women with cancer compared with 35.3 ± 5.3 years for women without cancer (P = 0.03). Live birth rates among women using autologous oocytes differed substantially by cancer status (47.7% without cancer versus 24.7% with cancer, P < 0.0001), and cancer

  16. Assisted reproductive techniques in Latin America: The Latin American Registry, 2014

    PubMed Central

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

    2017-01-01

    Multinational data on assisted reproduction techniques undertaken in 2014 were collected from 159 institutions in 15 countries in Latin America. Treatments included IVF/ ICSI, FET, OD, PGD and fertility preservation (FP). 41.34% of IVF/ICSI cycles were performed in women aged 35 to 39 years and 23.35% in women aged 40 and older. After removing cases with total freezing, delivery rate per oocyte retrieval was 25.05% for ICSI and 27.41% for IVF. Multiple births included 20.78% twins and 0.92 % triplets and over. In OD, twins reached 28.93% and triplets 1.07 %. Preterm deliveries reached 16.4% in singletons, 55.02% in twins and 76% in triplets. Perinatal mortality in 18,162 births was 23 per 1000 in singletons, 35 per 1000 in twins, and 36 per 1000 in high-order multiples. Elective single embryo transfer (eSET) represented only 2.63 % of fresh transfers, with a delivery rate of 32.15% per transfer. Elective double embryo transfer (eDET) represented 23.74% of transfers, with a delivery rate of 41.03% per transfer. Among babies born during this period 11,373 (62.6%) were singletons; 6,398 (35.2%) twins, and 391 (2.2%), triplets and more. Given the effect of multiple births on prematurity, morbidity and perinatal mortality, reinforcing the existing trend of reducing the number of embryos transferred is mandatory PMID:28837023

  17. Potential of human twin embryos generated by embryo splitting in assisted reproduction and research.

    PubMed

    Noli, Laila; Ogilvie, Caroline; Khalaf, Yacoub; Ilic, Dusko

    2017-03-01

    Embryo splitting or twinning has been widely used in veterinary medicine over 20 years to generate monozygotic twins with desirable genetic characteristics. The first human embryo splitting, reported in 1993, triggered fierce ethical debate on human embryo cloning. Since Dolly the sheep was born in 1997, the international community has acknowledged the complexity of the moral arguments related to this research and has expressed concerns about the potential for reproductive cloning in humans. A number of countries have formulated bans either through laws, decrees or official statements. However, in general, these laws specifically define cloning as an embryo that is generated via nuclear transfer (NT) and do not mention embryo splitting. Only the UK includes under cloning both embryo splitting and NT in the same legislation. On the contrary, the Ethics Committee of the American Society for Reproductive Medicine does not have a major ethical objection to transferring two or more artificially created embryos with the same genome with the aim of producing a single pregnancy, stating that 'since embryo splitting has the potential to improve the efficacy of IVF treatments for infertility, research to investigate the technique is ethically acceptable'. Embryo splitting has been introduced successfully to the veterinary medicine several decades ago and today is a part of standard practice. We present here an overview of embryo splitting experiments in humans and non-human primates and discuss the potential of this technology in assisted reproduction and research. A comprehensive literature search was carried out using PUBMED and Google Scholar databases to identify studies on embryo splitting in humans and non-human primates. 'Embryo splitting' and 'embryo twinning' were used as the keywords, alone or in combination with other search phrases relevant to the topics of biology of preimplantation embryos. A very limited number of studies have been conducted in humans and non

  18. 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.

  19. The epigenetic effects of assisted reproductive technologies: ethical considerations.

    PubMed

    Roy, M-C; Dupras, C; Ravitsky, V

    2017-08-01

    The use of assisted reproductive technologies (ART) has increased significantly, allowing many coping with infertility to conceive. However, an emerging body of evidence suggests that ART could carry epigenetic risks for those conceived through the use of these technologies. In accordance with the Developmental Origins of Health and Disease hypothesis, ART could increase the risk of developing late-onset diseases through epigenetic mechanisms, as superovulation, fertilization methods and embryo culture could impair the embryo's epigenetic reprogramming. Such epigenetic risks raise ethical issues for all stakeholders: prospective parents and children, health professionals and society. This paper focuses on ethical issues raised by the consideration of these risks when using ART. We apply two key ethical principles of North American bioethics (respect for autonomy and non-maleficence) and suggest that an ethical tension may emerge from conflicting duties to promote the reproductive autonomy of prospective parents on one hand, and to minimize risks to prospective children on the other. We argue that this tension is inherent to the entire enterprise of ART and thus cannot be addressed by individual clinicians in individual cases. We also consider the implications of the 'non-identity problem' in this context. We call for additional research that would allow a more robust evidence base for policy. We also call upon professional societies to provide clinicians with guidelines and educational resources to facilitate the communication of epigenetic risks associated with ART to patients, taking into consideration the challenges of communicating risk information whose validity is still uncertain.

  20. [Contribution of animal models to the study of reproduction, assisted reproductive technologies and of development].

    PubMed

    Jammes, Hélène; Fauque, Patricia; Jouannet, Pierre

    2010-02-01

    Children conceived through assisted reproductive technologies (ART) now account for a noteworthy proportion (-2.4%) of births in France. Considerable attention is being paid to the outcome of ART pregnancies. The vast majority of these children are apparently normal. However, they are at an increased risk of minor birth defects, low birth weight, and rare imprinting disorders such as Beckwith-Wiedemann syndrome (BWS), Angelman syndrome (AS) and Silver Russel syndrome (SRS). Animal models are important for investigating the possible role of each step of ART (ovarian stimulation, gamete manipulation, in vitro fertilization, embryo culture and embryo transfer) in epigenetic reprogramming This review discusses these issues in the context of epigenetic and developmental abnormalities observed in animals following ART More research is needed on ART-induced errors, focusing not only on genomic imprinting but also on non-imprinted loci, which may help explain some of the more subtle longer-term health effects emerging from studies with animal models.

  1. Italian law on medically assisted reproduction: do women's autonomy and health matter?

    PubMed

    Riezzo, Irene; Neri, Margherita; Bello, Stefania; Pomara, Cristoforo; Turillazzi, Emanuela

    2016-07-23

    In Italy in 2004, a very restrictive law was passed on medically assisted reproduction (MAR) (Law 40/2004) that placed Italy at the most conservative end of the European spectrum. The law was widely criticized and many couples seeking MAR brought their cases before the Italian Civil Courts with regard to pre-implantation genetic diagnosis (PGD), donor insemination and the issue of consent. Ten years on, having suffered the blows of the Italian Constitutional Court, little remains of law 40/2004. In 2009, the Constitutional Court declared the maximum limit of the number of embryos to be produced and transferred for each cycle (i.e. three), as stated in the original version of the law, to be constitutionally illegitimate. In 2014, the same Court declared as unconstitutional the ban on donor insemination, thus opening the way to heterologous assisted reproduction. Heterologous MAR is therefore perfectly legitimate in Italy. Finally, in 2015 a further ruling by the Constitutional Court granted the right to access MAR to couples who are fertile but carriers of genetic diseases. However, there is still much room for criticism. Many couples and groups are still, in fact, excluded from MAR. Same-sex couples, single women and those of advanced reproductive age are, at the present time, discriminated against in that Italian law denies these subjects access to MAR. The history of Law 40/2004 has been a particularly troubled one. Numerous rulings have, over the years, dismantled much of a law constructed in violation of the rights and autonomy of women and couples. However, a number of troubling issues still exist from what is left of the law and the debate is still open at national and transnational level regarding some of the contradictions and gaps in the law highlighted in this article. Only by abolishing the final prohibitions and adopting more liberal views on these controversial yet crucial issues will Law 40/2004 become what it should have been from the start, i.e. a

  2. 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

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

    PubMed

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

    2016-01-01

    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. 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. 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 surrogacy (P<0.05). The difference in rate of

  4. Morals or markets? Regulating assisted reproductive technologies as morality or economic policies in the states.

    PubMed

    Heidt-Forsythe, Erin

    2017-01-01

    The availability of assisted reproductive technologies (ARTs) in the medical marketplace complicates our understanding of reproductive public policy in the United States. Political debates over ARTs often are based on fundamental moral principles of life, reproduction, and kinship, similar to other reproductive policies in the United States. However, ARTs are an important moneymaking private enterprise for the U.S. biotechnology industry. This project investigates how the U.S. states regulate these unique and challenging technologies as either moral policies or economic policies. This study employs ordinary least squares (OLS) regression to estimate the significance of morality and economic policy variables on ART policies at the state level, noting associations between state-level political, economic, and gender variables on restrictive and permissive state-level ART policies. Economic variables (reflecting the biotechnology industry) and advocacy for access to ART on behalf of infertility patients increase the chances of states passing policies that enable consumer use of ARTs. Additionally, individual ART policies are distinct from one another in the ways that morality variables increase the chances of ART regulations. Surprisingly, the role of religious adherence among state residents varied in positive and negative relationships with individual policy passage. In general, these results support the hypothesis that ART laws are associated with economic as well as moral concerns of the states-ARTs lie at the intersection of issues of life and reproduction and of scientific innovation and health. What is most striking about these results is that they do not follow patterns seen in the legislation of abortion, contraception, and sexuality in general-those reproductive policies that are considered "morality policy." Similarly, economic variables are not consistently significant in the expected direction.

  5. Article processing charges, funding, and open access publishing at Journal of Experimental & Clinical Assisted Reproduction.

    PubMed

    Sills, Eric Scott; Vincent, Tina Thibault; Palermo, Gianpiero D

    2005-01-13

    Journal of Experimental & Clinical Assisted Reproduction is an Open Access, online, electronic journal published by BioMed Central with full contents available to the scientific and medical community free of charge to all readers. Authors maintain the copyright to their own work, a policy facilitating dissemination of data to the widest possible audience without requiring permission from the publisher. This Open Access publishing model is subsidized by authors (or their institutions/funding agencies) in the form of a single pound330 article processing charge (APC), due at the time of manuscript acceptance for publication. Payment of the APC is not a condition for formal peer review and does not apply to articles rejected after review. Additionally, this fee is waived for authors whose institutions are BioMed Central members or where genuine financial hardship exists. Considering ordinary publication fees related to page charges and reprints, the APC at Journal of Experimental & Clinical Assisted Reproduction is comparable to costs associated with publishing in some traditional print journals, and is less expensive than many. Implementation of the APC within this Open Access framework is envisioned as a modern research-friendly policy that supports networking among investigators, brings new research into reach rapidly, and empowers authors with greater control over their own scholarly publications.

  6. [Assisted human reproduction techniques: determination of parentage and users in comparative law].

    PubMed

    Germán Zurriaráin, Roberto

    2011-01-01

    The paper undertakes the determination of parentage and users of assisted reproduction techniques in comparative law, particularly in three European Union countries: Italy, France and Spain. The idea of artificially conceived child protection, present in the Italian provision, is substituted, partially in French law, and totally in Spanish law, by an exclusively individualistic outlook, configuring a true ″right to maternity″ for married women and for those not living with a male partner (single women, divorced or widowed) or with a female partner (lesbians), and for women inseminated artificially by the semen of the husband before or after their death, and for women already having culminated their fertile life.

  7. First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

    PubMed

    Póvoa, Ana; Xavier, Pedro; Matias, Alexandra; Blicksttein, Isaac

    2017-07-28

    To compare levels of β-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum β-hCG at 13 days after embryo transfer as well as samples of β-hCG and estradiol at 8-9 weeks+6 days. No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. β-hCG and estradiol were all significantly higher in twins (P<0.05). The data confirms the higher levels of β-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

  8. Determining access to assisted reproductive technology: reactions of clinic directors to ethically complex case scenarios.

    PubMed

    Stern, J E; Cramer, C P; Green, R M; Garrod, A; DeVries, K O

    2003-06-01

    Our aim was to increase understanding of how patient selection is handled by assisted reproductive technology (ART) clinicians. Ethically complex case scenarios were evaluated by the directors of USA ART clinics. Scenarios included using a son as sperm donor for his father, sex selection without associated disease, treatment of morally irresponsible couples, and a dispute over embryo disposition. Respondents reviewed eight scenarios and gave their opinions on whether to offer treatment. Reasons given for these decisions were placed into one of 13 categories. Survey response rate was 57%. Between 3 and 50% of respondents would treat in each case. Of reasons given, 'conditional' responses (requiring counselling, blood tests or agreement to other 'conditions') were common (31.4%). Non-maleficence (risk) accounted for 29.4% of responses, philosophy of medicine 18.9%, respect for patient autonomy 5.9% and legal concerns 4.6%. Discrimination and threats were each significant in one case. Reasons evoking absolutist beliefs, personal discomfort, commitment to justice, religion and ethical relativism were rare. Clinicians felt conflict between a desire to respect patient autonomy and their discomfort over the risk associated with the procedure. They raised concerns about misuse of medical technology. Attempts to resolve complex issues through negotiation and compromise were common.

  9. Assisted reproductive medicine in Poland --Fertility and Sterility Special Interest Group of the Polish Gynaecological Society (SPiN PTG) 2012 report.

    PubMed

    Janicka, Anna; Spaczyńiski, Robert Z; Kurzawa, Rafał

    2015-12-01

    The aim of this report is to present data concerning results and complications related to infertility treatment using assisted reproductive technology (ART) and insemination (IUI) in Poland in 2012. The report was prepared by the Fertility and Sterility Special Interest Group of the Polish Gynaecological Society (SPiN PTG), based on individual data provided by fertility clinics. Reporting was voluntary data were not subject to external verification. The report presents the availability and the structure of infertility treatment services, the number of procedures performed, their effectiveness and the most common complications. In 2014, 34 Polish fertility clinics provided information to the report, presenting data from 2012. The total number of reported treatment cycles using ART was 17,116 (incl. 10,714 fresh IVF/ICSI) and 14,727 IUI. The clinical pregnancy rate per cycle was on average 33.7% for fresh IVF/ICSI and 13.3% for IUI. The prevalence of multiple births was 15.7% and 6.2%, in case of IVF/ICSI and IUI methods respectively The most frequent complication in the course of treatment using ART was ovarian hyperstimulation syndrome (OHSS)--severe OHSS constituted 0.68% of all stimulated cycles. The SPiN PTG report shows the average effectiveness and safety of ART and was the only proof of responsibility and due diligence of fertility centres in Poland. However, due to the lack of a central register of fertility clinics, facultative participation in the report as well as incomplete information on pregnancy and delivery rate, the collected data do not reflect the full spectrum of Polish reproductive medicine.

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

    PubMed

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

    2017-02-01

    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. 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. 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. 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). Both cellular and environmental factors could be important and involved in ART improvement.

  11. Biomarkers of ovarian reserve as predictors of reproductive potential.

    PubMed

    Steiner, Anne Z

    2013-11-01

    The size of the oocyte pool, the ovarian reserve, can determine a woman's reproductive stage. Chronologic age, anti-Müllerian hormone (AMH) levels, early follicular phase follicle-stimulating hormone levels, and early follicular phase inhibin B levels are correlated with ovarian reserve. Therefore, these biomarkers of ovarian reserve should serve as predictors of reproductive potential. Clinical and epidemiologic studies suggest that historical and laboratory biomarkers of ovarian reserve are associated with natural and treatment-related fertility. However, controversy remains as to their ability to predict reproductive potential. For infertile women undergoing assisted reproductive technology treatment, these biomarkers tend to be highly specific but not sensitive for cycle failure (nonpregnancy). While these biomarkers are being used as "fertility tests" in the general population, their value as predictors of unassisted fertility is still uncertain. Among laboratory biomarkers, AMH appears to have the most promise; however, further studies are needed to refine cutoff values and to determine test characteristics in the prediction of natural fertility or infertility in the general population. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Immunology and human reproduction.

    PubMed

    Alecsandru, Diana; García-Velasco, Juan Antonio

    2015-06-01

    The immune system's role in recurrent reproductive failure is a controversial issue in assisted reproduction. New insight about maternal tolerance in assisted reproduction has been reported and could explain some of the recurrent miscarriage and/or recurrent implantation failure related causes named until now as unknown. Most of the previous studies about immune system implication in reproduction were focused on finding markers on peripheral blood. Maternal tolerance begins at the uterine level, so successful adaptation to the fetus happens after a complicated process. Insufficient invasion of the uterine lining by invading extravillous trophoblast is the primary defect in pregnancy disorders such as recurrent miscarriage, and this process is regulated by interaction between maternal killer immunoglobulin-like receptors (KIRs) expressed by the uterine natural killer cells and their ligand human leukocyte antigen (HLA)-C expressed by extravillous trophoblast. Pregnancies are an increased risk of disorders in mothers with KIR AA when the fetus has paternal HLA-C2. Recently, it has been reported that the expression of more than one paternal HLA-C by extravillous trophoblast in assisted reproduction may affect placentation in mothers with KIR AA. The review provides insight about the immune tolerance process. These insights could have an impact on the selection of single embryo transfer and/or oocyte/sperm donor according to HLA-C in patients with recurrent miscarriage or recurrent implantation failure and a KIR AA haplotype.

  13. Interventions to improve reproductive outcomes in women with elevated natural killer cells undergoing assisted reproduction techniques: a systematic review of literature.

    PubMed

    Polanski, L T; Barbosa, M A P; Martins, W P; Baumgarten, M N; Campbell, B; Brosens, J; Quenby, S; Raine-Fenning, N

    2014-01-01

    Is there any scientific evidence to support the routine use of adjuvant therapies for women with elevated natural killer (NK) cells undergoing assisted reproduction techniques (ARTs) in order to improve live birth rate? Due to the poor quality evidence, this review does not support the use of described adjuvant treatments in women found to have elevated absolute numbers or activity of NK cells undergoing ART. Deregulation in the numbers of NK cells and/or their activity, in the blood as well as in the endometrium, has been associated with various manifestations of reproductive failure. NK cell analysis is becoming increasingly popular as a test offered to investigate the causes of reproductive failure. Adjuvant therapies influencing the NK cells have been postulated as therapeutic options for couples where deregulation of this component of the maternal immune system is suspected as the cause of infertility or implantation failure. Systematic review. Embase, LILACS, MEDLINE, PsycINFO, CENTRAL and CINAHL databases from 1946 to present were searched with no language restrictions. Studies evaluating the use of adjuvant therapies in women undergoing ART where NK cell numbers and/or activity were assessed were considered eligible for inclusion. Only three studies (one in abstract form only) meeting the inclusion criteria were identified: two reported the use of intravenous immunoglobulins (IVIg) and one the use of oral prednisolone. All studies demonstrated a beneficial effect of the interventions on clinical pregnancy rates with a risk ratio (RR) of 1.63 [95% confidence interval (CI) 1.00-2.66] for prednisolone and 3.41 (95%CI 1.90-6.11) for IVIg. Studies assessing the efficacy of IVIg have also reported live birth rate with an RR of 3.94 (95% CI 2.01-7.69) favoring the intervention. Data heterogeneity was substantial however (I(2) = 66%) suggesting a cautious interpretation of the results. Differing study populations, lack of statistical power, method of data

  14. 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.

  15. 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. © 2011 Blackwell Publishing Ltd.

  16. Serum omega-3 fatty acids and treatment outcomes among women undergoing assisted reproduction.

    PubMed

    Chiu, Y-H; Karmon, A E; Gaskins, A J; Arvizu, M; Williams, P L; Souter, I; Rueda, B R; Hauser, R; Chavarro, J E

    2018-01-01

    generalizability of the findings to populations not undergoing infertility treatment may be limited. The use of a single measurement of serum fatty acids to characterize exposure may lead to potential misclassification during follow up. Serum ω3-PUFA are considered biomarkers of dietary intake. The association of higher serum long chain ω3-PUFA levels with improved ART outcomes suggests that increased intake of these fats be may be beneficial for women undergoing infertility treatment with ART. NIH grants R01-ES009718 from the National Institute of Environmental Health Sciences, P30-DK046200 and T32-DK007703-16 from the National Institute of Diabetes and Digestive and Kidney Diseases, and L50-HD085359 from the National Institute of Child Health and Human Development, and the Early Life Nutrition Fund from Danone Nutricia US. Dr Rueda is involved in a patent 9,295,662, methods for enhancing, improving, or increasing fertility or reproductive function (http://patents.com/us-9295662.html). This patent, however, does not lead to financial gain for Dr Rueda, or for Massachusetts General Hospital. Dr Rueda does not own any part of the company nor does he have any equity in any fertility related company. As Dr Rueda is not a physician, he does not evaluate patients or prescribe medications. All other coauthors have no conflicts of interest to declare. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

  17. Development of a security system for assisted reproductive technology (ART).

    PubMed

    Hur, Yong Soo; Ryu, Eun Kyung; Park, Sung Jin; Yoon, Jeong; Yoon, San Hyun; Yang, Gi Deok; Hur, Chang Young; Lee, Won Don; Lim, Jin Ho

    2015-01-01

    In the field of assisted reproductive technology (ART), medical accidents can result in serious legal and social consequences. This study was conducted to develop a security system (called IVF-guardian; IG) that could prevent mismatching or mix-ups in ART. A software program was developed in collaboration with outside computer programmers. A quick response (QR) code was used to identify the patients, gametes and embryos in a format that was printed on a label. There was a possibility that embryo development could be affected by volatile organic components (VOC) in the printing material and adhesive material in the label paper. Further, LED light was used as the light source to recognize the QR code. Using mouse embryos, the effects of the label paper and LED light were examined. The stability of IG was assessed when applied in clinical practice after developing the system. A total of 104 cycles formed the study group, and 82 cycles (from patients who did not want to use IG because of safety concerns and lack of confidence in the security system) to which IG was not applied comprised the control group. Many of the label paper samples were toxic to mouse embryo development. We selected a particular label paper (P touch label) that did not affect mouse embryo development. The LED lights were non-toxic to the development of the mouse embryos under any experimental conditions. There were no differences in the clinical pregnancy rates between the IG-applied group and the control group (40/104 = 38.5 % and 30/82 = 36.6 %, respectively). The application of IG in clinical practice did not affect human embryo development or clinical outcomes. The use of IG reduces the misspelling of patient names. Using IG, there was a disadvantage in that each treatment step became more complicated, but the medical staff improved and became sufficiently confident in ART to offset this disadvantage. Patients who received treatment using the IG system also went through a somewhat

  18. Disparities in Assisted Reproductive Technology Utilization by Race and Ethnicity, United States, 2014: A Commentary.

    PubMed

    Dieke, Ada C; Zhang, Yujia; Kissin, Dmitry M; Barfield, Wanda D; Boulet, Sheree L

    2017-06-01

    Disparities in infertility and access to infertility treatments, such as assisted reproductive technology (ART), by race/ethnicity, have been reported. However, identifying disparities in ART usage may have been hampered by missing race/ethnicity information in ART surveillance. We review infertility prevalence and treatment disparities, use recent data to examine ART use in the United States by race/ethnicity and residency in states with mandated insurance coverage for in vitro fertilization (IVF), and discuss approaches for reducing disparities. We used 2014 National ART Surveillance System (NASS) data to calculate rates of ART procedures per million women 15-44 years of age, a proxy measure of ART utilization, for Census-defined racial/ethnic groups in the United States; rates were further stratified by the presence of insurance mandates for IVF treatment. Missing race/ethnicity data (35.6% of cycles) were imputed. Asian/Pacific Islander (A/PI) women had the highest rates of ART utilization at 5883 ART procedures per million women 15-44 years of age in 2014, whereas American Indian/Alaska Native non-Hispanic women had the lowest rates at 807 per million, compared with other racial/ethnic groups. In each racial/ethnic category, ART utilization rates were higher for women in states with an insurance mandate for IVF treatment versus those without. In 2014, A/PI women had the highest rates of ART utilization. ART utilization for all racial/ethnic groups was higher in states with insurance mandates for IVF than those without, although disparities were still evident. Although mandates may increase access to infertility treatments, they are not sufficient to eliminate these disparities.

  19. Progress in understanding human ovarian folliculogenesis and its implications in assisted reproduction.

    PubMed

    Yang, Dong Zi; Yang, Wan; Li, Yu; He, Zuanyu

    2013-02-01

    To highlight recent progress in understanding the pattern of follicular wave emergence of human menstrual cycle, providing a brief overview of the new options for human ovarian stimulation and oocyte retrieval by making full use of follicular physiological waves of the patients either with normal or abnormal ovarian reserve. Literature review and editorial commentary. There has been increasing evidence to suggest that multiple (two or three) antral follicular waves are recruited during human menstrual cycle. The treatment regimens designed based on the theory of follicular waves, to promote increased success with assisted reproduction technology (ART) and fertility preservation have been reported. These new options for human ovarian stimulation and oocyte retrieval by making full use of follicular waves of the patients either with normal or abnormal ovarian reserve lead to new thinking about the standard protocols in ART and challenge the traditional theory that a single wave of antral follicles grows only during the follicular phase of the menstrual cycle. The understanding of human ovarian folliculogenesis may have profound implications in ART and fertility preservation. Further studies are needed to evaluate the optimal regimens in ART based on the theory of follicular waves and to identify non-invasive markers for predicting the outcome and the potential utilities of follicles obtained from anovulatory follicular waves in ART.

  20. Desires, Need, Perceptions, and Knowledge of Assisted Reproductive Technologies of HIV-Positive Women of Reproductive Age in Ontario, Canada.

    PubMed

    Zhang, Yimeng; Margolese, Shari; Yudin, Mark H; Raboud, Janet M; Diong, Christina; Hart, Trevor A; Shapiro, Heather M; Librach, Cliff; Gysler, Matt; Loutfy, Mona R

    2012-01-01

    The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument "The HIV Pregnancy Planning Questionnaire" at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV.

  1. Desires, Need, Perceptions, and Knowledge of Assisted Reproductive Technologies of HIV-Positive Women of Reproductive Age in Ontario, Canada

    PubMed Central

    Zhang, Yimeng; Margolese, Shari; Yudin, Mark H.; Raboud, Janet M.; Diong, Christina; Hart, Trevor A.; Shapiro, Heather M.; Librach, Cliff; Gysler, Matt; Loutfy, Mona R.

    2012-01-01

    The purpose of this cross-sectional study is to assess the desire, need, perceptions, and knowledge of assisted reproductive technologies (ARTs) for women living with HIV (WLWHIV) and determine correlates of ART knowledge desire. WLWHIV of reproductive age were surveyed using the survey instrument “The HIV Pregnancy Planning Questionnaire” at HIV/AIDS service organizations across Ontario, Canada. Of our cohort of 500 WLWHIV, median age was 38, 88% were previously pregnant, 78% desired more information regarding ART, 59% were open to the idea of receiving ART, 39% felt they could access a sperm bank, and 17% had difficulties conceiving (self-reported). Age, African ethnicity, and residence in an urban center were correlated with desire for more ART information. Of participants, 50% wanted to speak to an obstetrician/gynecologist regarding pregnancy planning, and 74% regarded physicians as a main source of fertility service information. While the majority of participants in our cohort desire access to ART information, most do not perceive these services as readily accessible. Healthcare practitioners were viewed as main sources of information regarding fertility services and need to provide accurate information regarding access. Fertility service professionals need to be aware of the increasing demand for ART among WLWHIV. PMID:22957265

  2. Fertility effects of cancer treatment.

    PubMed

    Marsden, Donald E; Hacker, Neville

    2003-01-01

    Cancer sufferers are a subfertile group, and most treatments have the potential to adversely affect gonadal function. As cancer treatment becomes more effective and survival rates improve there are more cancer survivors in the reproductive age group for whom parenting is an important consideration. This article outlines the effects on fertility of cancer treatments and techniques to minimise the risk of infertility. The overall prospects for younger cancer sufferers to either retain their fertility or have genetic offspring is now better than ever before, due to advances in assisted reproductive technology, the appropriate use of fertility sparing surgery and other techniques to reduce the toxicity of therapy on the reproductive organs. These advances raise new moral and ethical concerns that must be considered before advising cancer sufferers of the options for preserving reproductive capacity.

  3. 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

  4. Low birth weight: Is it related to assisted reproductive technology or underlying infertility?

    PubMed Central

    Kondapalli, Laxmi A.; Perales-Puchalt, Alfredo

    2013-01-01

    Since 1978, we have witnessed a successful evolution of assisted reproductive technology (ART), with improvement of the pregnancy rates and a growing demand. However, in recent years, there has been increasing concern regarding its safety due to the potential health impact on its infants. The raise of the developmental origins of adult disease has positioned low birth weight (LBW) as a significant health issue. Despite multiple studies have associated ART with LBW, the etiology of this association remains largely unknown. This paper reviews the potential association between different components of ART and infertility with LBW, while acknowledging the limitations to interpretation of the existing literature. PMID:23375144

  5. 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.

  6. Initial Effects of Reproduction Cutting Treatments on Residual Hard Mast Production in the Ouachita Mountains

    Treesearch

    Roger W. Perry; Ronald E. Thill

    2003-01-01

    We compared indices of total hard mast production (oak and hickory combined) in 20, second-growth, pine-hardwood stands under five treatments to determine the effects of different reproduction treatments on mast production in the Ouachita Mountains. We evaluated mast production in mature unharvested controls and stands under four reproduction cutting methods (single-...

  7. Hair and urine testing to assess drugs of abuse consumption in couples undergoing assisted reproductive technology (ART).

    PubMed

    Pichini, Simona; De Luca, Roberto; Pellegrini, Manuela; Marchei, Emilia; Rotolo, Maria Concetta; Spoletini, Roberta; D'Aloja, Paola; Pacifici, Roberta; Mortali, Claudia; Scaravelli, Giulia

    2012-05-10

    For the first time in Europe hair and urine testing have been applied to assess drugs of abuse consumption in couples undergoing assisted reproductive technology and the eventual association of toxic habits with other lifestyle, health status and sociodemographic factors was also investigated. Couples attending five assisted reproduction centers in Rome were invited to join the study. When they presented at the Centre for the visit, they were asked to answer a structured questionnaire concerning sociodemographic characteristics and lifestyle habits, and at the same time to provide hair and urine samples. Hair and urine testing for drugs of abuse, urinary profile of principal endogenous steroids involved in fertility process (testosterone, epitestosterone, androsterone, etiocholanolone and dehydroepiandrosterone) and of alcohol and tobacco smoke biomarkers were performed with validated methodologies. Of the 594 enrolled individuals (297 couples), 352 (164 couples and 24 single individuals from the couple) completed the questionnaire and gave both hair and urine samples, apart from 3 bald men, who only gave urine samples. Urine testing showed an overall 4.8% (17 individuals) positivity to drugs of abuse: 4.2% to cannabinoids, 1.4% to cocaine and 0.85% to both drugs. Results of 4cm segment hair samples testing matched those from urine samples. Thus, taking together, results of urine and hair testing confirmed repeated use of cannabis, cocaine and both drugs in 3.7, 0.85 and 0.57% examined individuals, respectively. Drug consumers were in a statistically higher percentage active smokers and alcohol drinkers, less prone to physical activity and with a trend towards higher weight than non consumers. Finally, repeated drug consumption was associated with significant lower concentration of urinary testosterone in males and of urinary dehydroepiandrosterone in females. The findings of the present study confirm the suitability of urine testing to disclose recent drugs of

  8. A Focus on Maternal Health Before Assisted Reproduction: Results From a Pilot Survey of Canadian IVF Medical Directors.

    PubMed

    Dayan, Natalie; Spitzer, Karen; Laskin, Carl A

    2015-07-01

    To describe current physician practice patterns in Canada with regard to performing in vitro fertilization in high-risk patients. All medical directors of IVF clinics registered with the Canadian Fertility and Andrology Society (n=35) were invited to participate in an online survey between January and May 2014. We carried out descriptive analyses of participants' responses regarding implementation of local restrictive policies for access to IVF. Whether practice patterns differed in hospital versus community-based clinics was assessed using chi-square testing with significance set at alpha<0.05. The response rate was 77.1%. More than one half of clinics (55.6%) were university-affiliated, and 29.6% were hospital-based. The majority of respondents (70.4%) used an upper age limit for permitting IVF (median 50 years, IQR 44 to 50), mostly because of lower pregnancy and live birth rates. Approximately one half of respondents limited treatment according to BMI (median upper permitted BMI 38 kg/m2, IQR 35 to 40 kg/m2) to minimize complications during pregnancy. Most respondents (77.8%) believed that routine pre-IVF medical assessment would be useful in their daily practice. There was a non-significant trend towards more restrictive policies in hospital-based clinics compared with community-based clinics. Our findings confirm that Canadian reproductive medicine physicians are taking maternal health factors into consideration when assessing patients' suitability for IVF. Nevertheless, there is between-clinic variability in the parameters used to assess eligibility for treatment. In light of the changing maternal demographic, more research is needed on assisted reproductive technology and perinatal outcomes in women who are at risk for pregnancy complications.

  9. 44 CFR 6.85 - Reproduction fees.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Reproduction fees. 6.85... HOMELAND SECURITY GENERAL IMPLEMENTATION OF THE PRIVACY ACT OF 1974 Fees § 6.85 Reproduction fees. (a... over 81/2 x 14 inches or whose physical characteristics do not permit reproduction by routine...

  10. 44 CFR 6.85 - Reproduction fees.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 44 Emergency Management and Assistance 1 2011-10-01 2011-10-01 false Reproduction fees. 6.85... HOMELAND SECURITY GENERAL IMPLEMENTATION OF THE PRIVACY ACT OF 1974 Fees § 6.85 Reproduction fees. (a... over 81/2 x 14 inches or whose physical characteristics do not permit reproduction by routine...

  11. Gender, infertility, motherhood, and assisted reproductive technology (ART) in Turkey.

    PubMed

    Sahinoglu, Serap; Buken, Nuket Ornek

    2010-01-01

    In Turkey, as in many other countries, infertility is generally regarded as a negative phenomenon in a woman's life and is associated with a lot of stigma by society. In other words, female infertility and having a baby using Assisted Reproductive Technologies (ART) have to be taken into consideration with respect to gender motherhood, social factors, religion and law. Yet if a woman chooses to use ART she has to deal with the consequences of her decision, such as being ostracized by society. Other types of procedures in this area, such as sperm and ova donation or surrogate motherhood, are not permitted in law. However; both before and after the development of this techonology, society has been finding its own solutions which are rarely questioned and are still performed This article will discuss what these practices are and try to reach some pragmatic conclusions concerning female infertility, the concept of motherhood and some traditional practices in Turkey.

  12. Prelinguistic Behavior of Infants of Assisted Reproductive Techniques

    PubMed Central

    Noori, Soudabeh; Nedaeifard, Leila; Agarasouli, Zahra; Koohpaiehzadeh, Jalil; Kermani, Ramin Mozafari; Fazeli, Abolhasan Shahzadeh

    2012-01-01

    Objective The aim of this study is assessment of effects of different assisted reproductive techniques (ART) like in vitro fertilization (IVF) and intra cytoplasmic sperm injection (ICSI) on prelinguistic behavior of infants conceived by these techniques. Methods In this descriptive, cross sectional study, prelinguistic behavior of 151 full term ART infants of Royan Institute have been assessed in Children's Health and Development Research Center of Tehran from August 2007 until August 2009. Questionnaires were completed by parents at 9 months old. The questionnaire was standard according to Early Language Milestone Scale-2 (ELM-2). Data were analyzed by SPSS version 16 and using chi-square test. Findings Twenty-two (14.5%) of infants were conceived by IVF and 129 (85.4%) by ICSI. Number of infants with delay in reduplicated babbling in ICSI method was more than in IVF. There was only a significant difference in echolalia delay in the two sexes. Echolalia was delayed more in boys. Delay of reduplicated babbling was more in infants of younger mothers. There was no relation between speech and language defect of parents and infants. Conclusion This study showed that prelingustic behavior of ART infants are affected by kind of ART method, infant sex, and mother's age at the time of pregnancy. PMID:23431035

  13. 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.

  14. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Reproductive media and supplements. 884.6180... Reproductive media and supplements. (a) Identification. Reproductive media and supplement are products that are used for assisted reproduction procedures. Media include liquid and powder versions of various...

  15. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Reproductive media and supplements. 884.6180... Reproductive media and supplements. (a) Identification. Reproductive media and supplement are products that are used for assisted reproduction procedures. Media include liquid and powder versions of various...

  16. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Reproductive media and supplements. 884.6180... Reproductive media and supplements. (a) Identification. Reproductive media and supplement are products that are used for assisted reproduction procedures. Media include liquid and powder versions of various...

  17. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Reproductive media and supplements. 884.6180... Reproductive media and supplements. (a) Identification. Reproductive media and supplement are products that are used for assisted reproduction procedures. Media include liquid and powder versions of various...

  18. 21 CFR 884.6180 - Reproductive media and supplements.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Reproductive media and supplements. 884.6180... Reproductive media and supplements. (a) Identification. Reproductive media and supplement are products that are used for assisted reproduction procedures. Media include liquid and powder versions of various...

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

    PubMed

    Sabarre, Kelley-Anne; Khan, Zainab; Whitten, Amanda N; Remes, Olivia; Phillips, Karen P

    2013-08-20

    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). 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. 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. 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.

  20. Surgical treatment of male infertility in the era of intracytoplasmic sperm injection – new insights

    PubMed Central

    Esteves, Sandro C.; Miyaoka, Ricardo; Agarwal, Ashok

    2011-01-01

    Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility. PMID:21915501

  1. 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

  2. How do cumulative live birth rates and cumulative multiple live birth rates over complete courses of assisted reproductive technology treatment per woman compare among registries?

    PubMed

    De Neubourg, D; Bogaerts, K; Blockeel, C; Coetsier, T; Delvigne, A; Devreker, F; Dubois, M; Gillain, N; Gordts, S; Wyns, C

    2016-01-01

    How do the national cumulative (multiple) live birth rates over complete assisted reproduction technology (ART) courses of treatment per woman in Belgium compare to those in other registries? Cumulative live birth rates (CLBRs) remain high with a low cumulative multiple live birth rate when compared with other registries and publications. In ART, a reduction in the multiple live birth rate could be achieved by reducing the number of embryos transferred. It has been shown that by doing so, live birth rates per cycle were maintained, particularly when the augmentation effect of attached frozen-thawed cycles was considered. A retrospective cohort study included all patients with a Belgian national insurance number who were registered in the national ART registry (Belrap) and who started a first fresh ART cycle between 1 July 2009 until 31 December 2011 with follow up until 31 December 2012. We analysed 12 869 patients and 38 008 cycles (both fresh and attached frozen cycles). CLBRs per patient who started a first ART cycle including fresh and consecutive frozen cycles leading to a live birth. Conservative estimates of cumulative live birth assumed that patients who did not return for treatment had no chance of achieving an ART-related live birth, whereas optimal estimates assumed that women discontinuing treatment would have the same chance of achieving a live birth as those continuing treatment. A maximum of six fresh ART cycles with corresponding frozen cycles was investigated and compared with other registries and publications. The CLBR was age dependent and declined from 62.9% for women <35 years, to 51.4% for women 35-37 years, to 34.1% for women 38-40 years and 17.7% for women 41-42 years in the conservative analysis after six cycles. In the optimal estimate, the CLBR declined from 85.9% for women <35 years, to 72.0% for women 35-37 years, to 50.4% for women 38-40 years and 36.4% for women 41-42 years. The cumulative multiple live birth rates for the whole

  3. Procreative tourism and reproductive freedom.

    PubMed

    Cohen, Jean

    2006-07-01

    In many societies, the use of assisted reproduction technology has produced a desire to control and regulate this form of treatment. Politicians have taken most decisions. These regulations hold important implications for patients, and there are no two countries with the same regulations. These important differences have led to a traffic of infertile couples across legislative borders to seek a solution to their problem. Would harmonization of laws have positive effects? It seems that it would lead to a minimal common legislation. Procreative tourism is actually a 'safety valve' for many European couples.

  4. Human somatic cell nuclear transfer and reproductive cloning: an Ethics Committee opinion.

    PubMed

    2016-04-01

    This document presents arguments that conclude that it is unethical to use somatic cell nuclear transfer (SCNT) for infertility treatment due to concerns about safety; the unknown impact of SCNT on children, families, and society; and the availability of other ethically acceptable means of assisted reproduction. This document replaces the ASRM Ethics Committee report titled, "Human somatic cell nuclear transfer and cloning," last published in Fertil Steril 2012;98:804-7. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  5. [Delay the age of procreation, decline in fertility and increased use of assisted reproduction: risk of birth defects].

    PubMed

    López Moratalla, Natalia; Palacios Ortega, Sara

    2011-01-01

    In recent years there has been a progressive decline in fertility, originated mainly on women by the aging of ovules and on man through changes in genetic material of sperm due to cumulative environmental factors over time. Infertility treatments and techniques of assisted reproduction, IVF or insemination, consist of, or preceded by ovarian stimulation treatment aimed to obtain a large number of mature ovules in one cycle. This stimulation does not resolve the crucial issue of changing the pattern of chemical modification, parental imprinting, which occurs in the epigenetic process of oogenesis. Ovules induced to mature and / or forced to fertilization, do not to provide a fresh genome to be passed in each generation passes from parents to children. These changes affect the regulation of expression of a gene cluster (known as imprinted genes) during embryonic development of the child, give him a predisposition to rare diseases that originate precisely in the chaos of such genes. Some factors that cause infertility can be traced to early stages of development. Therefore, infertility is already a generational issue. It is therefore necessary to inform and alert to important factors, and ways of life, giving rise to emerging problems.

  6. Antimüllerian hormone as a predictor of live birth following assisted reproduction: an analysis of 85,062 fresh and thawed cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for 2012-2013.

    PubMed

    Tal, Reshef; Seifer, David B; Wantman, Ethan; Baker, Valerie; Tal, Oded

    2018-02-01

    To determine if serum antimüllerian hormone (AMH) is associated with and/or predictive of live birth assisted reproductive technology (ART) outcomes. Retrospective analysis of Society for Assisted Reproductive Technology Clinic Outcome Reporting System database from 2012 to 2013. Not applicable. A total of 69,336 (81.8%) fresh and 15,458 (18.2%) frozen embryo transfer (FET) cycles with AMH values. None. Live birth. A total of 85,062 out of 259,499 (32.7%) fresh and frozen-thawed autologous non-preimplantation genetic diagnosis cycles had AMH reported for cycles over this 2-year period. Of those, 70,565 cycles which had embryo transfers were included in the analysis. Serum AMH was significantly associated with live birth outcome per transfer in both fresh and FET cycles. Multiple logistic regression demonstrated that AMH is an independent predictor of live birth in fresh transfer cycles and FET cycles when controlling for age, body mass index, race, day of transfer, and number of embryos transferred. Receiver operating characteristic (ROC) curves demonstrated that the areas under the curve (AUC) for AMH as predictors of live birth in fresh cycles and thawed cycles were 0.631 and 0.540, respectively, suggesting that AMH alone is a weak independent predictor of live birth after ART. Similar ROC curves were obtained also when elective single-embryo transfer (eSET) cycles were analyzed separately in either fresh (AUC 0.655) or FET (AUC 0.533) cycles, although AMH was not found to be an independent predictor in eSET cycles. AMH is a poor independent predictor of live birth outcome in either fresh or frozen embryo transfer for both eSET and non-SET transfers. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Public opinion regarding utilization of assisted reproductive technology (ART) in obese women.

    PubMed

    Shah, Divya K; Ginsburg, Elizabeth S; Correia, Katharine F; Barton, Sara E; Missmer, Stacey A

    2013-11-01

    There have been calls to restrict access to fertility treatment in women above a certain body mass index (BMI). It is important to consider public expectations before formulating policy. The study objective was to assess public opinion regarding provision of assisted reproductive technology (ART) to obese (BMI>30 kg/m(2)) women in the United States. The study was conducted through an Internet-based survey of U.S. residents ages 18-75. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression to describe predictors of response based on demographic characteristics. Of the 1049 respondents, 60.7% support the use of ART in obese women. Adjusting for age and gender, the odds of support were over twice as high in participants with BMI>40 kg/m(2) as in normal-weight respondents (OR=2.87, 95% CI=1.28-6.44). Fifty-five percent of participants supported a BMI limit for access to ART. Both increasing education (p-value=0.02) and BMI (p-value=0.01) were inversely associated with support of a BMI limit. Individuals who had themselves used ART were also less likely (OR=0.27, 95% CI=0.07--0.99) to support a BMI limit. In an Internet-based survey, participants who are in favor of ART are likely to support its use among obese women. More than 50% of these respondents also support implementation of a BMI limit for access to these services.

  8. Quality of life and psychosocial and physical well-being among 1,023 women during their first assisted reproductive technology treatment: secondary outcome to a randomized controlled trial comparing gonadotropin-releasing hormone (GnRH) antagonist and GnRH agonist protocols.

    PubMed

    Toftager, Mette; Sylvest, Randi; Schmidt, Lone; Bogstad, Jeanette; Løssl, Kristine; Prætorius, Lisbeth; Zedeler, Anne; Bryndorf, Thue; Pinborg, Anja

    2018-01-01

    To compare self-reported quality of life, psychosocial well-being, and physical well-being during assisted reproductive technology (ART) treatment in 1,023 women allocated to either a short GnRH antagonist or long GnRH agonist protocol. Secondary outcome of a prospective phase 4, open-label, randomized controlled trial. Four times during treatment a questionnaire on self-reported physical well-being was completed. Further, a questionnaire on self-reported quality of life and psychosocial well-being was completed at the day of hCG testing. Fertility clinics at university hospitals. Women referred for their first ART treatment were randomized in a 1:1 ratio and started standardized ART protocols. Gonadotropin-releasing hormone analogue; 528 women allocated to a short GnRH antagonist protocol and 495 women allocated to a long GnRH agonist protocol. Self-reported quality of life, psychosocial well-being, and physical well-being based on questionnaires developed for women receiving ART treatment. Baseline characteristics were similar, and response rates were 79.4% and 74.3% in the GnRH antagonist and GnRH agonist groups, respectively. Self-reported quality of life during ART treatment was rated similar and slightly below normal in both groups. However, women in the GnRH antagonist group felt less emotional (adjusted odds ratio [AOR] 0.69), less limited in their everyday life (AOR 0.74), experienced less unexpected crying (AOR 0.71), and rated quality of sleep better (AOR 1.55). Further, women receiving GnRH agonist treatment felt worse physically. Women in a short GnRH antagonist protocol rated psychosocial and physical well-being during first ART treatment better than did women in a long GnRH agonist protocol. However, the one item on self-reported general quality of life was rated similarly. NCT00756028. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  9. Just another reproductive technology? The ethics of human reproductive cloning as an experimental medical procedure

    PubMed Central

    Elsner, D

    2006-01-01

    Human reproductive cloning (HRC) has not yet resulted in any live births. There has been widespread condemnation of the practice in both the scientific world and the public sphere, and many countries explicitly outlaw the practice. Concerns about the procedure range from uncertainties about its physical safety to questions about the psychological well‐being of clones. Yet, key aspects such as the philosophical implications of harm to future entities and a comparison with established reproductive technologies such as in vitro fertilisation (IVF) are often overlooked in discussions about HRC. Furthermore, there are people who are willing to use the technology. Several scientists have been outspoken in their intent to pursue HRC. The importance of concerns about the physical safety of children created by HRC and comparisons with concerns about the safety of IVF are discussed. A model to be used to determine when it is acceptable to use HRC and other new assisted reproductive technologies, balancing reproductive freedom and safety concerns, is proposed. Justifications underpinning potential applications of HRC are discussed, and it is determined that these are highly analogous to rationalisations used to justify IVF treatment. It is concluded that people wishing to conceive using HRC should have a prima facie negative right to do so. PMID:17012502

  10. Just another reproductive technology? The ethics of human reproductive cloning as an experimental medical procedure.

    PubMed

    Elsner, D

    2006-10-01

    Human reproductive cloning (HRC) has not yet resulted in any live births. There has been widespread condemnation of the practice in both the scientific world and the public sphere, and many countries explicitly outlaw the practice. Concerns about the procedure range from uncertainties about its physical safety to questions about the psychological well-being of clones. Yet, key aspects such as the philosophical implications of harm to future entities and a comparison with established reproductive technologies such as in vitro fertilisation (IVF) are often overlooked in discussions about HRC. Furthermore, there are people who are willing to use the technology. Several scientists have been outspoken in their intent to pursue HRC. The importance of concerns about the physical safety of children created by HRC and comparisons with concerns about the safety of IVF are discussed. A model to be used to determine when it is acceptable to use HRC and other new assisted reproductive technologies, balancing reproductive freedom and safety concerns, is proposed. Justifications underpinning potential applications of HRC are discussed, and it is determined that these are highly analogous to rationalisations used to justify IVF treatment. It is concluded that people wishing to conceive using HRC should have a prima facie negative right to do so.

  11. 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.

  12. Assisted reproductive technologies in rhesus macaques

    PubMed Central

    Wolf, Don P

    2004-01-01

    The assisted reproductive technologies (ARTs) have been used in the production of rhesus monkey offspring at the Oregon National Primate Research Center (ONPRC) and that experience is summarized here. Additionally these technologies serve as a source of oocytes/embryos for monozygotic twinning, embryonic stem (ES) cell derivation and cloning. High fertilization efficiencies were realized with conventional insemination or following the use of intracytoplasmic sperm injection (ICSI) and approximately 50% of the resulting embryos grew in vitro to blastocysts. Both fresh and frozen sperm were employed in fertilization by ICSI and the resulting embryos could be low temperature stored for subsequent thawing and transfer when a synchronized recipient female was available or after shipment to another facility. Following the transfer of up to 3 embryos, an overall pregnancy rate of 30% was achieved with increasing rates dependent upon the number of embryos transferred. Singleton pregnancy outcomes following the transfer of ART produced embryos were similar to those observed in a control group of animals in the timed mated breeding colony at ONPRC. ICSI produced embryos were used in efforts to create monozygotic twins by blastomere separation or blastocyst splitting. While pregnancies were achieved following the transfer of demi-embryos, only one was a twin and it was lost to spontaneous abortion. ICSI produced embryos have also served as the source of blastocysts for the derivation of embryonic stem cells. These pluripotent cells hold potential for cell based therapies and we consider the monkey an important translational model in which to evaluate safety, efficacy and feasibility of regenerative medicine approaches based on the transplantation of stem cell-derived progeny. Finally, efforts to produce genetically-identical monkeys by nuclear transfer have been briefly summarized. PMID:15200674

  13. 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

  14. Assisted reproductive technology in Australia and New Zealand: cumulative live birth rates as measures of success.

    PubMed

    Chambers, Georgina M; Paul, Repon C; Harris, Katie; Fitzgerald, Oisin; Boothroyd, Clare V; Rombauts, Luk; Chapman, Michael G; Jorm, Louisa

    2017-08-07

    To estimate cumulative live birth rates (CLBRs) following repeated assisted reproductive technology (ART) ovarian stimulation cycles, including all fresh and frozen/thaw embryo transfers (complete cycles). Prospective follow-up of 56 652 women commencing ART in Australian and New Zealand during 2009-2012, and followed until 2014 or the first treatment-dependent live birth. CLBRs and cycle-specific live birth rates were calculated for up to eight cycles, stratified by the age of the women (< 30, 30-34, 35-39, 40-44, > 44 years). Conservative CLBRs assumed that women discontinuing treatment had no chance of achieving a live birth if had they continued treatment; optimal CLBRs assumed that they would have had the same chance as women who continued treatment. The overall CLBR was 32.7% (95% CI, 32.2-33.1%) in the first cycle, rising by the eighth cycle to 54.3% (95% CI, 53.9-54.7%) (conservative) and 77.2% (95% CI, 76.5-77.9%) (optimal). The CLBR decreased with age and number of complete cycles. For women who commenced ART treatment before 30 years of age, the CLBR for the first complete cycle was 43.7% (95% CI, 42.6-44.7%), rising to 69.2% (95% CI, 68.2-70.1%) (conservative) and 92.8% (95% CI, 91.6-94.0) (optimal) for the seventh cycle. For women aged 40-44 years, the CLBR was 10.7% (95% CI, 10.1-11.3%) for the first complete cycle, rising to 21.0% (95% CI, 20.2-21.8%) (conservative) and 37.9% (95% CI, 35.9-39.9%) (optimal) for the eighth cycle. CLBRs based on complete cycles are meaningful estimates of ART success, reflecting contemporary clinical practice and encouraging safe practice. These estimates can be used when counselling patients and to inform public policy on ART treatment.

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

    PubMed

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

    2016-02-01

    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). Retrospective cohort study using 2012 and 2013 data from the National ART Surveillance System. Infertility treatment centers. 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. Sequential single and double ETs. 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. 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%. 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. Published by Elsevier Inc.

  16. [Bioethical study on the expectations of women awaiting assisted reproduction in a public hospital in the Federal District, Brazil].

    PubMed

    Samrsla, Mônica; Nunes, Juliana Cezar; Kalume, Carolina; da Cunha, Antônio Carlos Rodrigues; Garrafa, Volnei

    2007-01-01

    To analyze the expectations of women who wait for Assisted Reproduction Treatment-RA in the public hospital chosen as the reference in the Public Health Network in the Federal District-HRAS, Brazil. For thirty days, 51 women of the 56 who went to the HRAS for infertility treatment were interviewed by a questionnaire including 10 objective questions related to the topic. This trial was divided into two groups. The first, the "control group", comprised 27 patients recently sent to the reference public hospital from local health care centers or a regional hospital. The second, the "study group", comprising 24 women already diagnosed by the medical staff of HRAS and in the waiting line for "in vitro" fertilization. According to the input provided by the two groups, results show that the average waiting time for treatment is so long that women actually age during this time and face the risk of having a dangerous pregnancy before they receive treatment. These results show that women unable to pay for treatment in a private fertilization clinic have a poorer chance of achieving RA: the health problem concerning this specific population ignores redressing or income distribution processes. Data show that, notwithstanding, this waiting period imposed by the State, expectations of the patients waiting for RA are reinforced. There is no basis to provide information about the waiting time. The unpredictable availability of the medication needed for in vitro fertilization, jeopardizes the future of this service offering the treatment.

  17. Leptin and its potential interest in assisted reproduction cycles.

    PubMed

    Catteau, A; Caillon, H; Barrière, P; Denis, M G; Masson, D; Fréour, T

    2016-04-01

    Leptin, an adipose hormone, has been shown to control energy homeostasis and food intake, and exert many actions on female reproductive function. Consequently, this adipokine is a pivotal factor in studies conducted on animal models and humans to decipher the mechanisms behind the infertility often observed in obese women. A systematic PubMed search was conducted on all articles, published up to January 2015 and related to leptin and its actions on energy balance and reproduction, using the following key words: leptin, reproduction, infertility, IVF and controlled ovarian stimulation. The available literature was reviewed in order to provide an overview of the current knowledge on the physiological roles of leptin, its involvement in female reproductive function and its potential interest as a prognostic marker in IVF cycles. Animal and human studies show that leptin communicates nutritional status to the central nervous system and emerging evidence has demonstrated that leptin is involved in the control of reproductive functions by acting both directly on the ovaries and indirectly on the central nervous system. With respect to the clinical use of leptin as a biomarker in IVF cycles, a systematic review of the literature suggested its potential interest as a predictor of IVF outcome, as high serum and/or follicular fluid leptin concentrations have correlated negatively with cycle outcome. However, these preliminary results remain to be confirmed. Leptin regulates energy balance and female reproductive function, mainly through its action on hypothalamic-pituitary-ovarian function, whose molecular and cellular aspects are progressively being deciphered. Preliminary studies evaluating leptin as a biomarker in human IVF seem promising but need further confirmation. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. 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…

  19. [COMPLICATIONS OF PREGNANCY, RESULTING FROM ASSISTED REPRODUCTIVE TECHNOLOGY].

    PubMed

    Aleksanyan, A

    2017-01-01

    When pregnancy occurs as a result of assisted reproductive technologies (ART), there are more chances of developing complications and adverse outcomes for the mother and fetus compared to spontaneous pregnancies. Taking into account the noted features, the purpose of our study was to determine the nature of the complications of induced pregnancy and their frequency, depending on the causes of infertility. Under our supervision were 86 women with induced single-pregnancy. Two clinical groups were formed depending on the causes of infertility: group I was represented by 53 observations, in which infertility of endocrine genesis took place; Group II included 33 women with tubal peritoneal infertility. Pregnancy, resulting from ART, should be attributed to the group at high risk of complications of pregnancy. Among the causes of female infertility, the tubal peritoneal factor is the least dangerous in terms of the complicated course of the gestational process, and the endocrine factors that can cause a two-fold increase in the frequency of the threat of abortion and pre-eclampsia are more dangerous. In turn, the cause of endocrine infertility are various factors that need to be determined when predicting the course of induced pregnancy. A special feature of maintaining this category of pregnant women is the constant observation and correction of dyshormonal disorders, which not only cause anovulation, but can also negatively affect the course of pregnancy.

  20. Patterns of acquisitive crime during methadone maintenance treatment among patients eligible for heroin assisted treatment.

    PubMed

    van der Zanden, Bart P; Dijkgraaf, Marcel G W; Blanken, Peter; van Ree, Jan M; van den Brink, Wim

    2007-01-05

    To determine the patterns of acquisitive crime during methadone maintenance treatment among chronic, treatment-resistant heroin users eligible for heroin assisted treatment in the Netherlands. We retrospectively assessed the type and number of illegal activities during 1 month of standard methadone maintenance treatment in 51 patients prior to the start of heroin assisted treatment. Data were collected using a semi-structured interview focussed on crime with special emphasis on property crime. Volume analyses consisted of frequencies and descriptives of mean numbers of offences per day and per type. In a Dutch population of problematic drug users eligible for and prior to commencing heroin assisted treatment, 70% reported criminal activities and 50% reported acquisitive crimes. Offending took place on 20.5 days per month with on average 3.1 offences a day. Acquisitive crime consisted mainly of shoplifting (mean 12.8 days, 2.2 times/day) and theft of bicycles (mean 5.8 days, 2.4 times/day); theft from a vehicle and burglaries were committed less frequently. The majority of these patients (63%) reported to have started offending in order to acquire illicit drugs and alcohol. During methadone maintenance treatment, 50% of criminally active, problematic heroin users eligible for heroin assisted treatment reported acquisitive crime. Shoplifting, thefts and/or other property crimes were committed on average two to three times on a crime day. This study discusses that the detail provided by self-reported crime data can improve cost estimates in economic evaluations of heroin assisted treatment.

  1. Trust women to choose: a response to John a Robertson's 'Egg freezing and Egg banking: empowerment and alienation in assisted reproduction'.

    PubMed

    Goold, Imogen

    2017-12-01

    In 'Egg Freezing and Egg Banking: Empowerment and Alienation in Assisted Reproduction', John A Robertson responds to the American Society of Reproductive Medicine's statement that oocyte preservation should no longer be considered an experimental treatment. He explores the implications of this development, focusing on the potentially empowering impact of oocyte preservation as a means for women to preserve their fertility. He also engages with concerns about the possibility that such a development may raise issues of alienation. He highlights some of the potential problems that may emerge as women gain the capacity to store and either donate or sell any eggs they do not need for their own reproductive purposes. Much of his paper is valuable and considered, but in places, his views rest on assumptions about women's attitudes to their fertility, understanding of the technology, and relationship with their gametes that are open to dispute. This paper teases out some of these assumptions and puts pressure on them by drawing on the growing body of data about what women actually do think and feel about fertility issues. It focuses on two of his main concerns-that social egg freezing may give women a false sense of security and that women may be harmed if a market in eggs leads to their alienation from their gametes. Via this response to Robertson, I aim to redress the tendency often seen in discussions around women, infertility, aging, and empowerment to unquestioningly accept what I argue are stereotypes and assumptions about women's views and capacity to reason.

  2. 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

  3. Embryo transfer techniques: an American Society for Reproductive Medicine survey of current Society for Assisted Reproductive Technology practices.

    PubMed

    Toth, Thomas L; Lee, Malinda S; Bendikson, Kristin A; Reindollar, Richard H

    2017-04-01

    To better understand practice patterns and opportunities for standardization of ET. Cross-sectional survey. Not applicable. Not applicable. An anonymous 82-question survey was emailed to the medical directors of 286 Society for Assisted Reproductive Technology member IVF practices. A follow-up survey composed of three questions specific to ET technique was emailed to the same medical directors. Descriptive statistics of the results were compiled. The survey assessed policies, protocols, restrictions, and specifics pertinent to the technique of ET. There were 117 (41%) responses; 32% practice in academic settings and 68% in private practice. Responders were experienced clinicians, half of whom had performed <10 procedures during training. Ninety-eight percent of practices allowed all practitioners to perform ET; half did not follow a standardized ET technique. Multiple steps in the ET process were identified as "highly conserved;" others demonstrated discordance. ET technique is divided among [1] trial transfer followed immediately with ET (40%); [2] afterload transfer (30%); and [3] direct transfer without prior trial or afterload (27%). Embryos are discharged in the upper (66%) and middle thirds (29%) of the endometrial cavity and not closer than 1-1.5 cm from fundus (87%). Details of each step were reported and allowed the development of a "common" practice ET procedure. ET training and practices vary widely. Improved training and standardization based on outcomes data and best practices are warranted. A common practice procedure is suggested for validation by a systematic literature review. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Should obese women's access to assisted fertility treatment be limited? A scientific and ethical analysis.

    PubMed

    Tremellen, Kelton; Wilkinson, Dominic; Savulescu, Julian

    2017-10-01

    Obesity is associated with a reduction in fertility treatment success and increased risks to mother and child. Therefore guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m 2 should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF. In this paper we challenge the ethical and scientific basis for such a ban. Livebirth rates for severely obese women are reduced by up to 30%, but this result is still far better than that observed for many older women who are allowed access to IVF. This prohibition is particularly unjust when IVF is the only treatment capable of producing a pregnancy, such as bilateral tubal blockage or severe male factor infertility. Furthermore, the absolute magnitude of risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment. We do not prohibit adults from engaging in dangerous sports, nor do we force parents to vaccinate their children, despite the risks. Similarly, we should not prohibit obese women from becoming parents because of increased risk to themselves or their child. Finally, prohibiting obese women's access to IVF to prevent potential harms such as 'fetal programing' is questionable, especially when compared to that child never being born at all. As such, we believe the RANZCOG ban on severely obese women's access to assisted reproductive treatment is unwarranted and should be revised. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  5. 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…

  6. Is cryopreservation of embryos a legitimate surrogate marker of embryo quality in studies of assisted reproductive technology conducted using national databases?

    PubMed

    Stern, Judy E; Lieberman, Ellice S; Macaluso, Maurizio; Racowsky, Catherine

    2012-04-01

    To investigate whether cryopreservation of supernumerary embryos is a good surrogate for embryo quality. Retrospective study of 6,859 assisted reproductive technology (ART) cycles from women aged <35 years with two fresh day 3 embryos transferred. National Society for Assisted Reproductive Technology Clinic Outcome Reporting System data from 2006-2008. Women undergoing ART. None. Embryo quality (good, fair, or poor), cell number, and live births were compared for cycles with and without cryopreservation, using χ(2) to evaluate statistical significance. The association of freezing with embryo quality was examined using multiple logistic regression after adjusting for confounders (patient age, oocyte yield, intracytoplasmic sperm injection [ICSI], assisted hatching, male factor infertility). Cycles with cryopreservation were more likely to have two embryos of good quality transferred (81.3% vs. 48.5%) and had more 8-cell embryos transferred (76.0% vs. 50.1%). Relative to cycles with two good embryos (good-good), the adjusted odds ratios (OR) for cryopreservation were: good-fair (OR = 0.301, 95% confidence interval [CI] = 0.257-0.354), fair-fair (OR = 0.308, 95% CI = 0.258-0.367), and any poor (OR = 0.058, 95% CI = 0.040-0.083). The live birth rate was 52.4% for cycles with freezing and 40.6% for cycles without. Embryo quality and cell number were both associated with embryo cryopreservation. However, although cryopreservation was a strong marker for good quality, not having cryopreservation did not reliably indicate poor quality, as almost half of those cycles had two good quality embryos. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Alkylation of sperm DNA is associated with male factor infertility and a reduction in the proportion of oocytes fertilised during assisted reproduction.

    PubMed

    Stocks, S J; Agius, R M; Cooley, N; Harrison, K L; Brison, D R; Horne, G; Gibbs, A; Povey, A C

    2010-04-30

    Approximately one-third of IVF cases in the UK are attributed to male factor infertility and in the majority of cases the origin of male infertility is unknown. The integrity of sperm DNA is important both for the success of assisted reproduction and the implications for the off-spring. One type of DNA damage that has not been investigated with respect to fertility outcomes is the adduct N7-methyldeoxyguanosine (N7-MedG), a biomarker for exposure to alkylating agents. A prospective cohort of couples attending for IVF had their N7-MedG levels in sperm measured using an immunoslot blot technique to examine whether sperm N7-MedG levels are associated with male factor infertility, semen quality measures or assisted reproduction outcomes. Sufficient DNA for analysis was obtained from 67/97 couples and N7-MedG was detected in 94% of sperm samples analysed. Men diagnosed with male factor infertility had significantly higher mean levels of N7-MedG in their sperm DNA (P=0.03). Logistic regression analysis showed that N7-MedG levels were significantly negatively associated with the proportion of oocytes successfully fertilised irrespective of the method of fertilisation used (IVF or intra-cytoplasmic sperm injection; ICSI, P<0.001). Therefore exposure to DNA alkylating agents is significantly associated with male infertility and the proportion of oocytes fertilised during assisted reproduction. Reducing such exposure may improve male fertility but further work is required to determine the relative importance of exogenous and endogenous sources of exposure. Copyright 2010 Elsevier B.V. All rights reserved.

  8. 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.

  9. Microfluidic analysis of oocyte and embryo biomechanical properties to improve outcomes in assisted reproductive technologies.

    PubMed

    Yanez, Livia Z; Camarillo, David B

    2017-04-01

    Measurement of oocyte and embryo biomechanical properties has recently emerged as an exciting new approach to obtain a quantitative, objective estimate of developmental potential. However, many traditional methods for probing cell mechanical properties are time consuming, labor intensive and require expensive equipment. Microfluidic technology is currently making its way into many aspects of assisted reproductive technologies (ART), and is particularly well suited to measure embryo biomechanics due to the potential for robust, automated single-cell analysis at a low cost. This review will highlight microfluidic approaches to measure oocyte and embryo mechanics along with their ability to predict developmental potential and find practical application in the clinic. Although these new devices must be extensively validated before they can be integrated into the existing clinical workflow, they could eventually be used to constantly monitor oocyte and embryo developmental progress and enable more optimal decision making in ART. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. The post-humanist embryo: genetic manipulation, assisted reproductive technologies and the Principle of Procreative Beneficence.

    PubMed

    Güell Pelayo, Francisco

    2014-01-01

    Drawing from Julian Savulescu's argument for the obligation to use technological interventions for the enhancement human life, the Principle of Procreative Beneficence (PPB) states that parents have a moral obligation to use available reproductive technologies, including techniques of genetic manipulation, to create children who have the best chance of enjoying the best possible life. The aim of this study is to analyse the extent to which the possibility of using genetic manipulation to promote specific personality traits and thereby enhance human life is actually supported by current scientific knowledge and to determine whether the techniques employed in embryo selection comply with the PPB. In light of this analysis, the importance of involving the scientific community in the enhancement debate will be made clear. Moreover, when current knowledge of genetic and epigenetic processes and evidence of the risks of assisted reproductive technologies are taken into account, we find sufficient reason - even when guided by the PPB - to abstain from the use of current techniques of genetic manipulation and embryonic selection.

  11. ESHRE's good practice guide for cross-border reproductive care for centers and practitioners.

    PubMed

    Shenfield, F; Pennings, G; De Mouzon, J; Ferraretti, A P; Goossens, V

    2011-07-01

    This paper outlines ESHRE's guidance for centers and physicians providing fertility treatment to foreign patients. This guide aims to ensure high-quality and safe assisted reproduction treatment, taking into account the patients, their future child and the interests of third-party collaborators such as gametes donors and surrogates. This is achieved by including considerations of equity, safety, efficiency, effectiveness (including evidence-based care), timeliness and patient centeredness.

  12. 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.

  13. Perinatal outcome of singleton siblings born after assisted reproductive technology and spontaneous conception: Danish national sibling-cohort study.

    PubMed

    Henningsen, Anna-Karina Aaris; Pinborg, Anja; Lidegaard, Øjvind; Vestergaard, Christina; Forman, Julie Lyng; Andersen, Anders Nyboe

    2011-03-01

    To compare the perinatal outcome of singleton siblings conceived differently. National population-based registry study. Denmark, from 1994 to 2008. Pairs of siblings (13,692 pairs; n = 27,384 children) conceived after IVF, intracytoplasmatic sperm injection (ICSI), frozen embryo replacement (FER), or spontaneous conception subcategorized into five groups according to succession: [1] IVF-ICSI vs. spontaneous conception (n = 7,758), [2] IVF-ICSI vs. FER (n = 716), [3] FER vs. FER (n = 34), [4] IVF-ICSI vs. IVF-ICSI (n = 2,876), and [5] spontaneous conception vs. spontaneous conception (n = 16,000). Observations were obtained from national registries. Birth weight, gestational age, low birth weight (<2,500 g), preterm birth (<37 weeks' gestation) and perinatal deaths. Mean birth weight was 65 g (95% confidence interval [CI], 41-89] lower in all assisted reproductive technology children compared with their spontaneously conceived siblings. FER children were 167 g (95% CI, 90-244] heavier than siblings born after replacement of fresh embryos. The difference in birth weight between firstborn and second born sibling depended on order of conception method. Higher risk of low birth weight with (odds ratio [OR], 1.4; 95%CI, 1.1-1.7] and preterm birth (OR, 1.3; 95% CI, 1.1-1.6] was observed in IVF/ICSI compared with spontaneous conception. When differentiating between order and mode of conception, it seems that assisted reproductive technology plays a role in mean birth weight and risk of low birth weight and preterm birth. Birth weight was higher in siblings born after FER compared with fresh embryos replacement. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Swedish sperm donors are driven by altruism, but shortage of sperm donors leads to reproductive travelling.

    PubMed

    Ekerhovd, Erling; Faurskov, Anders; Werner, Charlotte

    2008-01-01

    Swedish legislation requires that sperm donors are identifiable to offspring. In Denmark sperm donors remain anonymous. The aim of this study was to examine sperm donation in Sweden by identifying socio-demographic backgrounds, motivations and attitudes among donors and to describe options and plans of sperm recipients. Furthermore, the willingness of Swedish health care providers to assist in treatment abroad, where sperm from an anonymous donor were to be used, was assessed. The extent of travelling to Denmark for reproductive purposes was also examined. Thirty Swedish sperm donors completed a questionnaire and were interviewed about their backgrounds, motivations and attitudes. Thirty couples where the infertility workup had shown azoospermia were interviewed about their options for achieving parenthood. The willingness to assist in fertility treatment abroad and the extent of reproductive cross border travelling were assessed by interviewing health care providers and by contacting Danish clinics. Almost all donors were Caucasian. The main motivation for sperm donors was to help others. Owing to shortage of sperm donors many Caucasian recipients intended to have treatment abroad. For most non-Caucasian recipients sperm from a donor of appropriate ethnicity were not available in Sweden. Whether the sperm donor was anonymous or identifiable was not of major importance to most sperm recipients. Health care providers expressed unanimous willingness to assist in treatment with sperm from an anonymous donor. Our inquiry indicated that more than 250 Swedish sperm recipients travel to Denmark annually. Identifiable sperm donors are driven by altruistic motives, but shortage of sperm donors leads to reproductive travelling. Recruitment strategies to increase the number of sperm donors in Sweden are therefore warranted.

  15. Effects of reproductive morbidity on women's lives and costs of accessing treatment in Yemen.

    PubMed

    Dejong, Jocelyn; Bahubaishi, Najia; Attal, Bothaina

    2012-12-01

    Research on the consequences of reproductive morbidity for women's lives and their economic and social roles is relatively under-developed. There is also a lack of consensus on appropriate conceptual frameworks to understand the social determinants of reproductive morbidity as well as their social and economic implications. We report here on an exploratory study in Yemen using quantitative (n=72 women) and qualitative methods (n=35 women), in 2005 and 2007 respectively, with women suffering from uterine prolapse, infertility or pelvic inflammatory disease (PID). It explored women's views on how reproductive morbidity affected their lives, marital security and their households, and the burden of paying for treatment. We also interviewed six health professionals about women's health care-seeking for these conditions. Sixty per cent of women reported that treatment was not affordable, and 43% had to sell assets or take out a loan to pay for care. Prolapse and PID interfered particularly in subsistence and household activities while infertility created social pressure. Reproductive morbidity is not a priority in Yemen, given its multiple public health needs and low resources, but by failing to provide comprehensive and affordable services for women, the country incurs developmental losses. Copyright © 2012 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

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

    PubMed

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

    2016-01-01

    Assisted Reproductive Technology (ART) reports generated by the Centers for Disease Control and Prevention (CDC) exclude embryo banking cycles from outcome calculations. 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). 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. 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. Exclusion of embryo banking cycles from US National Assisted Reproductive Technology outcome reports significantly inflates reported success rates especially in older women.

  17. 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

  18. Treatment-seeking for symptoms of reproductive tract infections among young women in India.

    PubMed

    Sabarwal, Shagun; Santhya, K G

    2012-06-01

    Small proportions of Indian women report seeking treatment for symptoms suggestive of reproductive tract infections (RTIs). Most studies on treatment-seeking have focused broadly on women of reproductive age, and little is known about the experiences of adolescent girls and young women, particularly the unmarried. Data from 2,742 married and 2,108 unmarried women aged 15-24 who reported at least one symptom of an RTI in the past three months were drawn from a subnationally representative survey of youth in India in 2006-2008. Multivariate logistic regression analysis was conducted to identify associations between respondents' characteristics and treatment-seeking from a formal medical provider. In addition, among those who had used such providers, associations between characteristics and use of private rather than public providers were identified. About two-fifths of married and one-third of unmarried women had sought treatment from formal medical providers for their RTI symptoms. While married women's experience of intimate partner violence was negatively associated with seeking treatment from a formal provider (odds ratio, 0.8), their perceived access to sexual and reproductive health services and their awareness of STI symptoms were positively associated with such treatment (1.3-1.4). Both married and unmarried women were more likely to seek treatment from private than from public providers, and two indicators of women's autonomy were positively correlated with using private providers (1.6-2.8). Limited treatment-seeking for RTI symptoms by young women underscores the need to address power imbalances within marriage and to encourage health care providers to develop appropriate strategies to reach younger, as well as unmarried, women.

  19. Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the Society for Assisted Reproductive Technologies Database.

    PubMed

    Senapati, Suneeta; Sammel, Mary D; Morse, Christopher; Barnhart, Kurt T

    2016-07-01

    To assess the impact of endometriosis, alone or in combination with other infertility diagnoses, on IVF outcomes. Population-based retrospective cohort study of cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. Not applicable. A total of 347,185 autologous fresh and frozen assisted reproductive technology cycles from the period 2008-2010. None. Oocyte yield, implantation rate, live birth rate. Although cycles of patients with endometriosis constituted 11% of the study sample, the majority (64%) reported a concomitant diagnosis, with male factor (42%), tubal factor (29%), and diminished ovarian reserve (22%) being the most common. Endometriosis, when isolated or with concomitant diagnoses, was associated with lower oocyte yield compared with those with unexplained infertility, tubal factor, and all other infertility diagnoses combined. Women with isolated endometriosis had similar or higher live birth rates compared with those in other diagnostic groups. However, women with endometriosis with concomitant diagnoses had lower implantation rates and live birth rates compared with unexplained infertility, tubal factor, and all other diagnostic groups. Endometriosis is associated with lower oocyte yield, lower implantation rates, and lower pregnancy rates after IVF. However, the association of endometriosis and IVF outcomes is confounded by other infertility diagnoses. Endometriosis, when associated with other alterations in the reproductive tract, has the lowest chance of live birth. In contrast, for the minority of women who have endometriosis in isolation, the live birth rate is similar or slightly higher compared with other infertility diagnoses. Copyright © 2016. Published by Elsevier Inc.

  20. Human implantation: the last barrier in assisted reproduction technologies?

    PubMed

    Edwards, Robert G

    2006-12-01

    Implantation processes are highly complex involving the actions of numerous hormones, immunoglobulins, cytokines and other factors in the endometrium. They are also essential matters for the success of assisted reproduction. The nature of early embryonic development is of equal significance. It involves ovarian follicle growth, ovulation, fertilization and preimplantation growth. These processes are affected by imbalanced chromosomal constitutions or slow developmental periods. Post-implantation death is also a significant factor in cases of placental insufficiency or recurrent abortion. Clearly, many of these matters can significantly affect birth rates. This review is concerned primarily with the oocyte, the early embryo and its chromosomal anomalies, and the nature of factors involved in implantation. These are clearly among the most important features in determining successful embryonic and fetal growth. Successive sections cover the endocrine stimulation of follicle growth in mice and humans, growth of human embryos in vitro, their apposition and attachment to the uterus, factors involved in embryo attachment to uterine epithelium and later stages of implantation, and understanding the gene control of polarities and other aspects of preimplantation embryo differentiation. New aspects of knowledge include the use of human oocyte maturation in vitro as an approach to simpler forms of IVF, and new concepts in developmental genetics.

  1. Systemic oxidative stress could predict assisted reproductive technique outcome.

    PubMed

    Ahelik, A; Mändar, R; Korrovits, P; Karits, P; Talving, E; Rosenstein, K; Jaagura, M; Salumets, A; Kullisaar, T

    2015-05-01

    Previous studies have indicated that OxS (oxidative stress) may appear as a possible reason for poor ART outcome. Our aim was to study OxS levels in both partners of couples seeking Assisted reproduction Technology (ART). Altogether 79 couples were recruited. Oxidative DNA damage (8-OHdG) and lipid peroxidation (8-EPI) were measured, and clinical background and ART outcomes were recorded. Both OxS markers accurately reflected clinical conditions with prominent negative effects attributable to genital tract infections, endometriosis, uterine myoma and smoking. Furthermore, the level of OxS was also affected by partner's state of health. The highest 8-EPI levels were detected in both partners when biochemically detectable pregnancies did not develop into clinically detectable pregnancies (in women, 97,8 ± 16,7 vs 72.9 ± 22,9, p = 0.007; in men, 89.6 ± 20,4 vs 72,1 ± 22,6, p = 0.049). To conclude, high grade systemix OxS in both partners may negatively affect the maintenance and outcome of pregnancy. Applying the detection of OxS in ART patients may select patients with higher success rate and/or those who require antioxidant therapy. This would lead to improvement of ART outcome as well as natural fertility.

  2. [Management by assisted reproductive technology in women with endometriosis: CNGOF-HAS Endometriosis Guidelines].

    PubMed

    Chauffour, C; Pouly, J-L; Gremeau, A-S

    2018-03-01

    Should the presence of endometriosis change the management of assisted reproductive technology? There is no difference in pregnancy rate after IVF between an agonist or antagonist protocol in patients with endometriosis, so the choice between one or the other of these protocols is free. But the review of the literature has shown an improvement in the chances of pregnancy in case of prolonged ovulation suppression before stimulation for IVF with a GnRH agonist analogue or with oral contraception, especially in cases of severe endometriosis. Endometriosis, regardless of the stage and type of lesions, would have no effect on the IVF results in terms of pregnancy rate and live birth rate, but with a lower number of oocytes collected, especially in cases of severe endometriosis. In a context of superficial endometriosis without pain and of infertility, surgical treatment of superficial endometriosis is not recommended just to increase the chances of pregnancy in IVF. Surgery may have a place in case of failure of IVF to improve the results of the ART. In case of recurrence of endometriosis, surgery is not better than IVF, a medico-surgical concertation is recommended. In addition, studies on ovulation stimulation for IVF do not show any aggravation of the symptoms associated with endometriosis lesions, or an acceleration of its progression, or an increase in the rate of recurrence of the disease. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  3. 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.

  4. The Social Impact of the Offer of Assisted Reproductive Techniques (ART) in a University Hospital in Rio de Janeiro.

    PubMed

    Costa, Tonia; Corrêa, Marilena C D V

    2015-02-01

    The aim of this study is to report the procedures undertaken in the laboratory of semen of a university hospital specialized in human reproduction in Rio de Janeiro, principally Homologous Artificial Insemination (HAI) taking into account a more social aspect. This descriptive and retrospective study was based on documentary research. The source of information included medical records and registers containing the procedures performed in the laboratory of semen and the HAI. Testimonies, questionings and suggestions given by the couples during the process were also registered. The couples were clearly informed about the techniques and many times they externalized their demands, doubts and desires in relation to the procedures, treatment and issues concerning their wish to have children and start a family. The discussion shows concerns over the techniques and theories used in this context when performing procedures in the laboratory of semen. The bond to the service remains based on the idea that "now my dream of having kids will come true". Nevertheless, for the operationalization of the access to ARTs, at the public sector of medicine, we should count on the implementation of the National Politics in Assisted Reproduction. It did not take place and today it has even been removed, no longer being in force. It makes very clear the distance between the "accomplishment of the desire for children" and the reality of the provision of means and resources for ART at the medical public level in Brazil.

  5. In vitro fertilisation treatment and factors affecting success.

    PubMed

    Huang, Jack Yu Jen; Rosenwaks, Zev

    2012-12-01

    The efficacy of assisted reproductive technologies has improved significantly over the past decades. The main indications for in vitro fertilisation include tubal obstruction, severe male-factor infertility, severe endometriosis, ovulatory dysfunction, diminished ovarian reserve, and infertility of unexplained cause. In vitro fertilisation has also become an effective treatment option for couples wishing to undergo pre-implantation genetic diagnosis or screening, and for those wishing to cryopreserve their oocytes or embryos for preservation of fertility. The management of women in late reproductive age poses a major challenge; the optimum in vitro fertilisation treatment for poor responders remains elusive. The success of in vitro fertilisation treatment can be optimised by taking an individualised, patient-centered approach to controlled ovarian hyperstimulation. Key components involve selection of an appropriate controlled ovarian protocol, close-cycle monitoring, adjustment of gonadotropin dosage to avoid hyper-response, and individualised timing of human chorionic gonadotropin injection. Future directions of assisted reproductive technologies include development of non-invasive embryo selection methods, use of transcriptomics, proteomics, metabolomics, and time-lapse imaging technologies. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Disparities between online assisted reproduction patient education for same-sex and heterosexual couples.

    PubMed

    Jin, Helen; Dasgupta, Shoumita

    2016-10-01

    Does the prevalence of online education in fertility center websites differ for lesbian, gay, bisexual, transgender (LGBT) couples compared to online education for heterosexual couples? This review of fertility center websites showed that the majority of websites with patient education for heterosexual couples do not have similar materials for LGBT couples. In order to have biologically related children, LGBT individuals or couples utilize assisted reproductive technologies (ART). Fertility clinic websites provide online education to familiarize patients with the different ART procedures; however, no studies have examined the prevalence of educational information for LGBT couples compared to information for heterosexual couples utilizing ART. This website review evaluated Centers for Disease Control and Prevention (CDC)-reported fertility center websites. Websites were reviewed in 2014 using the latest 2011 CDC report, and reviewed again in 2015 with the latest 2013 CDC report. Patient education information was coded using categories determined after a sample review, and differences were analyzed with χ(2) tests, with P-values calculated with Fisher's exact test. In 2014, 31.1% (121) of 389 websites with information for heterosexual couples also contained information for LGBT couples. In 2015, the number of fertility centers with information for LGBT couples increased by 52.9% to 185 (P < 0.001) of 407 (45.5%) fertility center websites. However, the majority of fertility clinic websites (54.5%) with information for heterosexual couples still do not include information specific to LGBT couples. The lack of online information on fertility center websites may not directly reflect the quality of care LGBT individuals or couples receive in the clinic, and the effect of this absence of online information on the clinical experiences of LGBT patients is unknown. These findings add to the growing body of work showing disparities in the treatment of LGBT persons compared

  7. Veterinary management of snake reproduction.

    PubMed

    Stahl, Scott J

    2002-09-01

    The reptile veterinarian should approach the breeder with a comprehensive plan involving a review of proper husbandry, nutrition, record keeping, and a thorough prebreeding evaluation of the snakes. In addition, an evaluation of the reproductive strategy, assistance with confirming and monitoring gestation, and a review of potential reproductive complications will help to prepare the snake owner for a successful breeding season.

  8. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff.

    PubMed

    Gameiro, S; Boivin, J; Dancet, E; de Klerk, C; Emery, M; Lewis-Jones, C; Thorn, P; Van den Broeck, U; Venetis, C; Verhaak, C M; Wischmann, T; Vermeulen, N

    2015-11-01

    Based on the best available evidence in the literature, what is the optimal management of routine psychosocial care at infertility and medically assisted reproduction (MAR) clinics? Using the structured methodology of the Manual for the European Society of Human Reproduction and Embryology (ESHRE) Guideline Development, 120 recommendations were formulated that answered the 12 key questions on optimal management of routine psychosocial care by all fertility staff. The 2002 ESHRE Guidelines for counselling in infertility has been a reference point for best psychosocial care in infertility for years, but this guideline needed updating and did not focus on routine psychosocial care that can be delivered by all fertility staff. This guideline was produced by a group of experts in the field according to the 12-step process described in the ESHRE Manual for Guideline Development. After scoping the guideline and listing a set of 12 key questions in PICO (Patient, Intervention, Comparison and Outcome) format, thorough systematic searches of the literature were conducted; evidence from papers published until April 2014 was collected, evaluated for quality and analysed. A summary of evidence was written in a reply to each of the key questions and used as the basis for recommendations, which were defined by consensus within the guideline development group (GDG). Patient and additional clinical input was collected during the scoping and the review phase of the guideline development. The guideline group, comprising psychologists, two medical doctors, a midwife, a patient representative and a methodological expert, met three times to discuss evidence and reach consensus on the recommendations. 120 recommendations that aim at guiding fertility clinic staff in providing optimal evidence-based routine psychosocial care to patients dealing with infertility and MAR. The guideline is written in two sections. The first section describes patients' preferences regarding the psychosocial

  9. Assisted reproductive technology use, embryo transfer practices, and birth outcomes after infertility insurance mandates: New Jersey and Connecticut.

    PubMed

    Crawford, Sara; Boulet, Sheree L; Jamieson, Denise J; Stone, Carol; Mullen, Jewel; Kissin, Dmitry M

    2016-02-01

    To explore whether recently enacted infertility mandates including coverage for assisted reproductive technology (ART) treatment in New Jersey (2001) and Connecticut (2005) increased ART use, improved embryo transfer practices, and decreased multiple birth rates. Retrospective cohort study using data from the National ART Surveillance System. We explored trends in ART use, embryo transfer practices and birth outcomes, and compared changes in practices and outcomes during a 2-year period before and after passing the mandate between mandate and non-mandate states. Not applicable. Cycles of ART performed in the United States between 1996 and 2013. Infertility insurance mandates including coverage for ART treatment passed in New Jersey (2001) and Connecticut (2005). Number of ART cycles performed, number of embryos transferred, multiple live birth rates. Both New Jersey and Connecticut experienced an increase in ART use greater than the non-mandate states. The mean number of embryos transferred decreased significantly in New Jersey and Connecticut; however, the magnitudes were not significantly different from non-mandate states. There was no significant change in ART birth outcomes in either mandate state except for an increase in live births in Connecticut; the magnitude was not different from non-mandate states. The infertility insurance mandates passed in New Jersey and Connecticut were associated with increased ART treatment use but not a decrease in the number of embryos transferred or the rate of multiples; however, applicability of the mandates was limited. Published by Elsevier Inc.

  10. 2017 in-training initiative of the Journal of Assisted Reproduction and Genetics: the JARG Young Investigator Forum.

    PubMed

    Goldman, Kara N; Patrizio, Pasquale; Albertini, David

    2017-01-01

    The Journal of Assisted Reproduction and Genetics introduces the JARG Young Investigator Forum, an in-training initiative aimed to expand opportunities for young investigators. The JARG Young Investigator Forum has three primary goals: first, to increase opportunities for trainees and young investigators to contribute as researchers and writers. Trainees will be invited to publish mini-reviews based on their area of research interest/expertise and will have the opportunity to indicate "in-training" when submitting manuscripts as first author Educational research pertaining to reproductive medicine training will be added to the purview of the journal. Second, the Young Investigator Forum will increase opportunities for trainees to serve as journal reviewers and will provide mentorship throughout the peer review process. Third, trainees will have the unique opportunity to gain editorial experience by serving as a "guest editor" of the Young Investigator Forum, overseeing all editorial aspects of their assigned particular issue. Through authorship, peer review, and editorial experience, we seek to nurture the academic skills that are critical to a well-rounded career. The JARG Young Investigator Forum aims to foster career development for a generation of trainees who represent the future of reproductive medicine, and here, we outline the primary goals and objectives of the initiative.

  11. The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology, 2009.

    PubMed

    Zegers-Hochschild, F; Adamson, G D; de Mouzon, J; Ishihara, O; Mansour, R; Nygren, K; Sullivan, E; van der Poel, S

    2009-11-01

    Many definitions used in medically assisted reproduction (MAR) vary in different settings, making it difficult to standardize and compare procedures in different countries and regions. With the expansion of infertility interventions worldwide, including lower resource settings, the importance and value of a common nomenclature is critical. The objective is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technology (ART) being practiced worldwide. Seventy-two clinicians, basic scientists, epidemiologists and social scientists gathered together at the WHO headquarters in Geneva, Switzerland in December, 2008. Several months in advance, three working groups were established which were responsible for terminology in three specific areas: clinical conditions and procedures, laboratory procedures and outcome measures. Each group reviewed the existing ICMART glossary, made recommendations for revisions and introduced new terms to be considered for glossary expansion. A consensus was reached on 87 terms, expanding the original glossary by 34 terms, which included definitions for numerous clinical and laboratory procedures. Special emphasis was placed in describing outcome measures such as cumulative delivery rates and other markers of safety and efficacy in ART. Standardized terminology should assist in analysis of worldwide trends in MAR interventions and in the comparison of ART outcomes across countries and regions. This glossary will contribute to a more standardized communication among professionals responsible for ART practice, as well as those responsible for national, regional and international registries.

  12. Admissions for early parenting difficulties among women with infants conceived by assisted reproductive technologies: a prospective cohort study.

    PubMed

    Fisher, Jane R W; Rowe, Heather; Hammarberg, Karin

    2012-06-01

    To describe rate of and risks for residential early parenting service (REPS) admissions in women with infants conceived with assisted reproductive technology (ART). A prospective study of women who conceived with ART. Self-report telephone interview and questionnaire data were collected in two pregnancy and three postpartum waves. Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia. A consecutive cohort of women with ART pregnancies. None. REPS admission up to 18 months postpartum. Of 239 eligible women. 183 (77%) were recruited, six experienced pregnancy loss, and 153/177 (86%) were retained. In total, 17% (26/153) of participants were admitted to a REPS, 3.37 times more than the population admission rate of 5.05%. Admission risk was increased by primiparity, inadequate breastfeeding advice, low caregiving confidence when discharged from maternity hospital, lower early postpartum mood, unsettled infant behavior, and insufficient help from others. Compared with spontaneous conception, women who conceived with ART are at elevated risk of early parenting difficulties. Early interventions to address breastfeeding difficulties, management of unsettled infant behavior, social isolation, and postpartum anxiety are indicated. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  13. Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment - a prospective cohort study.

    PubMed

    Volgsten, Helena; Schmidt, Lone; Skoog Svanberg, Agneta; Ekselius, Lisa; Sundström Poromaa, Inger

    2018-05-17

    This is a prospective cohort study with the objective to describe psychiatric disorders, such as any mood and anxiety disorders, in both women and men five years after assisted reproductive technology (ART). The Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), was used as the diagnostic tool to evaluate psychiatric disorders. Logistic regression analysis was used to calculate odds ratios (ORs) and confidence interval (CI) for factors associated with psychiatric disorders at the follow-up. Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire. Approximately 11.5% of women and 5.5% of men fulfilled the criteria for any psychiatric diagnosis. Of these, any mood disorder was present in 9.4% of women and 4.4% of men. The major risk factor for mood or anxiety disorders at follow-up was mood or anxiety disorders at the time of the index ART. Mood disorders were not more common in women who remained childless after ART. In conclusion, these findings indicate that psychiatric disorders at five years follow-up after ART are less common than at the baseline assessment in conjunction with the ART.

  14. Ovarian reserve in women of late reproductive age by the method of treatment of PCOS.

    PubMed

    Beltadze, Ketevan; Barbakadze, Ludmila

    2015-05-01

    The prevalence of polycystic ovarian syndrome (PCOS) particularly is increased in adolescents. Very few longitudinal follow-up for assessment of ovarian reserve in women of late reproductive age with previously confirmed PCOS have been conducted, especially after its diagnosis and treatment in adolescence. The aim of the present study was to compare of the ovarian reserve of the women of late reproductive age by the method of treatment of PCOS in adolescence. This cross sectional study in an unselected population was conducted from January to June 2014. A total of 123 women of late reproductive age were included. They had been diagnosed with PCOS between 1984 and 1990 when they were 13-18 yr. From these, first group of the study was consisted of 67 participants who underwent conservative treatment with antiandrogens and combined oral contraceptives and second group of the study was consisted of 56 participants after surgery (34-bilateral ovarian drilling and 22- ovarian wedge resection). At the time of investigation patients were 35-45 yr. The participants were collected via analysis of histories at primary diagnosis of PCOS in adolescence and at the time of the investigation analyses of reproductive hormones were conducted. Data were compared between the groups. After conservative treatment PCOS women had higher levels of anti- mullerian hormone and lower follicle-stimulating hormone levels (p=0.02 and p=0.04, respectively). The number of antral follicles and mean ovarian volume were significantly greater also, than in women who underwent surgical treatment (p=0.03 and p=0.04, respectively). Our data suggest that PCOS patients who underwent conservative treatment have the better ovarian reserve than women who underwent surgical treatment of PCOS in adolescence.

  15. Cigarette smoking impairs clinical outcomes of assisted reproduction technologies: a meta-analysis of the literature.

    PubMed

    Budani, Maria Cristina; Fensore, Stefania; Di Marzio, Marco; Tiboni, Gian Mario

    2018-06-12

    There is convincing evidence that cigarette smoking can impair female reproductive potential. This meta-analysis updates the knowledge regarding the effects of cigarette smoking on clinical outcomes of assisted reproductive technologies (ART). Twenty-six studies were included in this meta-analysis. Results were expressed as odds ratios (OR) with 95% confidence intervals (CI) and statistical heterogeneity between the studies was evaluated with Higgins (I 2 ), Breslow (τ 2 ), Birge's ratio (H 2 ) indices and Chi-square test (χ 2 ). A P-value < 0.05 was considered statistically significant. The analysis showed a significant decrease in live birth rate per cycle for smoking patients (OR 0.59, 95% CI 0.44-0.79; P = 0.0005), a significant lower clinical pregnancy rate per cycle for smoking women (OR 0.53, 95% CI 0.41-0.68; P < 0.0001), and a significant increase in terms of spontaneous miscarriage rate (OR 2.22, 95% CI 1.10-4.48; P = 0.025) for smokers. These findings demonstrate clear negative effects of cigarette smoking on the outcome of ART programs. Copyright © 2018 Elsevier Inc. All rights reserved.

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

    PubMed

    Makuch, M Y; Bahamondes, L

    2012-01-01

    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. 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. 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. Infertile couples' access to ART procedures is restricted due to the insufficient services and lack of political commitment to support existing and new services..

  17. Maternal Smoking Among Women With and Without Use of Assisted Reproductive Technologies

    PubMed Central

    Tong, Van T.; Kissin, Dmitry M.; Bernson, Dana; Copeland, Glenn; Boulet, Sheree L.; Zhang, Yujia; Jamieson, Denise J.; England, Lucinda J.

    2016-01-01

    Objective To estimate smoking prevalence during the year before pregnancy and during pregnancy and adverse outcomes among women who delivered infants with and without assisted reproductive technology (ART) using linked birth certificates (BC) and National ART Surveillance System (NASS) data. Methods Data were analyzed for 384,390 women and 392,248 infants born in Massachusetts and Michigan during 2008–2009. Maternal smoking prevalence was estimated using smoking indicated from BC by ART status. For ART users, to evaluate underreporting, prepregnancy smoking was estimated from BC, NASS, or both sources. Effect of prenatal smoking on preterm and mean birthweight (term only) for singleton infants were examined by ART status. Results Maternal smoking prevalence estimates were significantly lower for ART users than nonusers (pre-pregnancy = 3.2% vs. 16.7%; prenatal = 1.0% vs. 11.1%, p < 0.05). When combining smoking information from BC and NASS, prepregnancy smoking prevalence estimates for ART users could be as high as 4.4% to 6.1%. Adverse effects of smoking on infant outcomes in ART pregnancies were consistent with the effects seen in non-ART pregnancies, specifically decline in infant birthweight and increase in preterm delivery, although association between smoking and preterm was not significant. Conclusion A low, but substantial proportion of ART users smoked before and during pregnancy. As ART users are highly motivated to get pregnant, it should be clearly communicated that smoking can decrease fertility and adversely affect pregnancy outcomes. Continued efforts are needed to encourage smoking cessation and maintain tobacco abstinence among all women of reproductive age. PMID:27243366

  18. Loss of treatment benefit when heroin-assisted treatment is stopped after 12 months.

    PubMed

    Demaret, Isabelle; Quertemont, Etienne; Litran, Géraldine; Magoga, Cécile; Deblire, Clémence; Dubois, Nathalie; Charlier, Corinne; Lemaitre, André; Ansseau, Marc

    2016-10-01

    In 2013, during a recent heroin-assisted treatment trial, participants in heroin-assisted treatment (HAT) decreased significantly more their street heroin use than participants in oral methadone treatment. After the trial, HAT was discontinued. To examine whether the treatment benefits were sustained three months after the trial, the use of street heroin by the participants was analyzed in a follow-up study. At the follow-up assessment, street heroin use increased in the experimental group. The two groups no longer showed a significant difference (p=0.55) in the level of street heroin use. A predetermined and forced end of HAT was followed by a significant increase in the level of street level use. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    PubMed

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

    2016-08-01

    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. 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. 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. 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.

  20. Ethical issues in newer assisted reproductive technologies: A view from Nigeria.

    PubMed

    Fadare, J O; Adeniyi, A A

    2015-12-01

    Infertility is a prevalent condition in many developing countries with significant physical and psychosocial implications. The aim of this study is to discuss briefly the ethics of newer assisted reproductive technology (ART) with special emphasis on the peculiarities in Nigeria. MEDLINE and Google Scholar were searched for English-language articles from January 1990 to July 2014 using the search terms "ethics of ART AND Nigeria," "ethical issues in in vitro fertilization AND Nigeria." Using the above search phrases, a total of 43 articles were retrieved out of which only 5 dealt specifically with the subject matter. The core ethical issues found in the reviewed literature are listed in [Table 1]. Inequitable access to ART due to its high cost, lack of regulatory body, safety of the procedure, and fate of the embryos were the main themes identified from the papers. Surrogacy, sex selection, and gamete donation were additional relevant ethical issues. There is an urgent need for stakeholders in developing countries to formulate cultural and context-specific guidelines to help address some of these ethical dilemmas.

  1. Growth of Oak Reproduction Increased by Shelterwood Treatments in Northern Arkansas

    Treesearch

    David L. Graney

    1999-01-01

    Nine-year survival and growth of oak (Quercus alba L., Q. rubra L., and Q. velutina Lam.) reproduction was evaluated in upland oak stands representing a range in site quality, residual overstory stocking, and understory treatments. Analysis of variance was used to test for differences in establishment, survival...

  2. [Follow-up of children conceived by assisted reproductive technologies].

    PubMed

    Bouillon, C; Fauque, P

    2013-05-01

    Since the birth of the first baby conceived by in vitro fertilization (IVF) 30 years ago (Louise Brown in 1978), there has been a rapid and constant increase in the number of couples using assisted reproductive technologies (ART). Around four million of children have been born from couples experiencing fertility problems, through the use of ART, comprising roughly 2-3 % of all births in Europe and U.S. That highlights that these modes of fertilization are now well assumed by our societies. However, several questions on health of these children remain to be elucidated. As evoked in this review, even if methodological limitations exist, numerous studies have reported increased risks of birth defects, like prematurity, foetal hypotrophy, neonatal complications, congenital malformations and epigenetic diseases among ART-conceived children as compared to naturally conceived children. Nowadays, it is difficult to determine if these increased risks found in ART infants are a consequence of the ART procedures or are inherent to the infertility problems per se. However, absolute risks remain moderate and reassuring as well as the data on follow-up into infancy and early childhood. Nevertheless, because the effects may occur at the adulthood, there is a need for long-term follow-up of children born after ART. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  3. ARTs and the problematic conceptualisation of declining reproduction.

    PubMed

    Majumdar, Anindita

    2018-01-01

    The routinisation of assisted reproduction in India has led to its proliferation and the easy identification of infertility. However, clinical and popular discourse tends to focus primarily on age-related deficiencies in reproduction. Here, both the "dangers" of declining reproduction as well as the facilitation of delayed reproduction are areas of focus and eulogisation. Bringing together the diverse elements of the medico-social conversation, the aim of this commentary is to examine the ways in which the ARTs are used to make sense of declining reproduction.

  4. Cross-border reproductive care: a committee opinion.

    PubMed

    2013-09-01

    Cross-border reproductive care (CBRC) is a growing worldwide phenomenon, raising questions about why assisted reproductive technology (ART) patients travel abroad, what harms and benefits may result, and what duties health care providers may have in advising and treating patients who travel for reproductive services. Cross-border care offers benefits and poses harms to ART stakeholders, including patients, offspring, providers, gamete donors, gestational carriers, and local populations in destination countries. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  5. [Impact of end-stage renal disease and kidney transplantation on the reproductive system].

    PubMed

    Delesalle, A-S; Robin, G; Provôt, F; Dewailly, D; Leroy-Billiard, M; Peigné, M

    2015-01-01

    Chronic renal failure leads to many metabolic disorders affecting reproductive function. For men, hypergonadotropic hypogonadism, hyperprolactinemia, spermatic alterations, decreased libido and erectile dysfunction are described. Kidney transplantation improves sperm parameters and hormonal function within 2 years. But sperm alterations may persist with the use of immunosuppressive drugs. In women, hypothalamic-pituitary-ovarian axis dysfunction due to chronic renal failure results in menstrual irregularities, anovulation and infertility. After kidney transplantation, regular menstruations usually start 1 to 12 months after transplantation. Fertility can be restored but luteal insufficiency can persist. Moreover, 4 to 20% of women with renal transplantation suffer from premature ovarian failure syndrome. In some cases, assisted reproductive technologies can be required and imply risks of ovarian hyperstimulation syndrome and must be performed with caution. Pregnancy risks for mother, fetus and transplant are added to assisted reproductive technologies ones. Only 7 authors have described assisted reproductive technologies for patients with kidney transplantation. No cases of haemodialysis patients have been described yet. So, assisted reproductive technologies management requires a multidisciplinary approach with obstetrics, nephrology and reproductive medicine teams' agreement. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  6. Egg Production and Donation: A New Frontier in the Global Landscape of Cross-Border Reproductive Care: Ethical Concerns.

    PubMed

    Neri, Margherita; Turillazzi, Emanuela; Pascale, Natasha; Riezzo, Irene; Pomara, Cristoforo

    2016-01-01

    Cross-border reproductive care (CBRC) is a multifaceted phenomenon. It may involve both the movement of patients to undertake assisted reproductive treatment through technologies otherwise denied and the movement of assisted reproduction professionals, egg and sperm donors and surrogates, as well as the importing and exporting of gametes. The reasons for CBRC vary between countries. In this global landscape, the search for donor oocytes is one of the main reasons for patients seeking cross-border reproductive care. The egg market has led to ethical and political concerns about the means of procuring donor oocytes, the possibility of exploiting economically underprivileged women mainly in poor countries, and the issue of the responsibility and accountability of medical doctors and fertility clinics. Ethical concerns relating to international egg donation are discussed with special focus on the issues of compensation/ reimbursement, the health and welfare of women donating eggs, informed consent to donation, the possible conflict of interest for physicians involved in egg donation programmes, and equity in the distribution of economic resources from CBRC. Finally, the need for global solutions to this global issue is underlined.

  7. Use of electroacupuncture and transcutaneous electrical acupoint stimulation in reproductive medicine: a group consensus.

    PubMed

    Qu, Fan; Li, Rong; Sun, Wei; Lin, Ge; Zhang, Rong; Yang, Jing; Tian, Li; Xing, Guo-Gang; Jiang, Hui; Gong, Fei; Liang, Xiao-Yan; Meng, Yan; Liu, Jia-Yin; Zhou, Li-Ying; Wang, Shu-Yu; Wu, Yan; He, Yi-Jing; Ye, Jia-Yu; Han, Song-Ping; Han, Ji-Sheng

    With the rapid development of assisted reproductive technology, various reproductive disorders have been effectively addressed. Acupuncture-like therapies, including electroacupuncture (EA) and transcutaneous electrical acupoint stimulation (TEAS), become more popular world-wide. Increasing evidence has demonstrated that EA and TEAS are effective in treating gynecological disorders, especially infertility. This present paper describes how to select acupoints for the treatment of infertility from the view of theories of traditional Chinese medicine and how to determine critical parameters of electric pulses of EA/TEAS based on results from animal and clinical studies. It summarizes the principles of clinical application of EA/TEAS in treating various kinds of reproductive disorders, such as polycystic ovary syndrome (PCOS), pain induced by oocyte retrieval, diminished ovarian reserve, embryo transfer, and oligospermia/ asthenospermia. The possible underlying mechanisms mediating the therapeutic effects of EA/TEAS in reproductive medicine are also examined.

  8. Ethical issues in human reproduction: Islamic perspectives.

    PubMed

    Serour, G I

    2013-11-01

    Sexual and reproductive rights of women are essential components of human rights. They should never be transferred, renounced or denied for any reason based on race, religion, origin, political opinion or economic conditions. Women have the right to the highest attainable standard of health care for all aspects of their reproductive and sexual health (RSH). The principle of autonomy emphasizes the important role of women in the decision-making. Choices of women in reproduction, after providing evidence based information, should be respected. Risks, benefits and alternatives should be clearly explained before they make their free informed consent. Justice requires that all be treated with equal standard and have equal access to their health needs without discrimination or coercion. When resources are limited there is tension between the principle of justice and utility. Islamic perspectives of bioethics are influenced by primary Sharia namely the Holy Quran, authenticated traditions and saying of the Profit Mohamed (PBUH), Igmaa and Kias (analogy). All the contemporary ethical principles are emphasized in Islamic Shariaa, thus these principles should be observed when providing reproductive and sexual health services for Muslim families or communities. The Family is the basic unit in Islam. Safe motherhood, family planning, and quality reproductive and sexual health information and services and assisted reproductive technology are all encouraged within the frame of marriage. While the Shiaa sect permits egg donation, and surrogacy the Sunni sect forbids a third party contribution to reproduction. Harmful practices in RSH as FGM, child marriage and adolescent pregnancy are prohibited in Islam. Conscientious objection to treatment should not refrain the physician from appropriate referral.

  9. Measuring reproductive tourism through an analysis of Indian ART clinic Websites.

    PubMed

    Deonandan, Raywat; Loncar, Mirhad; Rahman, Prinon; Omar, Sabrina

    2012-01-01

    India is fast becoming the most prominent player in the global industry of reproductive tourism, in which infertile people cross international borders to seek assisted reproduction technologies. This study was conducted to better understand the extent and manner in which Indian clinics seek foreign clients. A systematic search of official Indian assisted reproduction technologies clinic Websites was undertaken, and instances noted where foreign clients were overtly targeted, and where maternal surrogacy was overtly offered. A total of 159 clinics with Web addresses were identified, though only 78 had functioning Websites. All were published in English, with the majority clustered in the states of Maharashtra (14) and Gujarat (9). Of the 78 functioning Websites, 53 (68%) featured some mention of maternal surrogacy services, and 42 (54%) made overt overtures to foreign clients. Qualitative appeals to foreigners included instructions for international adoption, visa application, and the legal parental disposition of the surrogate. All Maharashtran clinic Websites that mentioned surrogacy also overtly featured reproductive tourism. Preimplantation diagnosis services were not offered disproportionately by clinics mentioning reproductive tourism. Based upon clinic online profiles, reproductive tourism comprises a substantial fraction of India's assisted reproduction technologies clinics' business focus, clustering around its most tourist-friendly locales, and surrogacy may be a strong motivator for international clientele.

  10. Cultural and ethical challenges of assisted reproductive technologies in the management of infertility among the Yoruba of southwestern Nigeria.

    PubMed

    Jegede, Ayodele S; Fayemiwo, Adetona S

    2010-06-01

    This paper discusses the cultural and ethical issues arising from the use of Assisted Reproductive Health Technologies. Twenty-five In-depth interviews were conducted with 5 couples of reproductive age who have never conceived or brought pregnancy to term after one year of unprotected intercourse, 4 adult males, 4 adult females, a gyneacologist, a nurse, a herbalist and 2 religious leaders in Ibadan, Nigeria. Content analysis was used for data analysis. Legitimacy of children born through ART, religious obligation, patriarchy, polygamy and value of children are cultural issues surrounding ARTs while decision making about it, discrimination against children born through ART, psychological problems and loss of self esteem, side effects of the technologies and the cost of accessing them are the ethical challenges. The findings have methodological implications for conducting infertility research in non-western societies.

  11. Age and stem origin of Appalachian hardwood reproduction following a clearcut-herbicide treatment

    Treesearch

    G.R., Jr. Trimble; E.H. Tryon; H. Clay Smith; J.D. Hillier; J.D. Hillier

    1986-01-01

    Seven years after a clearcut-herbicide treatment in a West Virginia Appalachian hardwood stand, root-stem age was determined for sugar maple, black cherry, and white ash. Sugar maple stems originated from advanced reproduction, black cherry originated primarily from seedlings that germinated during or after treatment, and white ash stems were a mixture of seedlings,...

  12. 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. © 2014 Wiley Periodicals Inc.

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

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Granucci, G.; Ricci, D.; Farina, D.

    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 phasemore » 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.« less

  14. Comparative analysis of three sperm DNA damage assays and sperm nuclear protein content in couples undergoing assisted reproduction treatment.

    PubMed

    Simon, L; Liu, L; Murphy, K; Ge, S; Hotaling, J; Aston, K I; Emery, B; Carrell, D T

    2014-05-01

    Is there an association between sperm DNA damage, measured by three different assays, sperm nuclear protein content and clinical outcomes in assisted reproduction treatment (ART)? Sperm DNA damage measured by terminal deoxynucleotidyltransferase-mediated dUTP nick-end labelling (TUNEL) and the Comet assay were significantly associated with ART outcomes in our single institution study. Abnormal protamine expression is known to be associated with sperm DNA damage and male infertility. A number of studies have shown a significant relationship between sperm DNA damage and ART outcomes. To date, there are no large studies providing direct comparisons of DNA damage tests within the same study population. Thus, the prognostic value for each method remains unknown. Cross-sectional study of 238 men from infertile couples undergoing ART at the University Center for Reproductive Medicine, Utah, USA, between April 2011 and March 2013. Sperm from men undergoing ART were tested for DNA damage using the alkaline Comet assay, TUNEL and flow cytometric chromatin evaluation (FCCE) assays. Histone retention was analysed using the aniline blue staining method, whereas protamine content (proteins P1 and P2) and ratio were analysed using acid urea gel electrophoresis. The prognostic value of each sperm DNA test to predict clinical pregnancy was calculated. Histone retention was associated with sperm DNA damage (P < 0.001), reduced embryo quality (P = 0.005) and clinical pregnancies (P < 0.001). The mean percentage of sperm with DNA damage was significantly higher in sperm from non-pregnant couples compared with that from pregnant couples, as measured by TUNEL assay (15.04 ± 1.16% versus 8.79 ± 0.56%; P < 0.001) and alkaline Comet assay (72.79 ± 2.49% versus 55.86 ± 2.29%; P < 0.001). There was no association between clinical pregnancies and DNA fragmentation index measured by FCCE (12.97 ± 1.46 versus 14.93 ± 1.65; P = 0.379). Of the protamine parameters analysed, only the P1/P2

  15. 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

  16. 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…

  17. The market for reproductive tourism: an analysis with special reference to Greece.

    PubMed

    Paraskou, Anastasia; George, Babu P

    2017-01-01

    For many people, the need for parenthood remains unfulfilled due to biological reasons and a remedy for these individuals is assisted reproduction (AR). Because of widely differing and sometimes incompatible legislations around the world related to AR, there is considerable confusion across national borders. Within Europe, Greece seems to be in a comparatively favorable position because of lower restrictions and the availability of decent quality specialized medical facilities. This research is a market study with a business perspective and explores the emerging landscape of reproductive tourism (RT) in Greece. The research adopted mixed methods. First, open-ended questions were used to interview foreign medical tourists and staff in various AR clinics. Based on the insights from these interviews and guided by the extent literature, a survey instrument was prepared and administered among 130 patients. Findings indicate that Greece still lack policies that nurture transparency and dynamic response to technological changes in AR. Also, the travel industry lack specialists who can effectively liaison with clinics, who understand the availability of AR technologies, regulations, and the unique needs of AR tourists. Globally, the need for assisted reproduction has tremendously increased; yet, the supply of facilities is lagging far behind. There is a unique advantage for clinics located in touristic locations in countries that offer cheaper treatment options. Given the shape of its debt-ridden economy, Greece needs foreign exchange inflows and gaining first mover advantage in reproductive tourism is probably an important way to achieve this. This research draws up a reproductive tourism strategy for Greece.

  18. Laser assisted zona hatching does not lead to immediate impairment in human embryo quality and metabolism.

    PubMed

    Uppangala, Shubhashree; D'Souza, Fiona; Pudakalakatti, Shivanand; Atreya, Hanudatta S; Raval, Keyur; Kalthur, Guruprasad; Adiga, Satish Kumar

    2016-12-01

    Laser assisted zona hatching (LAH) is a routinely used therapeutic intervention in assisted reproductive technology for patients with poor prognosis. However, results are not conclusive in demonstrating the benefits of zona hatching in improving the pregnancy rate. Recent observations on LAH induced genetic instability in animal embryos prompted us to look into the effects of laser assisted zona hatching on the human preimplantation embryo quality and metabolic uptake using high resolution nuclear magnetic resonance (NMR) technology. This experimental prospective study included fifty embryos from twenty-five patients undergoing intra cytoplasmic sperm injection. Embryo quality assessment followed by profiling of spent media for the non-invasive evaluation of metabolites was performed using NMR spectroscopy 24 hours after laser treatment and compared with that of non-treated sibling embryos. Both cell number and embryo quality on day 3 of development did not vary significantly between the two groups at 24 hours post laser treatment interval. Time lapse monitoring of the embryos for 24 hours did not reveal blastomere fragmentation adjacent to the point of laser treatment. Similarly, principal component analysis of metabolites did not demonstrate any variation across the groups. These results suggest that laser assisted zona hatching does not affect human preimplantation embryo morphology and metabolism at least until 24 hours post laser assisted zona hatching. However, studies are required to elucidate laser induced metabolic and developmental changes at extended time periods. AH: assisted hatching; ART: assisted reproductive technology; DNA: deoxy-ribo nucleic acid; LAH: laser assisted hatching; MHz: megahertz; NMR: nuclear magnetic resonance; PCA: principal component analysis; PGD: preimplantation genetic diagnosis; TLM: time lapse monitoring.

  19. Reproductive Tract Infections and Treatment Seeking Behavior among Married Adolescent Women 15-19 Years in India.

    PubMed

    Prusty, Ranjan Kumar; Unisa, Sayeed

    2013-01-01

    India is home to the highest number of adolescents in the world. Adolescents in India suffer from lack of knowledge and empowerment to make informed sexual and reproductive health decisions. This paper analyses the prevalence of reproductive tract infections and sexually transmitted infections (RTI/STI) and treatment seeking behavior among married adolescent women in India aged 15-19 years. Data from the District Level Household Survey (DLHS, 2007-08) of India were used. The prevalence of RTIs symptoms and treatment seeking behavior among women by different socio-demographic characteristics was analyzed. Factor analysis was utilized to create an index using information about 11 symptoms of RTI/STI collected in the survey. Linear and binary logistic regressions were used to know the association between infections and treatment seeking behavior with socio-demographic factors. About 15 percent of adolescent women reported having any symptoms of RTI/STI. The main symptoms reported were low backache, pain in the lower abdomen, pain during intercourse and itching or irritation around the vulvar region. Factor analysis showed the concentration of diseases in three clusters - infection in around the vulva, other reproductive infection and abnormal discharge; and intercourse related problems. Major predictors of both symptoms of reproductive infections and treatment seeking behavior from multivariate analysis are age, education, wealth, region and awareness about RTI/STI. Knowledge and treatment seeking behavior is poor among adolescent women in India. There is need for programmatic and policy emphasis on increasing knowledge and awareness through family life education including in educational curriculum at school level.

  20. 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.

  1. Use of letrozole in assisted reproduction: a systematic review and meta-analysis

    PubMed Central

    Requena, Antonio; Herrero, Julio; Landeras, José; Navarro, Esperanza; Neyro, José L.; Salvador, Cristina; Tur, Rosa; Callejo, Justo; Checa, Miguel A.; Farré, Magí; Espinós, Juan J.; Fábregues, Francesc; Graña-Barcia, María

    2008-01-01

    BACKGROUND Letrozole is the third-generation aromatase inhibitor (AI) most widely used in assisted reproduction. AIs induce ovulation by inhibiting estrogen production; the consequent hypoestrogenic state increases GnRH release and pituitary follicle-stimulating hormone (FSH) synthesis. METHODS A systematic search of the literature was performed for both prospective and retrospective studies. Meta-analyses of randomized clinical trials (RCTs) were performed for three comparisons: letrozole versus clomiphene citrate (CC), letrozole + FSH versus FSH in intrauterine insemination (IUI) and letrozole + FSH versus FSH in IVF. In the absence of RCTs, non-randomized studies were pooled. RESULTS Nine studies were included in the meta-analysis. Four RCTs compared the overall effect of letrozole with CC in patients with polycystic ovary syndrome. The pooled result was not significant for ovulatory cycles (OR = 1.17; 95% CI 0.66–2.09), or for pregnancy rate per cycle (OR = 1.47; 95% CI 0.73–2.96) or for pregnancy rate per patient (OR = 1.37; 95% CI 0.70–2.71). In three retrospective studies which compared L + FSH with FSH in ovarian stimulation for IUI, the pooled OR was 1.15 (95% CI 0.78−1.71). A final meta-analysis included one RCT and one cohort study that compared letrozole + gonadotrophin versus gonadotrophin alone: the pooled pregnancy rate per patient was not significantly different (OR = 1.40; 95% CI 0.67–2.91). CONCLUSIONS Letrozole is as effective as other methods of ovulation induction. Further randomized-controlled studies are warranted to define more clearly the efficacy and safety of letrozole in human reproduction. PMID:18812422

  2. Growth and male reproduction improvement of non-thermal dielectric barrier discharge plasma treatment on chickens

    NASA Astrophysics Data System (ADS)

    Jiao Zhang, Jiao; Luong Huynh, Do; Chandimali, Nisansala; Kang, Tae Yoon; Kim, Nameun; Mok, Young Sun; Kwon, Taeho; Jeong, Dong Kee

    2018-05-01

    This study investigated whether plasma treatment of fertilized eggs before hatching could affect the growth and reproduction of chickens. Three point five-day-incubated fertilized eggs exposed to non-thermal dielectric barrier discharge plasma at 2.81 W of power for 2 min resulted in the highest growth in chickens. Plasma growth-promoting effect was regulated by the reactive oxygen species homeostasis and the improvement of energy metabolism via increasing serum hormones and adenosine triphosphate levels which were resulted from the regulation of genes involved in antioxidant defense, hormone biosynthesis and energetic metabolism. Interestingly, plasma-treated male chickens conspicuously grew faster than females. Further, aspects of male reproductive system (testosterone level and sperm quality) were improved by the plasma treatment but female reproduction (estradiol and progesterone levels, egg-laying rate and egg weight) had no significant changes. Unfortunately, offspring whose parents were the optimal plasma-treated chickens did not show any difference on growth characteristics and failed to inherit excellent growth features from their parents. Our results suggest a new method to improve the growth rate and male reproductive capacity in poultry but it is only effective in the plasma direct-treated generation.

  3. Can assisted reproductive technologies cause adult-onset disease? Evidence from human and mouse

    PubMed Central

    Vrooman, Lisa A.; Bartolomei, Marisa S.

    2016-01-01

    Millions of children have been born worldwide though assisted reproductive technologies (ART). Consistent with the Developmental Origins of Health and Disease hypothesis, there is concern that ART can induce adverse effects, especially because procedures coincide with epigenetic reprogramming events. Although the majority of studies investigating the effects of ART have focused on perinatal outcomes, more recent studies demonstrate that ART-conceived children may be at increased risk for postnatal effects. Here, we present the current epidemiological evidence that ART-conceived children have detectable differences in blood pressure, body composition, and glucose homeostasis. Similar effects are observed in the ART mouse model, which have no underlying infertility, suggesting that cardiometabolic effects are likely caused by ART procedures and not due to reasons related to infertility. We propose that the mouse system can, consequently, be used to adequately study, modify, and improve outcomes for ART children. PMID:27474254

  4. Influence of clinical mastitis and its treatment outcome on reproductive performance in crossbred cows: A retrospective study.

    PubMed

    Kumar, Narender; Manimaran, A; Sivaram, M; Kumaresan, A; Jeyakumar, S; Sreela, L; Mooventhan, P; Rajendran, D

    2017-05-01

    Evaluation of the effect of clinical mastitis (CM) and its treatment outcome on the reproductive performance in crossbred cows retrospectively. Datasets of 835 lactating cows affected with CM during a period of 12 years (2001-2012) were considered for this study. Mastitis treatment related data and reproductive parameters such as days to first detected heat (DTFDH), days to first insemination (DTFI), days open (DO), and number of services per conception (SC) were collected from mastitis treatment and artificial insemination registers, respectively. Data were analyzed by ANOVA using SPSS 20 software. The means were compared with the Duncan's multiple comparison post-hoc test. CM affected cows had significantly (p<0.05) higher DTFDH, DTFI, DO and SC compared to clinically healthy cows. Cows diagnosed with a single episode of CM had significantly (p<0.05) delayed DTFDH while, DO and SC were significantly higher (p<0.05) in cows diagnosed by multiple episodes of CM. SC was significantly (p<0.05) higher in cows diagnosed with both relapse and recurrence. Severe CM affected cows had significantly (p<0.05) altered reproductive parameters. The reproductive parameters were altered to high extent when CM occurred during the breeding period. CM-affected cows had higher DTFDH, DTFI, DO and SC compared to clinically healthy cows. The negative effects of CM on reproduction parameters were higher when CM occurred during the breeding period.

  5. 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

    2018-02-01

    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

  6. Race matters: a systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes.

    PubMed

    Wellons, Melissa F; Fujimoto, Victor Y; Baker, Valerie L; Barrington, Debbie S; Broomfield, Diana; Catherino, William H; Richard-Davis, Gloria; Ryan, Mary; Thornton, Kim; Armstrong, Alicia Y

    2012-08-01

    To systematically review the reporting of race/ethnicity in Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System (CORS) publications. Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology of literature published in PubMed on race/ethnicity that includes data from SART CORS. Not applicable. Not applicable. In vitro fertilization cycles reported to SART. Any outcomes reported in SART CORS. Seven publications were identified that assessed racial/ethnic disparities in IVF outcomes using SART data. All reported a racial/ethnic disparity. However, more than 35% of cycles were excluded from analysis because of missing race/ethnicity data. Review of current publications of SART data suggests significant racial/ethnic disparities in IVF outcomes. However, the potential for selection bias limits confidence in these findings, given that fewer than 65% of SART reported cycles include race/ethnicity. Our understanding of how race/ethnicity influences ART outcome could be greatly improved if information on race/ethnicity was available for all reported cycles. Copyright © 2012 American Society for Reproductive Medicine. All rights reserved.

  7. Cryopreserved oocyte versus fresh oocyte assisted reproductive technology cycles, United States, 2013.

    PubMed

    Crawford, Sara; Boulet, Sheree L; Kawwass, Jennifer F; Jamieson, Denise J; Kissin, Dmitry M

    2017-01-01

    To compare characteristics, explore predictors, and compare assisted reproductive technology (ART) cycle, transfer, and pregnancy outcomes of autologous and donor cryopreserved oocyte cycles with fresh oocyte cycles. Retrospective cohort study from the National ART Surveillance System. Fertility treatment centers. Fresh embryo cycles initiated in 2013 utilizing embryos created with fresh and cryopreserved, autologous and donor oocytes. Cryopreservation of oocytes versus fresh. Cancellation, implantation, pregnancy, miscarriage, and live birth rates per cycle, transfer, and/or pregnancy. There was no evidence of differences in cancellation, implantation, pregnancy, miscarriage, or live birth rates between autologous fresh and cryopreserved oocyte cycles. Donor cryopreserved oocyte cycles had a decreased risk of cancellation before transfer (adjusted risk ratio [aRR] 0.74, 95% confidence interval [CI] 0.57-0.96) as well as decreased likelihood of pregnancy (aRR 0.88, 95% CI 0.81-0.95) and live birth (aRR 0.87, 95% CI 0.80-0.95); however, there was no evidence of differences in implantation, pregnancy, or live birth rates when cycles were restricted to those proceeding to transfer. Donor cryopreserved oocyte cycles proceeding to pregnancy had a decreased risk of miscarriage (aRR 0.75, 95% CI 0.58-0.97) and higher live birth rate (aRR 1.05, 95% CI 1.01-1.09) with the transfer of one embryo, but higher miscarriage rate (aRR 1.28, 95% CI 1.07-1.54) and lower live birth rate (aRR 0.95, 95% CI 0.92-0.99) with the transfer of two or more. There was no evidence of differences in ART outcomes between autologous fresh and cryopreserved oocyte cycles. There was evidence of differences in per-cycle and per-pregnancy outcomes between donor cryopreserved and fresh oocyte cycles, but not in per-transfer outcomes. Published by Elsevier Inc.

  8. Robotics in reproductive medicine.

    PubMed

    Sroga, Julie; Patel, Sejal Dharia; Falcone, Tommaso

    2008-01-01

    In the past decade, robotic technology has been increasingly incorporated into various industries, including surgery and medicine. This chapter will review the history, development, current applications, and future of robotic technology in reproductive medicine. A literature search was performed for all publications regarding robotic technology in medicine, surgery, reproductive endocrinology, and its role in both surgical education and telepresence surgery. As robotic assisted surgery has emerged, this technology provides a feasible option for minimally invasive surgery, impacts surgical education, and plays a role in telepresence surgery.

  9. Dual ovarian stimulation and random start in assisted reproductive technologies: from ovarian biology to clinical application.

    PubMed

    Vaiarelli, Alberto; Venturella, Roberta; Vizziello, Damiano; Bulletti, Francesco; Ubaldi, Filippo M

    2017-06-01

    The opportunity to use gonadotropins to stimulate the growth of antral follicles coming from different follicular waves available in different moment of the menstrual cycle allowed the implementation of innovative protocols in assisted reproductive technologies. The purpose of this review is to explore the possible advantages related to these new controlled ovarian stimulation (COS) strategies. Women exhibit major and minor wave patterns of ovarian follicular development during the menstrual cycle, as it is in animal species. These observations led to the introduction of two new strategies for COS: the random start and the double ovarian stimulation within a single menstrual cycle. The use of gonadotropin-releasing hormone antagonist COS protocols, started randomly at any day of the menstrual cycle, is today a standard procedure in those cases where obtaining oocytes is an urgent task, such as in case of fertility preservation for malignant diseases or other medical indications.On the other hand, in poor prognosis patients, double ovarian stimulation has been suggested with the aim of maximizing the number of oocytes retrieved within a single menstrual cycle and, in turn increasing the chance to obtain a reproductively competent embryo. Randomized control trials are necessary to confirm these preliminary findings.

  10. Congenital anomalies in infants conceived by assisted reproductive techniques.

    PubMed

    Mozafari Kermani, Ramin; Nedaeifard, Leila; Nateghi, Mohammad Reza; Shahzadeh Fazeli, Abolhassan; Ahmadi, Ebrahim; Osia, Mohammad Ali; Jafarzadehpour, Ebrahim; Nouri, Soudabeh

    2012-04-01

    Many studies show that congenital defects in infants conceived by assisted reproductive techniques (ART) are more than infants of normal conception (NC). The aim of this study is to determine the frequency of congenital anomalies in ART infants from Royan Institute and to compare congenital anomalies between two ART techniques.  In a cross-sectional descriptive study, 400 ART infants from Royan Institute who resided in Tehran were selected by non-random, consecutive sampling. Infants were examined twice (until 9 months of age) by a pediatrician. Infants' congenital anomalies were described by each body system or organ and type of ART. Data were analyzed by SPSS version 16 and Fisher's exact test. The frequency of different organ involvement in the two examinations were: 40 (10%) skin, 25 (6.2%) urogenital system, 21 (5.2%) gastrointestinal tract, 13 (3.2%) visual, and 8 (2%) cardiovascular system. Major congenital defects in infants conceived by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) were hypospadiasis, inguinal hernia, patent ductus arteriosus plus ventricular septal defect (PDA + VSD), developmental dysplasia of the hip, lacrimal duct stenosis during the first year of life, hydronephrosis and urinary reflux over grade III, undescending testis, ureteropelvic junction stenosis, and torticoli. Two-thirds of ART infants had no defects. A total of 7% of IVF and ICSI infants had one of the major abovementioned congenital anomalies. This rate was higher than NC infants (2%-3%). There was no difference between the ICSI and IVF group.

  11. 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'…

  12. 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

  13. Sexual and gender minority peoples' recommendations for assisted human reproduction services.

    PubMed

    Ross, Lori E; Tarasoff, Lesley A; Anderson, Scott; Epstein, Rachel; Marvel, Stu; Steele, Leah S; Green, Datejie

    2014-02-01

    To determine what recommendations lesbian, gay, bisexual, trans, and queer (LGBTQ) people have for provision of assisted human reproduction (AHR) services to their communities. Using a semi-structured guide, we interviewed a purposeful sample of 66 LGBTQ-identified individuals from across the province of Ontario who had used or had considered using AHR services since 2007. Participants were predominantly cisgender (non-trans), white, same-sex partnered, urban women with relatively high levels of education and income. Participants made recommendations for changes to the following aspects of AHR service provision: (1) access to LGBTQ-relevant information, (2) adoption of patient-centred practices by AHR service providers, (3) training and education of service providers regarding LGBTQ issues and needs, (4) increased visibility of LGBTQ people in clinic environments, and (5) attention to service gaps of particular concern to LGBTQ people. Many of the recommendations made by study participants show how patient-centred models may address inequities in service delivery for LGBTQ people and for other patients who may have particular AHR service needs. Our results suggest that service providers need education to enact these patient-centred practices and to deliver equitable care to LGBTQ patients.

  14. Kant's 'formula of humanity' and assisted reproductive technology: a case for duties to future children.

    PubMed

    Patrone, Tatiana

    2017-11-01

    The paper asks the question whether Kant's ethical theory can be applied to issues in assisted reproductive technology (ART). It argues against three objections to applying Kant's ethics to ART: (i) the non-identity objection, (ii) the gen-ethics objection, and (iii) the care-ethics objection. After showing that neither of the three objections is sufficiently persuasive the paper proposes a reading of Kant's 'formula of humanity,' and especially its negative clause (i.e., the 'merely as means' clause), that can be of some guidance in ART. The paper conclude that although Kant's 'formula of humanity' cannot be used as a simple litmus test for determining whether an ART practice is morally permissible or not, it nonetheless can supply us with some guidance in our moral deliberation.

  15. Male reproductive health and yoga

    PubMed Central

    Sengupta, Pallav; Chaudhuri, Prasenjit; Bhattacharya, Koushik

    2013-01-01

    Now-a-days reproductive health problems along with infertility in male is very often observed. Various Assisted Reproductive Technologies have been introduced to solve the problem, but common people cannot afford the cost of such procedures. Various ayurvedic and other alternative medicines, along with regular yoga practice are proven to be not only effective to enhance the reproductive health in men to produce a successful pregnancy, but also to regulate sexual desire in men who practice celibacy. Yoga is reported to reduce stress and anxiety, improve autonomic functions by triggering neurohormonal mechanisms by the suppression of sympathetic activity, and even, today, several reports suggested regular yoga practice from childhood is beneficial for reproductive health. In this regard the present review is aimed to provide all the necessary information regarding the effectiveness of yoga practice to have a better reproductive health and to prevent infertility. PMID:23930026

  16. Workplace reproductive problems.

    PubMed

    Frazier, L M

    2000-12-01

    Occupational exposures can harm reproductive processes in men or women. Exposures may affect fertility, pregnancy outcomes or the child's health after delivery. The goal of patient management is to provide counseling at an appropriate level. Over-restricting the patient should be avoided while hazardous exposures should be identified and reduced. The occupational history can be used to estimate the magnitude of each exposure. If the exposure is a known reproductive hazard and the exposure level appears significant, there are several options for making the job safer. Modifications in work practices can be accomplished by advising the patient about changing work practices, writing formal work restrictions and talking with the employer. Temporary job transfers may be available. In some cases, a medical leave is needed. The primary care provider can play a key role in assisting patients to reduce reproductive risks.

  17. Reproductive Tract Infections and Treatment Seeking Behavior among Married Adolescent Women 15-19 Years in India

    PubMed Central

    Prusty, Ranjan Kumar; Unisa, Sayeed

    2013-01-01

    Background: India is home to the highest number of adolescents in the world. Adolescents in India suffer from lack of knowledge and empowerment to make informed sexual and reproductive health decisions. This paper analyses the prevalence of reproductive tract infections and sexually transmitted infections (RTI/STI) and treatment seeking behavior among married adolescent women in India aged 15-19 years. Methods: Data from the District Level Household Survey (DLHS, 2007-08) of India were used. The prevalence of RTIs symptoms and treatment seeking behavior among women by different socio-demographic characteristics was analyzed. Factor analysis was utilized to create an index using information about 11 symptoms of RTI/STI collected in the survey. Linear and binary logistic regressions were used to know the association between infections and treatment seeking behavior with socio-demographic factors. Results: About 15 percent of adolescent women reported having any symptoms of RTI/STI. The main symptoms reported were low backache, pain in the lower abdomen, pain during intercourse and itching or irritation around the vulvar region. Factor analysis showed the concentration of diseases in three clusters - infection in around the vulva, other reproductive infection and abnormal discharge; and intercourse related problems. Major predictors of both symptoms of reproductive infections and treatment seeking behavior from multivariate analysis are age, education, wealth, region and awareness about RTI/STI. Conclusions and Public Health Implications: Knowledge and treatment seeking behavior is poor among adolescent women in India. There is need for programmatic and policy emphasis on increasing knowledge and awareness through family life education including in educational curriculum at school level. PMID:27621963

  18. Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology.

    PubMed

    Wennberg, Anna Lena; Opdahl, Signe; Bergh, Christina; Aaris Henningsen, Anna-Karina; Gissler, Mika; Romundstad, Liv Bente; Pinborg, Anja; Tiitinen, Aila; Skjærven, Rolv; Wennerholm, Ulla-Britt

    2016-10-01

    To compare the effect of maternal age on assisted reproductive technology (ART) and spontaneous conception (SC) pregnancies regarding maternal and neonatal complications. Nordic retrospective population-based cohort study. Data from national ART registries were cross-linked with national medical birth registries. Not applicable. A total of 300,085 singleton deliveries: 39,919 after ART and 260,166 after SC. None. Hypertensive disorders in pregnancy (HDP), placenta previa, cesarean delivery, preterm birth (PTB; <37 weeks), low birth weight (LBW; <2,500 g), small for gestational age (SGA), and perinatal mortality (≥28 weeks). Adjusted odds ratios (AORs) were calculated. Associations between maternal age and outcomes were analyzed. The risk of placenta previa (AOR 4.11-6.05), cesarean delivery (AOR 1.18-1.50), PTB (AOR 1.23-2.19), and LBW (AOR 1.44-2.35) was significantly higher in ART than in SC pregnancies for most maternal ages. In both ART and SC pregnancies, the risk of HDP, placenta previa, cesarean delivery, PTB, LBW, and SGA changed significantly with age. The AORs for adverse neonatal outcomes at advanced maternal age (>35 years) showed a greater increase in SC than in ART. The change in risk with age did not differ between ART and SC for maternal outcomes at advanced maternal age. Having singleton conceptions after ART results in higher maternal and neonatal outcome risks overall, but the impact of age seems to be more pronounced in couples conceiving spontaneously. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. Harm as the price of liberty? Pre-implantation diagnosis and reproductive freedom.

    PubMed

    Haker, Hille

    2003-01-01

    Reproductive autonomy is often used as an argument to offer assisted reproduction services to women and to continue research into improving this service. What is often overlooked, however, is the gendered and normative background of parenthood, especially of motherhood. In this paper, I attempt to make women visible and to listen to their voices. Turning to the women's stories, the ethical perspective might be reversed: the so-called 'side-effects' of the overall successful assisted reproduction with or without genetic diagnosis, are to be considered the 'main effects' of assisted reproduction--true for the majority of couples and women. Autonomy, then, must be reformulated as concept of moral agency in the context of divergent social contexts and cultures of parenthood, of socially shaped images of disability, and in the context of scientific visions of technology which do not necessarily match with the medical practice.

  20. [Osteopontin and male reproduction].

    PubMed

    Liu, Qian; Xie, Qing-Zhen

    2012-05-01

    Osteopontin (OPN) is an extracellular matrix protein with multifunctions, expressed in various tissues and body fluids, involved in various physiological and pathological processes. It is also detected in the reproductive tract of both males and females, and participates in the implantation, development and differentiation of embryos. Recent studies have indicated that OPN is closely related with male fertility and may affect sperm quality and fertilization. An insight into the functions of OPN may help to explain the mechanisms of male infertility and improve the success rate of assisted reproductive technology.

  1. The implications of male human papilloma virus infection in couples seeking assisted reproduction technologies.

    PubMed

    Çağlar, Gamze Sinem; Garrido, Nicolas

    2018-03-01

    Human papilloma virus (HPV) is one of the most common viral sexually-transmitted diseases worldwide. The prevalence of HPV is higher in infertile males when compared with fertile men and ranges between 10 and 35.7% in men affected by unexplained infertility. HPV can bind to spermatozoa and can potentially be transferred to fertilized oocytes. Viral detection in blastocysts and trophoblastic cells is associated with impaired embryo development and poor pregnancy outcomes. Nevertheless, attempts to eliminate HPV-DNA from sperm samples through routine washing techniques have failed. In assisted reproduction technologies (ART), intracytoplasmic sperm injection involves no natural selection of the sperm cell, which means that these procedures have a plausible risk of injecting sperm containing HPV. The possible detrimental effects of HPV on ART in couples with infected male partners are summarized in this review.

  2. Influence of clinical mastitis and its treatment outcome on reproductive performance in crossbred cows: A retrospective study

    PubMed Central

    Kumar, Narender; Manimaran, A.; Sivaram, M.; Kumaresan, A.; Jeyakumar, S.; Sreela, L.; Mooventhan, P.; Rajendran, D.

    2017-01-01

    Aim: Evaluation of the effect of clinical mastitis (CM) and its treatment outcome on the reproductive performance in crossbred cows retrospectively. Materials and Methods: Datasets of 835 lactating cows affected with CM during a period of 12 years (2001-2012) were considered for this study. Mastitis treatment related data and reproductive parameters such as days to first detected heat (DTFDH), days to first insemination (DTFI), days open (DO), and number of services per conception (SC) were collected from mastitis treatment and artificial insemination registers, respectively. Data were analyzed by ANOVA using SPSS 20 software. The means were compared with the Duncan’s multiple comparison post-hoc test. Results: CM affected cows had significantly (p<0.05) higher DTFDH, DTFI, DO and SC compared to clinically healthy cows. Cows diagnosed with a single episode of CM had significantly (p<0.05) delayed DTFDH while, DO and SC were significantly higher (p<0.05) in cows diagnosed by multiple episodes of CM. SC was significantly (p<0.05) higher in cows diagnosed with both relapse and recurrence. Severe CM affected cows had significantly (p<0.05) altered reproductive parameters. The reproductive parameters were altered to high extent when CM occurred during the breeding period. Conclusion: CM-affected cows had higher DTFDH, DTFI, DO and SC compared to clinically healthy cows. The negative effects of CM on reproduction parameters were higher when CM occurred during the breeding period. PMID:28620250

  3. Antral follicle counts are strongly associated with live-birth rates after assisted reproduction, with superior treatment outcome in women with polycystic ovaries.

    PubMed

    Holte, Jan; Brodin, Thomas; Berglund, Lars; Hadziosmanovic, Nermin; Olovsson, Matts; Bergh, Torbjörn

    2011-09-01

    To evaluate the association of antral follicle count (AFC) with in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI) outcome in a large unselected cohort of patients covering the entire range of AFC. Prospective observational study. University-affiliated private infertility center. 2,092 women undergoing 4,308 IVF-ICSI cycles. AFC analyzed for associations with treatment outcome and statistically adjusted for repeated treatments and age. Pregnancy rate, live-birth rate, and stimulation outcome parameters. The AFC was log-normally distributed. Pregnancy rates and live-birth rates were positively associated with AFC in a log-linear way, leveling out above AFC ∼30. Treatment outcome was superior among women with polycystic ovaries, independent from ovulatory status. The findings were significant also after adjustment for age and number of oocytes retrieved. Pregnancy and live-birth rates are log-linearly related to AFC. Polycystic ovaries, most often excluded from studies on ovarian reserve, fit as one extreme in the spectrum of AFC; a low count constitutes the other extreme, with the lowest ovarian reserve and poor treatment outcome. The findings remained statistically significant also after adjustment for the number of oocytes retrieved, suggesting this measure of ovarian reserve comprises information on oocyte quality and not only quantity. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. Honeymoon, medical treatment or big business? An analysis of the meanings of the term "reproductive tourism" in German and Israeli public media discourses.

    PubMed

    Bassan, Sharon; Michaelsen, Merle A

    2013-08-20

    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. 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. 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.

  5. Birth Outcomes by Infertility Diagnosis Analyses of the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART).

    PubMed

    Luke, Barbara; Stern, Judy E; Kotelchuck, Milton; Declercq, Eugene R; Cohen, Bruce; Diop, Hafsatou

    2015-01-01

    To evaluate assisted reproductive technology (ART) pregnancy outcomes by infertility diagnosis. ART data on women who were treated and gave birth in Massachusetts were linked to vital records and hospital utilization data. Live births were categorized by 8 mutually exclusive ART diagnoses. Risks of prematurity, low birthweight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA), pregnancy hypertension, gestational diabetes, prenatal hospitalizations, and primary cesarean delivery were modeled using logistic regression, adjusted for parental characteristics, treatment parameters, and plurality (adjusted odds ratios [AORs] and 95% confidence intervals); the reference group were pregnancies with the diagnosis of malefactor. Among the 7,354 singleton and twin pregnancies, there were nonsignificant differences in the risks for LBW, SGA, or LGA. Significantly increased risks included gestational diabetes (ovulation disorders, AOR 1.80, 1.35-2.41), prematurity (ovulation disorders, AOR 1.36, 1.08-1.71; other factors, AOR 1.33, 1.05-1.67), prenatal hospital admissions (endometriosis, tubal and other factors, ovulation disorders, and uterine factors, AORs ranging from 1.66-2.68), and primary cesarean section (uterine factors, AOR 1.96, 1.15-3.36). Although the infant outcomes of LBW, SGA, and LGA were generally similar across diagnosis groups, specific diagnoses had greater risks for prematurity, gestational diabetes, prenatal hospital utilization, and primary cesarean delivery. (J Reprod Med 2015;

  6. Review: MicroRNAs in assisted reproduction and their potential role in IVF failure.

    PubMed

    Siristatidis, Charalampos; Vogiatzi, Paraskevi; Brachnis, Nikos; Liassidou, Aspasia; Iliodromiti, Zoe; Bettocchi, Stefano; Chrelias, Charalampos

    2015-01-01

    MicroRNAs (miRNAs) have recently emerged as important regulators of gene expression stability. In the endometrium, miRNAs are involved in the dynamic changes associated with the menstrual cycle, implicated in implantation and in reproductive disorders. We performed a review in an attempt to assess the potential biological pathways linking altered miRNAs profiles with in vitro fertilisation (IVF) failure. Crucially, as miRNAs appear to have a significant role in the course of reproduction, they are excellent research candidates with the potential to enable a better understanding over the underlying molecular activities that prevent implantation and further progression of the embryo. Further steps include in-depth pathway mapping of the implantation process and the characterization of the respective miRNAs and associated links. The efficiency of any intervention should determine whether miRNA profiling could possibly be adopted in routine practice to substantially improve the diagnostic accuracy and, in parallel, the directed treatment of the next-generation IVF. Copyright © 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  7. The relevance and use of mouse embryo bioassays for quality control in an assisted reproductive technology program.

    PubMed

    Scott, L F; Sundaram, S G; Smith, S

    1993-09-01

    To define both the limits of a mouse embryo bioassay for quality control in an assisted reproductive technology (ART) program and the areas where it can be effectively used. Embryos at the pronuclear and two-cell stage from three different strains of mice were used to assess the effectiveness of this assay for media quality control using five different media routinely used in ART. Pronuclear and two-cell embryos from CD-1 mice were used to test the ability of a mouse embryo bioassay to control for water quality, contaminants in the culture system, and fluctuations in the environmental conditions using a medium, culture system, and scoring technique that were optimized for this strain. The mouse embryo bioassay is not effective in differentiating media appropriate for supporting human embryo development since the development of mouse embryos in vitro is strain, stage, and media related. However, CD-1 embryos were shown to be sensitive to variations in water quality, pH, temperature, incubator conditions, and contaminants in the system when grown in a protein-free medium optimized for their development. Both total blastocyst number and the cell count in the blastocysts were affected. Pronuclear embryos were more sensitive to perturbations in the culture system than two-cell embryos. A mouse embryo bioassay can be effectively used as a means of quality control of water, chemicals, and contact materials and for technique standardization and training in an assisted reproduction program. All the conditions of the test should be defined, pronuclear embryos should be used, and the end point should be fully expanded blastocysts and/or cell numbers in these blastocysts where appropriate.

  8. Embryo transfer practices in the United States: a survey of clinics registered with the Society for Assisted Reproductive Technology.

    PubMed

    Jungheim, Emily S; Ryan, Ginny L; Levens, Eric D; Cunningham, Alexandra F; Macones, George A; Carson, Kenneth R; Beltsos, Angeline N; Odem, Randall R

    2010-09-01

    To gain a better understanding of factors influencing clinicians' embryo transfer practices. Cross-sectional survey. Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). None. None. Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. Six percent of respondents reported following their own, independent guidelines for the number of embryos to transfer after IVF. Of the 94% of respondents who reported routinely following ASRM embryo transfer guidelines, 52% would deviate from these guidelines for patient request, 51% for cycles involving the transfer of frozen embryos, and 70% for patients with previously failed IVF cycles. All respondents reported routinely discussing the risks of multiple gestations associated with standard embryo transfer practices, whereas only 34% reported routinely discussing single embryo transfer with all patients. Although the majority of clinicians responding to our survey reported following ASRM embryo transfer guidelines, at least half would deviate from these guidelines in a number of different situations. Copyright (c) 2010 American Society for Reproductive Medicine. All rights reserved.

  9. Dynamism to promote reproductive medicine and its development, Rihachi Iizuka.

    PubMed

    Sueoka, K

    2001-12-01

    Rihachi Iizuka has contributed strong leadership for the remarkable development of reproductive medicine which has undergone a complete transformation in the previous half century. The Keio University Hospital introduced artificial insemination as the first assisted reproductive technology in Japan. As it follows, lizuka and his colleagues first reported the live birth of a female infant in August 1949 after heterologous insemination: AID. Iizuka and his colleagues were also among the first to successfully inseminate a woman with sperm that had been frozen. He developed the new cryopreservation medium for human semen called "KS Cryo-medium". He also developed semen preparation methods of washing and concentrating sperm counts by centrifugation with Percoll (colloidal silica derivative) solution for oligozoospermic patients. These methods are broadly used in the clinical field. Furthermore, he developed the X-, Y-bearing sperm preseparation method using Percoll which is the so-called "gender selection" procedure for preventing X-linked genetic disorders. The most striking assisted reproductive technology was in vitro fertilization first carried out in Britain. Prior to the clinical application in Japan, the Japan Society of Fertilization and Implantation was established as the main organ for the exchange of official scientific information by lizuka in 1982. As rapid development and spreading of in vitro fertilization and its implicated technologies, lizuka and his colleague of the department had the first success of offspring following embryo freezing and thawing in Japan which was performed at the Tokyo Dental College Ichikawa General Hospital. Already the numbers of offspring following in vitro fertilization treatment has risen to approximately 1% of births in Japan. Rihachi lizuka still undertakes the responsibility for reproductive medicine as he has done so far.

  10. Introduction: Immunology and assisted reproductive technology in the 21st century.

    PubMed

    Garcia-Velasco, Juan A

    2017-06-01

    In the past few years we have witnessed reproductive immunology taking a leading role after repeated implantation failure. We still face the problem of even euploid embryos that either fail to implant or are miscarried. These focused articles present the attending clinician with the most recent evidence to understand how immunology contributes to human reproduction, what can be done at the clinical level, and what is still an area for research and should not be offered to patients outside of a clinical research scenario. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  11. Applied reproductive technologies and genetic resource banking for amphibian conservation.

    PubMed

    Kouba, Andrew J; Vance, Carrie K

    2009-01-01

    As amphibian populations continue to decline, both government and non-government organisations are establishing captive assurance colonies to secure populations deemed at risk of extinction if left in the wild. For the most part, little is known about the nutritional ecology, reproductive biology or husbandry needs of the animals placed into captive breeding programs. Because of this lack of knowledge, conservation biologists are currently facing the difficult task of maintaining and reproducing these species. Academic and zoo scientists are beginning to examine different technologies for maintaining the genetic diversity of founder populations brought out of the wild before the animals become extinct from rapidly spreading epizootic diseases. One such technology is genetic resource banking and applied reproductive technologies for species that are difficult to reproduce reliably in captivity. Significant advances have been made in the last decade for amphibian assisted reproduction including the use of exogenous hormones for induction of spermiation and ovulation, in vitro fertilisation, short-term cold storage of gametes and long-term cryopreservation of spermatozoa. These scientific breakthroughs for a select few species will no doubt serve as models for future assisted breeding protocols and the increasing number of amphibians requiring conservation intervention. However, the development of specialised assisted breeding protocols that can be applied to many different families of amphibians will likely require species-specific modifications considering their wide range of reproductive modes. The purpose of this review is to summarise the current state of knowledge in the area of assisted reproduction technologies and gene banking for the conservation of amphibians.

  12. Reproductive Medicine in Amphibians.

    PubMed

    Chai, Norin

    2017-05-01

    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. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Ethical Issues of Reproductive Technologies: Legal and Ethical.

    ERIC Educational Resources Information Center

    Kammler, Kim

    Ethical issues which surround the reproductive technologies being used to assist infertile couples include social impact, surrogacy, access to service and confidentiality. The use of reproductive technologies does not appear to cause harm, and often does a lot of good for the family and society. Surrogacy could be a valuable tool for the infertile…

  14. Association of birth defects with the mode of assisted reproductive technology in a Chinese data-linkage cohort.

    PubMed

    Yu, Hui-Ting; Yang, Qing; Sun, Xiao-Xi; Chen, Guo-Wu; Qian, Nai-Si; Cai, Ren-Zhi; Guo, Han-Bing; Wang, Chun-Fang

    2018-05-01

    To evaluate the impact of assisted reproductive technology (ART) on the offspring of Chinese population. Retrospective, data-linkage cohort. Not applicable. Live births resulting from ART or natural conception. None. Birth defects coded according to ICD-10. Births after ART were more likely to be female and multiple births, especially after intracytoplasmic sperm injection (ICSI). ART was associated with a significantly increased risk of birth defects, especially, among singleton births, a significantly increased risk in fresh-embryo cycles after in vitro fertilization (IVF) and frozen-embryo cycles after ICSI. Associations between ART and multiple defects, between ART and gastrointestinal malformation, genital organs malformation, and musculoskeletal malformation among singleton births, and between ART and cardiac septa malformation among multiple births were observed. This study suggests that ART increases the risk of birth defects. Subgroup analyses indicate higher risk for both fresh and frozen embryos, although nonsignificantly for frozen embryos after IVF and for fresh embryos were presented with low power. Larger sample size research is needed to clarify effects from fresh- or frozen-embryo cycles after IVF and ICSI. Copyright © 2018 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  15. Adverse obstetric and perinatal outcomes in subfertile women conceiving without assisted reproductive technologies.

    PubMed

    Jaques, Alice M; Amor, David J; Baker, H W Gordon; Healy, David L; Ukoumunne, Obioha C; Breheny, Sue; Garrett, Claire; Halliday, Jane L

    2010-12-01

    To determine whether adverse perinatal outcomes are increased in subfertile women. Cohort study. Two tertiary assisted reproductive technologies (ART) centers; Victorian births register. Records of women who registered with the clinics (1991-2000), but did not have an infant using ART, were linked to the birth register (1991-2004) to identify singleton non-ART births within 5 years of registration (N = 2171). Controls, matched by maternal age and year of infant's birth, were selected randomly from birth records (N = 4363). None. Adverse obstetric and perinatal outcomes. After adjusting for confounders, compared with controls, subfertile women had increased odds of hypertension or preeclampsia (adjusted odds ratio [OR] 1.29, 1.02-1.61), antepartum hemorrhage (adjusted OR 1.41, 1.05-1.89), perinatal death (adjusted OR 2.19, 1.10-4.36), low birth weight (adjusted OR 1.44, 1.11-1.85), preterm birth <37 weeks (adjusted OR 1.32, 1.05-1.67) or <31 weeks (adjusted OR 2.37, 1.35-4.13), and cesarean delivery (adjusted OR 1.56, 1.37-1.77). There was weak evidence for increased birth defects (adjusted OR 1.30, 0.98-1.72) and gestational diabetes (adjusted OR 1.25, 0.96-1.63). No increased risk was found for prelabor rupture of membranes, small for gestational age, or postpartum hemorrhage. Subfertile women with singleton births are at increased risk of several adverse outcomes. These risks should be considered during their antenatal care and when analyzing adverse effects of ART. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. Dental treatment and employment outcomes among social assistance recipients in Ontario, Canada.

    PubMed

    Singhal, Sonica; Mamdani, Muhammad; Mitchell, Andrew; Tenenbaum, Howard; Lebovic, Gerald; Quiñonez, Carlos

    2016-10-01

    Policy advocates continue to argue for the expansion of dental care services for people on social assistance in order to meet their health needs and to promote the move from welfare-to-work. However, there is little to no evidence to support the idea that receiving dental care ultimately improves employment outcomes. A retrospective cohort study was designed using administrative data from five Ontario regions and from the province's social assistance ministry. Employment outcomes among treatment and no-treatment cohorts were assessed at three, six and 12 months from baseline. Multivariable regression modeling was performed. We received data for 8742 people (2742 treatment, 6000 no-treatment). At one year, employment outcomes were not significantly different between the two groups (adjusted odds ratio=0.93; 95% CI: 0.83-1.03). Post-hoc analysis show that the change in proportion of individuals leaving social assistance for employment over time was significantly higher (p=0.0014) among those receiving treatment (13-29%; 124% increase) than those not receiving treatment (18-33%; 83% increase). At one year, dental treatment alone does not appear to be significantly associated with leaving assistance for employment in this population. However, this study suggests that people who received dental treatment may have been particularly disadvantaged and dental treatment may help to level them up in terms of employment outcomes over time. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Arab Americans, African Americans, and infertility: barriers to reproduction and medical care.

    PubMed

    Inhorn, Marcia C; Fakih, Michael Hassan

    2006-04-01

    To compare barriers to infertility care among African Americans and Arab Americans. Qualitative study using semi-structured reproductive histories and open-ended ethnographic interviews. Infertile volunteers in a private IVF clinic in Dearborn, Michigan, an Arab American ethnic enclave community in metropolitan Detroit. Arab American men presenting for infertility diagnosis and treatment, including assisted reproductive technologies. None. Perceived barriers to effective infertility care. Arab Americans and African Americans living in metropolitan Detroit are at increased risk of infertility and share similar histories of poverty, racism, and cultural barriers to medical treatment. This study, which focused on infertile Arab American men living in or near Dearborn (an ethnic enclave community composed mainly of recent immigrants and war refugees), revealed significant barriers to effective infertility care, including economic constraints, linguistic and cultural barriers, and social marginalization in mainstream U.S. society, particularly after September 11, 2001. Arab Americans experience disparities in access to infertility care, largely because of poverty and social marginalization in post-September 11th America.

  19. Surgical treatment of multiple symmetric lipomatosis with ultrasound-assisted liposuction.

    PubMed

    Bassetto, Franco; Scarpa, Carlotta; De Stefano, Fabio; Busetto, Luca

    2014-11-01

    Multiple symmetric lipomatosis (MSL) is a rare disease of unknown etiology, characterized by the presence of multiple, symmetrical, noncapsulated lipomas, mostly in the neck and upper trunk. To date, there is no effective medical treatment of MSL. Surgical treatment is based on 2 options, namely, lipectomy and/or liposuction. In this retrospective study, we compare traditional lipectomy with ultrasound-assisted liposuction. Our initial experience demonstrates that the ultrasound-assisted liposuction procedure can be applied to patients with MSL, allowing simultaneous treatment of multiple areas in a single session and the removal of a substantial amount of fat, thus improving aesthetic results. If lipomas are circumscribed and isolated, traditional lipectomy is probably to be preferred.

  20. 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 ( P atient- O riented S trategies E ncompassing I ndividualize D O ocyte N umber) 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

  1. Use of preimplantation genetic diagnosis and preimplantation genetic screening in the United States: a Society for Assisted Reproductive Technology Writing Group paper.

    PubMed

    Ginsburg, Elizabeth S; Baker, Valerie L; Racowsky, Catherine; Wantman, Ethan; Goldfarb, James; Stern, Judy E

    2011-10-01

    To comprehensively report Society for Assisted Reproductive Technology (SART) member program usage of preimplantation genetic testing (PGT), preimplantation genetic diagnosis (PGD) for diagnosis of specific conditions, and preimplantation genetic screening for aneuploidy (PGS). Retrospective study. United States SART cohort data. Women undergoing a PGT cycle in which at least one embryo underwent biopsy. PGT. PGT use, indications, and delivery rates. Of 190,260 fresh, nondonor assisted reproductive technology (ART) cycles reported to SART CORS in 2007-2008, 8,337 included PGT. Of 6,971 cycles with a defined indication, 1,382 cycles were for genetic diagnosis, 3,645 for aneuploidy screening (PGS), 527 for translocation, and 1,417 for elective sex election. Although the total number of fresh, autologous cycles increased by 3.6% from 2007 to 2008, the percentage of cycles with PGT decreased by 5.8% (4,293 in 2007 and 4,044 in 2008). As a percentage of fresh, nondonor ART cycles, use dropped from 4.6% (4,293/93,433) in 2007 to 4.2% (4,044/96,827) in 2008. The primary indication for PGT was PGS: cycles performed for this indication decreased (-8.0%). PGD use for single-gene defects (+3.2%), elective sex selection (+5.3%), and translocation analysis (+0.5%) increased. PGT usage varied significantly by geographical region. PGT usage in the United States decreased between 2007 and 2008 owing to a decrease in PGS. Use of elective sex selection increased. High transfer cancellation rates correlated with reduced live-birth rates for some PGT indications. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Developing the Maternity Portfolio to promote maternal role attainment in women who have undergone artificial reproductive treatment.

    PubMed

    Iwata, Hiroko; Mori, Emi; Maekawa, Tomoko; Maehara, Kunie; Sakajo, Akiko; Ozawa, Harumi; Morita, Akiko

    2012-12-01

    The purpose of this study was to develop the Maternity Portfolio to promote maternal role attainment in women who underwent artificial reproductive treatment. The following procedures were undertaken to develop the Maternity Portfolio: (i) a literature review was conducted to identify studies and articles related to maternal diary or portfolio usage; (ii) the research members discussed objectives and usages of the Maternity Portfolio; (iii) a trial product was developed in collaboration with two pregnant women (one following artificial reproductive treatment and one infertility patient) and seven nurses, and after feedback was completed, the product was revised; and (iv) the final product of the Maternity Portfolio was patented. The final Maternity Portfolio product consisted of a 40-page booklet; it contained an information section and a patient comments section. Following artificial reproductive treatment, this booklet can be provided to women during the first trimester. Women would then be instructed to bring the Maternity Portfolio to their prenatal checkups, where a nursing intervention program would be conducted by certified nurses. Through this program and the Maternity Portfolio, participating women are expected to obtain necessary information and maternal role attainment. The Maternity Portfolio was developed to promote maternal role attainment for women who have undergone artificial reproductive treatment. The intervention study with the Maternity Portfolio is a work in progress; therefore, a future evaluation of the study will clarify both positive and negative aspects, which should facilitate refinement of the functions and qualities of the Maternity Portfolio. © 2011 The Authors. Japan Journal of Nursing Science © 2011 Japan Academy of Nursing Science.

  3. Patterns of globalized reproduction: Egg cells regulation in Israel and Austria

    PubMed Central

    2012-01-01

    Since the successful introduction of in vitro fertilization in 1978, medically assisted reproduction (MAR) has proliferated in multiple clinical innovations. Consequently, egg cells have become an object of demand for both infertility treatment and stem cell research, and this raises complex legal, ethical, social and economic issues. In this paper we compare how the procurement and use of human egg cells is regulated in two countries: Israel and Austria. Israel is known for its scientific leadership, generous public funding, high utilization and liberal regulation of assisted reproductive technology (ART). Austria lies at the other extreme of the regulatory spectrum in terms of restrictions on reproductive interventions. In both countries, however, there is a constant increase in the use of the technology, and recent legal developments make egg cells more accessible. Also, in both countries the scarcity of egg cells in concert with the rising demand for donations has led to the emergence of cross-border markets and global 'reproductive tourism' practices. In Israel, in particular, a scandal known as the 'eggs affair' was followed by regulation that allowed egg cell donations from outside the country under certain conditions. Cross-border markets are developed by medical entrepreneurs, driven by global economic gaps, made possible by trans-national regulatory lacunae and find expression as consumer demand. The transnational practice of egg cell donations indicates the emergence of a global public health issue, but there is a general lack of medical and epidemiological data on its efficacy and safety. We conclude that there is need for harmonisation of domestic laws and formulation of new instruments for international governance. PMID:22913734

  4. Patterns of globalized reproduction: Egg cells regulation in Israel and Austria.

    PubMed

    Shalev, Carmel; Werner-Felmayer, Gabriele

    2012-04-18

    Since the successful introduction of in vitro fertilization in 1978, medically assisted reproduction (MAR) has proliferated in multiple clinical innovations. Consequently, egg cells have become an object of demand for both infertility treatment and stem cell research, and this raises complex legal, ethical, social and economic issues.In this paper we compare how the procurement and use of human egg cells is regulated in two countries: Israel and Austria. Israel is known for its scientific leadership, generous public funding, high utilization and liberal regulation of assisted reproductive technology (ART). Austria lies at the other extreme of the regulatory spectrum in terms of restrictions on reproductive interventions.In both countries, however, there is a constant increase in the use of the technology, and recent legal developments make egg cells more accessible. Also, in both countries the scarcity of egg cells in concert with the rising demand for donations has led to the emergence of cross-border markets and global 'reproductive tourism' practices. In Israel, in particular, a scandal known as the 'eggs affair' was followed by regulation that allowed egg cell donations from outside the country under certain conditions.Cross-border markets are developed by medical entrepreneurs, driven by global economic gaps, made possible by trans-national regulatory lacunae and find expression as consumer demand. The transnational practice of egg cell donations indicates the emergence of a global public health issue, but there is a general lack of medical and epidemiological data on its efficacy and safety. We conclude that there is need for harmonisation of domestic laws and formulation of new instruments for international governance.

  5. The impact of high progesterone levels on the day of HCG administration in assisted human reproduction treatments.

    PubMed

    Tanada, Michelli S; Yoshida, Ivan H; Santos, Monise; Berton, Caroline Z; Souto, Elen; Carvalho, Waldemar P de; Cordts, Emerson B; Barbosa, Caio P

    2018-06-01

    Progesterone is a steroid hormone that acts on the endometrium. It is known for producing physical and mood-related side effects. Few studies have looked into how progesterone levels affect embryo development and quality. This study aimed to find a cutoff level for serum progesterone on the day of HCG administration from which embryo quality is impaired. The study included 145 cycles, from which 885 oocytes and 613 embryos were obtained. All patients had their serum progesterone levels measured on the day of HCG administration. Data sets were collected from patient medical records. The chi-square test was used to assess qualitative variables and the Mann-Whitney test to evaluate quantitative variables. Statistical analysis revealed that serum progesterone levels and reproductive variables were not significantly associated. In regards to oocyte maturity, however, when progesterone levels were greater than 1.3 ng/mL the probability of oocytes being immature increased by 12.7%. The fragmentation rate of embryos categorized as "top quality" in D3 increased proportionately to increases in progesterone levels (12.23%). High progesterone levels appeared to be correlated with increased embryo fragmentation rates, but high serum levels of the hormone on the day of HCG administration had no impact on reproductive variables and were not associated with impaired embryo development.

  6. The impact of legally restricted embryo transfer and reimbursement policy on cumulative delivery rate after treatment with assisted reproduction technology.

    PubMed

    Peeraer, K; Debrock, S; Laenen, A; De Loecker, P; Spiessens, C; De Neubourg, D; D'Hooghe, T M

    2014-02-01

    What is the impact of the Belgian legislation (1 July 2003), coupling reimbursement of six assisted reproduction technology (ART) cycles per patient to restricted embryo transfer policy, on cumulative delivery rate (CDR) per patient? The introduction of Belgian legislation in ART had no negative impact on the CDR per patient based on realistic estimates within six cycles or 36 months. The introduction of Belgian legislation limiting the number of embryos for transfer resulted in a reduction of the multiple pregnancy rate (MPR) per cycle by 50%. A retrospective cohort study with a study group after implementation of the new ART legislation (July 2003 to June 2006) and the control group, before legislation (July 1999 to June 2002). CDR was compared in an academic tertiary setting between a study group after legislation (n = 795 patients, 1927 fresh and 383 frozen-thawed embryo transfer (FET) cycles) and a control group before legislation (n = 463 patients, 876 fresh and 185 FET cycles) within six cycles or 36 months, delivery or discontinuation of treatment. The CDR was estimated using life table analysis considering pessimistic, optimistic and realistic scenarios and compared after adjustment for confounding variables. In the realistic scenario we included information on embryo quality to define the prognosis of each patient discontinuing treatment. In the realistic scenario, CDR within 36 months was comparable (all ages, P = 0.221) in study group (60.8%) and control group (65.6%), as well as in different age groups (<36 years, P = 0.242; 36-39 years, P = 0.851; 40-42 years, P = 0.840). In the realistic scenario applied to six cycles, we found lower CDRs in the study group than in the control group within the two first cycles (all ages, P = 0.009; <36 years, P = 0.007) but no difference in CDRs between the two groups within the four subsequent cycles (all ages P = 0.232; <36 years, P = 0.198). The CDR within six cycles was 60 and 65.3% for study group and control

  7. The Ethical, Legal, and Social Issues Impacted by Modern Assisted Reproductive Technologies

    PubMed Central

    Brezina, Paul R.; Zhao, Yulian

    2012-01-01

    Background. While assisted reproductive technology (ART), including in vitro fertilization has given hope to millions of couples suffering from infertility, it has also introduced countless ethical, legal, and social challenges. The objective of this paper is to identify the aspects of ART that are most relevant to present-day society and discuss the multiple ethical, legal, and social challenges inherent to this technology. Scope of Review. This paper evaluates some of the most visible and challenging topics in the field of ART and outlines the ethical, legal, and social challenges they introduce. Major Conclusions. ART has resulted in a tectonic shift in the way physicians and the general population perceive infertility and ethics. In the coming years, advancing technology is likely to exacerbate ethical, legal, and social concerns associated with ART. ART is directly challenging society to reevaluate the way in which human life, social justice and equality, and claims to genetic offspring are viewed. Furthermore, these issues will force legal systems to modify existing laws to accommodate the unique challenges created by ART. Society has a responsibility to ensure that the advances achieved through ART are implemented in a socially responsible manner. PMID:22272208

  8. Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance.

    PubMed

    Titov, Nickolai; Andrews, Gavin; Davies, Matthew; McIntyre, Karen; Robinson, Emma; Solley, Karen

    2010-06-08

    Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided. Would guidance from a technician be as effective as guidance from a clinician? Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and

  9. Internet Treatment for Depression: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance

    PubMed Central

    Titov, Nickolai; Andrews, Gavin; Davies, Matthew; McIntyre, Karen; Robinson, Emma; Solley, Karen

    2010-01-01

    Background Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided. Question: Would guidance from a technician be as effective as guidance from a clinician? Method Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program. Conclusions Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to

  10. Quality of information about success rates provided on assisted reproductive technology clinic websites in Australia and New Zealand.

    PubMed

    Hammarberg, Karin; Prentice, Tess; Purcell, Isabelle; Johnson, Louise

    2018-06-01

    Many factors influence the chance of having a baby with assisted reproductive technologies (ART). A 2016 Australian Competition and Consumer Commission (ACCC) investigation concluded that ART clinics needed to improve the quality of information they provide about chance of ART success. To evaluate changes in the quality of information about success rates provided on the websites of ART clinics in Australia and New Zealand before and after the ACCC investigation. Desktop audits of websites of ART clinics in Australia and New Zealand were conducted in 2016 and 2017 and available information about success rates was scored using a matrix with eight variables and a possible range of scores of 0-9. Of the 54 clinic websites identified in 2016, 32 had unique information and were eligible to be audited. Of these, 29 were also eligible to be audited in 2017. While there was a slight improvement in the mean score from 2016 to 2017 (4.93-5.28), this was not statistically significantly different. Of the 29 clinics, 14 had the same score on both occasions, 10 had a higher and five a lower information quality score in 2017. To allow people who consider ART to make informed decisions about treatment they need comprehensive and accurate information about what treatment entails and what the likely outcomes are. As measured by a scoring matrix, most ART clinics had not improved the quality of the information about success rates following the ACCC investigation. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  11. Patient and tissue identification in the assisted reproductive technology laboratory.

    PubMed

    Pomeroy, Kimball O; Racowsky, Catherine

    2012-06-01

    Several high-profile cases involving in vitro fertilization have recently received considerable media attention and highlight the importance of assuring patient and tissue identification. Within the assisted reproductive technology (ART) laboratory, there are many steps where wrong patient or tissue identity could have drastic results. Erroneous identity can result in tragic consequences for the patient, the laboratory, and for those working in the program as a whole. Such errors can result in enormous psychological and financial costs, as well as a loss in confidence. There are several critical steps that should be taken every single time and for each specific procedure performed in the ART laboratory to ensure the correct identification of patients and their tissue. These steps should be detailed in protocols that include the method of identification, the two unique identifiers that will be used, the sources of these identifiers, and often a system in which more than one person is involved in the identification. Each protocol should ideally include a checklist that is actively used for the implementation of each procedure. The protocol should also indicate what to do if the identification does not match up, including rapid handling and notification of the patient involved in the error. All ART laboratories should instill in their employees an atmosphere of full and open disclosure for cases where mistakes are made. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Assisted reproductive technologies are an integrated part of national strategies addressing demographic and reproductive challenges.

    PubMed

    Ziebe, Søren; Devroey, Paul

    2008-01-01

    The decline in the total fertility rate in the latter half of the 20th century in many European countries is becoming increasingly important in determining the demographic composition of Europe and its individual member states. This review focuses on discussion surrounding how assisted reproductive technology (ART) can impact declining fertility rates. This article summarizes key aspects of presentations given at the 'State of the ART 2007-ART and Society' meeting held in Lyon, France, in June 2007. For each topic, searches were conducted in MEDLINE and other databases and the results, alongside unpublished data and personal opinion, were presented to the Workshop Group. Individual subjects were discussed and any disagreements or omissions resolved. Although reduced fertility rates will have an impact on total population number, it is the change in the age structure of the population that is likely to be the most challenging factor faced by the European Union (EU). With evidence suggesting that an ageing population threatens future standards of living and social cohesion, managing demographic change through integrated policy response has become an important component of EU legislation. However, current measures fail to tackle the contribution that ART may play in alleviating falling fertility rates. Indeed, ART can have an important impact on economic and demographic factors, and should be incorporated into a population policy mix. Current barriers to ART include legislative restriction across different EU countries, limited availability to ART and current perception of ART in society. The inclusion of ART as part of a population policy mix in Europe is justified but must involve better communication among ART professionals, politicians and the general public.

  13. Current status of assisted reproductive technology in Korea, 2011.

    PubMed

    Lee, Gyoung Hoon; Song, Hyun Jin; Lee, Kyu Sup; Choi, Young Min

    2016-03-01

    The number of assisted reproductive technology (ART) clinics, ART cycles, clinical pregnancy rate (CPR), and number of newborns conceived using ART have steadily increased in South Korea. This aim of this study was to describe the status of ART in South Korea between January 1 and December 31, 2011. A localized online survey was created and sent to all available ART centers via email in 2015. Fresh embryo transfer (FET) cases were categorized depending on whether standard in vitro fertilization, intracytoplasmic sperm injection (ICSI), or half-ICSI procedures were used. Thawed embryo transfer (TET) and other related procedures were surveyed. Data from 36,990 ART procedures were provided by 74 clinics. Of the 30,410 cycles in which oocytes were retrieved, a complete transfer was performed in 91.0% (n=27,683). In addition, 9,197 cycles were confirmed to be clinical pregnancies in the FET cycles, representing a pregnancy rate of 30.2% per oocyte pick-up and 33.2% per ET. The most common number of embryos transferred in the FET procedures was three (38.1%), followed by two (34.7%) and one (14.3%). Of the 8,826 TET cycles, 3,137 clinical pregnancies (31.1%) were confirmed by ultrasonography. While the overall clinical pregnancy rate for the TET cycles performed was lower than the rate reported in 2010 (31.1% vs. 35.4%), the overall CPR for the FET cycles was higher than in 2010 (33.2% in 2011 and 32.9% in 2010). The most common number of embryos transferred in FET cycles was three, as was the case in 2010.

  14. Socioeconomic profile of couples seeking the public healthcare system (SUS) for infertility treatment.

    PubMed

    Tavares, Rachel; Cunha, Gisele; Aguiar, Lilian; Duarte, Shaytner Campos; Cardinot, Nilza; Bastos, Elizabeth; Coelho, Francisco

    2016-08-01

    The number of couples seeking assisted reproduction services in pursuit of the dream of conceiving a child is growing. In developing countries 10 to 15% of couples of childbearing age cannot bear a child by natural means and the impossibility of conceiving a child has a significant impact on the health and well-being of the couple. The aim of this study was to evaluate the socioeconomic profile and the main causes of infertility of couples seeking assisted reproduction treatment through the public healthcare system. We analyzed 600 medical records of couples who sought infertility treatment at the public healthcare system, and we divided them into three groups according to age: 35 years, 35 to 39, and 40 years or more. In each group we analyzed the cause of infertility, the number of children of the spouses, the education level and family income. The main cause of infertility was male-related in 34%, followed by tubal factor in 31.5%. We found that 56% of the women were less than 35 years old and 58% of the couples earned less than 3 minimum wages. The profile of the couples was: low-income, low education and less than 35 years of age. The cost of assisted reproductive treatment is still high, being restricted to couples of higher socioeconomic statuses. An effective public healthcare policy could minimize this problem by improving the quality of care for couples seeking infertility treatment at the public healthcare system.

  15. Dealing with uterine fibroids in reproductive medicine.

    PubMed

    Gambadauro, P

    2012-04-01

    Women who wish to conceive are nowadays more likely to present with uterine fibroids, mainly because of the delay in childbearing in our society. The relationship between uterine fibroids and human reproduction is still controversial and counselling patients might sometimes be challenging. This paper is to assist those involved in the management of patients of reproductive age presenting with uterine fibroids. The interference of fibroids on fertility largely depends on their location. Submucous fibroids interfere with fertility and should be removed in infertile patients, regardless of the size or the presence of symptoms. Intramural fibroids distorting the cavity reduce the chances of conception, while investigations on intramural fibroids not distorting the cavity have so far given controversial results. No evidence supports the systematic removal of subserosal fibroids in asymptomatic, infertile patients. Myomectomy is still the 'gold standard' in fibroid treatment for fertility-wishing patients. In experienced hands, hysteroscopic myomectomy is minimally invasive, safe, and effective. Abdominal and laparoscopic myomectomy might be challenging, but potential risks could be reduced by new strategies and techniques.

  16. Comparison of semen quality and outcome of assisted reproductive techniques in Chinese men with and without hepatitis B

    PubMed Central

    Zhou, Xu-Ping; Hu, Xiao-Ling; Zhu, Yi-Min; Qu, Fan; Sun, Sai-Jun; Qian, Yu-Li

    2011-01-01

    In this study, we aimed to determine the effects of hepatitis B virus (HBV) infection on sperm quality and the outcome of assisted reproductive technology (ART). A total of 916 men (457 HBV-positive and 459 HBV-negative) seeking fertility assistance from January 2008 to December 2009 at the Women's Hospital in the School of Medicine at Zhejiang University were analysed for semen parameters. Couples in which the men were hepatitis B surface antigen (HBsAg)-seropositive were categorized as HBV-positive and included 587 in vitro fertilisation (IVF) and 325 intracytoplasmic sperm injection (ICSI) cycles from January 2004 to December 2009; negative controls were matched for female age, date of ova retrieval, ART approach used (IVF or ICSI) and randomized in a ratio of 1:1 according to the ART treatment cycles (587 for IVF and 325 for ICSI). HBV-infected men exhibited lower semen volume, lower total sperm count as well as poor sperm motility and morphology (P<0.05) when compared to control individuals. Rates of two-pronuclear (2PN) fertilisation, high-grade embryo acquisition, implantation and clinical pregnancy were also lower among HBV-positive patients compared to those of HBV-negative patients after ICSI and embryo transfer (P<0.05); IVF outcomes were similar between the two groups (P>0.05). Logistic regression analysis showed that HBV infection independently contributed to increased rates of asthenozoospermia and oligozoospermia/azoospermia (P<0.05) as well as decreased rates of implantation and clinical pregnancy in ICSI cycles (P<0.05). Our results suggest that HBV infection in men is associated with poor sperm quality and worse ICSI and embryo transfer outcomes but does not affect the outcome of IVF and embryo transfer. PMID:21399651

  17. Cryopreserved oocyte versus fresh oocyte assisted reproductive technology cycles, United States, 2013

    PubMed Central

    Crawford, Sara; Boulet, Sheree L.; Kawwass, Jennifer F.; Jamieson, Denise J.; Kissin, Dmitry M.

    2017-01-01

    Objective To compare characteristics, explore predictors, and compare assisted reproductive technology (ART) cycle, transfer, and pregnancy outcomes of autologous and donor cryopreserved oocyte cycles with fresh oocyte cycles. Design Retrospective cohort study from the National ART Surveillance System. Setting Fertility treatment centers. Patient(s) Fresh embryo cycles initiated in 2013 utilizing embryos created with fresh and cryopreserved, autologous and donor oocytes. Intervention(s) Cryopreservation of oocytes versus fresh. Main Outcomes Measure(s) Cancellation, implantation, pregnancy, miscarriage, and live birth rates per cycle, transfer, and/or pregnancy. Result(s) There was no evidence of differences in cancellation, implantation, pregnancy, miscarriage, or live birth rates between autologous fresh and cryopreserved oocyte cycles. Donor cryopreserved oocyte cycles had a decreased risk of cancellation before transfer (adjusted risk ratio [aRR] 0.74, 95% confidence interval [CI] 0.57–0.96) as well as decreased likelihood of pregnancy (aRR 0.88, 95% CI 0.81–0.95) and live birth (aRR 0.87, 95% CI 0.80–0.95); however, there was no evidence of differences in implantation, pregnancy, or live birth rates when cycles were restricted to those proceeding to transfer. Donor cryopreserved oocyte cycles proceeding to pregnancy had a decreased risk of miscarriage (aRR 0.75, 95% CI 0.58–0.97) and higher live birth rate (aRR 1.05, 95% CI 1.01–1.09) with the transfer of one embryo, but higher miscarriage rate (aRR 1.28, 95% CI 1.07–1.54) and lower live birth rate (aRR 0.95, 95% CI 0.92–0.99) with the transfer of two or more. Conclusion(s) There was no evidence of differences in ART outcomes between autologous fresh and cryopreserved oocyte cycles. There was evidence of differences in per-cycle and per-pregnancy outcomes between donor cryopreserved and fresh oocyte cycles, but not in per-transfer outcomes. PMID:27842997

  18. Cross-border reproductive care: an Ethics Committee opinion.

    PubMed

    2016-12-01

    Cross-border reproductive care (CBRC) is a growing worldwide phenomenon, raising questions about why assisted reproductive technology (ART) patients travel abroad, what harms and benefits may result, and what duties health-care providers may have in advising and treating patients who travel for reproductive services. Cross-border care offers benefits and poses harms to ART stakeholders, including patients, offspring, providers, gamete donors, gestational carriers, and local populations in destination countries. This document replaces the previous document of the same name, last published in 2013 (Fertil Steril 2013;100:645-50). Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  19. An international view of surgically assisted conception and surrogacy tourism.

    PubMed

    Ahmad, Nehaluddin

    2011-01-01

    Modern medicine, specifically assisted reproductive technology (ART), has overtaken the law in many jurisdictions around the world. New technologies and practices open a Pandora's Box of ethical, religious, social and legal questions, and may present a variety of significant legal problems to the courts and legislators. Surrogate motherhood and pregnancy through ART have both attracted controversy. Some groups condemn ART and want it banned while its supporters acknowledge there is a need for legislative guidelines and regulations. A proposed statute, the Assisted Reproductive Technique Services Act, aimed at regulating reproductive technologies, including surrogacy arrangements, will be introduced in the Malaysian parliament, probably in 2012, and the Assisted Reproductive Technology (Regulation) Bill 2010 is already before the Indian parliament. This paper will discuss several of the potential socio-legal issues surrounding ART in the light of the complex situation, with a comparative analysis of the Malaysian, USA, UK and Indian positions.

  20. Patient and cycle characteristics predicting high pregnancy rates with single-embryo transfer: an analysis of the Society for Assisted Reproductive Technology outcomes between 2004 and 2013.

    PubMed

    Mersereau, Jennifer; Stanhiser, Jamie; Coddington, Charles; Jones, Tiffany; Luke, Barbara; Brown, Morton B

    2017-11-01

    To analyze factors associated with high live birth rate and low multiple birth rate in fresh and frozen-thawed assisted reproductive technology (ART) cycles. Retrospective cohort analysis. Not applicable. The study population included 181,523 women undergoing in vitro fertilization with autologous fresh first cycles, 27,033 with fresh first oocyte donor cycles, 37,658 with fresh second cycles, and 35,446 with frozen-thawed second cycles. None. Live birth rate and multiple birth rate after single-embryo transfer (SET) and double embryo transfer (DET) were measured, in addition to cycle characteristics. In patients with favorable prognostic factors, including younger maternal age, transfer of a blastocyst, and additional embryos cryopreserved, the gain in the live birth rate from SET to DET was approximately 10%-15%; however, the multiple birth rate increased from approximately 2% to greater than 49% in both autologous and donor fresh and frozen-thawed transfer cycles. This study reports a 10%-15% reduction in live birth rate and a 47% decrement in multiple birth rate with SET compared with DET in the setting of favorable patient prognostic factors. Our findings present an opportunity to increase the rate of SET across the United States and thereby reduce the multiple birth rate and its associated poor perinatal outcomes with assisted reproductive technology pregnancies. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Globalization and gametes: reproductive 'tourism,' Islamic bioethics, and Middle Eastern modernity.

    PubMed

    Inhorn, Marcia C

    2011-04-01

    'Reproductive tourism' has been defined as the search for assisted reproductive technologies (ARTs) and human gametes (eggs, sperm, embryos) across national and international borders. This article conceptualizes reproductive tourism within 'global reproscapes,' which involve the circulation of actors, technologies, money, media, ideas, and human gametes, all moving in complicated manners across geographical landscapes. Focusing on the Muslim countries of the Middle East, the article explores the Islamic 'local moral worlds' informing the movements of Middle Eastern infertile couples. The ban on third-party gamete donation in Sunni Muslim-majority countries and the recent allowance of donor technologies in the Shia Muslim-majority countries of Iran and Lebanon have led to significant movements of infertile couples across Middle Eastern national borders. In the new millennium, Iran is leading the way into this 'brave new world' of high-tech, third-party assisted conception, with Islamic bioethical discourses being used to justify various forms of technological assistance. Although the Middle East is rarely regarded in this way, it is a key site for understanding the intersection of technoscience, religious morality, and modernity, all of which are deeply implicated in the new world of reproductive tourism.

  2. The Psychologist's Role in Family Building with Reproductive Technology.

    ERIC Educational Resources Information Center

    Mikesell, Susan G.

    About 1 in 12 couples in the United States face the "how to have" element of reproductive choices. Assistive Reproductive Technology (ART) involves manipulation of genetic material outside of the body. Infertile couples have a large range of options in the achievement of a conception and are easily overwhelmed. As new choices are offered…

  3. Developmental programming: insulin sensitizer treatment improves reproductive function in prenatal testosterone-treated female sheep.

    PubMed

    Veiga-Lopez, Almudena; Lee, James S; Padmanabhan, Vasantha

    2010-08-01

    Prenatal testosterone (T) excess causes reproductive and metabolic disruptions including insulin resistance, attributes of women with polycystic ovary syndrome. This study tested the hypothesis that insulin resistance contributes toward severity of reproductive disruptions in prenatally T-treated females. Pregnant sheep were injected im with 100 mg of T-propionate semiweekly from d 30-90 of gestation. Immediately after the first breeding season, a subset of controls and prenatal T-treated (TR) sheep were administered an insulin sensitizer (rosiglitazone; 8 mg/d) orally for 8 months. Untreated control and prenatal T-treated females (T group) were studied in parallel. Biochemical analyses revealed rosiglitazone to be safe for use in sheep. Glucose tolerance tests performed before and after the insulin sensitizer treatment found that insulin sensitizer decreased cumulative insulin, cumulative insulin/glucose ratio, and insulin area under the curve by about 50% and increased the insulin sensitivity index by about 70% in the TR compared with the T group. Twenty percent of TR females showed a reduced number of cycles in the second relative to first breeding season as opposed to 80% of T group females showing such deterioration. Insulin sensitizer treatment also decreased the number of aberrant cycles (>/=18 d) during the second breeding season in the TR group relative to the first as opposed to the T group females showing an increase in the second breeding season relative to the first. These findings provide evidence that insulin sensitizer treatment prevents further deterioration of the reproductive axis in prenatal T-treated sheep, a finding of translational relevance to women with polycystic ovary syndrome.

  4. Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility.

    PubMed

    Maroufizadeh, Saman; Karimi, Elaheh; Vesali, Samira; Omani Samani, Reza

    2015-09-01

    To investigate the impact of the number of previous infertility treatment failures on anxiety and depression. In a cross-sectional study, individuals (men and women, but not couples) aged at least 18 years who had a history of infertility and could read and write in Persian were enrolled at the Royan Institute, Tehran, Iran, between November 1, 2013, and February 28, 2014. Participants provided demographic and infertility information and completed the Persian version of the Hospital Anxiety and Depression Scale (HADS). Overall, 330 patients (122 men, 208 women) were included. Mean scores on the HADS anxiety and depression subscales (HADS-A and HADS-D) were 8.40±4.51 and 5.95±3.54, respectively. In multiple regression analysis, mean HADS-A scores were significantly higher for patients with one treatment failure (9.57±4.58) than for those without a history of treatment (7.79±4.13; P=0.003). HADS-D scores were significantly higher for patients with two failures (6.92±3.69) than for those with no previous treatment (5.59±3.79; P=0.019). Patients with infertility have increased depression and anxiety after infertility treatment failure. Counseling or treatment for these potential psychological effects should be considered after infertility treatment failure. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  5. The mixed message behind "Medication-Assisted Treatment" for substance use disorder.

    PubMed

    Robinson, Sean M; Adinoff, Bryon

    2018-01-01

    The gap between treatment utilization and treatment need for substance use disorders (SUDs) remains a significant concern in our field. While the growing call to bridge this gap often takes the form of more treatment services and/or better integration of existing services, this perspective proposes that more effective labels for and transparent descriptions of existing services would also have a meaningful impact. Adopting the perspective of a consumer-based health-care model (wherein treatments and services are products and patients are consumers) allows us to consider how labels like Addiction-focused Medical Management, Medication-Assisted Treatment, Medication-Assisted Therapy, and others may actually be contributing to the underutilization problem rather than alleviating it. In this perspective, "Medication-Assisted Therapy" for opioid-use disorder (OUD) is singled out and discussed as inherently confusing, providing the message that pharmacotherapy for this disorder is a secondary treatment to other services which are generally regarded, in practice, as ancillary. That this mixed message is occurring amidst a nationwide "opioid epidemic" is a potential cause for concern and may actually serve to reinforce the longstanding, documented stigma against OUD pharmacotherapy. We recommend that referring to pharmacotherapy for SUD as simply "medication," as we do for other chronic medical disorders, will bring both clarity and precision to this effective treatment approach.

  6. Processing of semen by density gradient centrifugation selects spermatozoa with longer telomeres for assisted reproduction techniques.

    PubMed

    Yang, Qingling; Zhang, Nan; Zhao, Feifei; Zhao, Wanli; Dai, Shanjun; Liu, Jinhao; Bukhari, Ihtisham; Xin, Hang; Niu, Wenbing; Sun, Yingpu

    2015-07-01

    The ends of eukaryotic chromosomes contain specialized chromatin structures called telomeres, the length of which plays a key role in early human embryonic development. Although the effect of sperm preparation techniques on major sperm characteristics, such as concentration, motility and morphology have been previously documented, the possible status of telomere length and its relation with sperm preparation techniques is not well-known for humans. The aim of this study was to investigate the role of density gradient centrifugation in the selection of spermatozoa with longer telomeres for use in assisted reproduction techniques in 105 samples before and after sperm processing. After density gradient centrifugation, the average telomere length of the sperm was significantly longer (6.51 ± 2.54 versus 5.16 ± 2.29, P < 0.01), the average motile sperm rate was significantly higher (77.9 ± 11.8 versus 44.6 ± 11.2, P < 0.01), but average DNA fragmentation rate was significantly lower (11.1 ± 5.9 versus 25.9 ± 12.9, P < 0.01) compared with raw semen. Additionally, telomere length was positively correlated with semen sperm count (rs = 0.58; P < 0.01). In conclusion, density gradient centrifugation is a useful technique for selection of sperm with longer telomeres. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  7. 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

  8. Attitudes of fertile and infertile woman towards new reproductive technologies: a case study of Lithuania

    PubMed Central

    2014-01-01

    Background This article analyzes several key issues in the debate: the acceptability of in vitro fertilization; regulation of assisted reproduction and the possibilities of reimbursement for assisted reproduction treatment in Lithuania. Method Two groups of respondents participated in the survey: fertile women and women with fertility disorders. 93 completed questionnaires from women with fertility problems and 146 from women with no fertility problems were analysed. Results Fertile respondents more frequently perceived the embryo as a human being (Fertile Individuals – 68.5%; Infertile Individuals – 35.5%; p < 0.05) and more frequently maintained that assisted reproduction treatment should be only partly reimbursed (Fertile Individuals – 71.3%; Infertile Individuals – 39.8%; p < 0.05). Respondents with fertility disorders more frequently thought that artificial insemination procedure could also be applied to unmarried couples (Fertile Individuals – 51.4%; Infertile Individuals – 76.3%; p < 0.05), and more frequently agreed that there should be no age limit for artificial insemination procedures (Fertile Individuals – 36.3%; Infertile Individuals – 67.7%; p < 0.05). The majority of respondents in both groups (Fertile Individuals – 77.4%; Infertile Individuals – 82.8%; p < 0.05) believed that donation of reproductive cells should be regulated by law. Fertile respondents more frequently considered that strict legal regulation was necessary in case of the number of transferred embryos (Fertile Individuals – 69.2%; Infertile Individuals – 39.8%; p < 0.05) and freezing of embryos (Fertile Individuals – 69.9%; Infertile Individuals – 57.0%; p < 0.05). Conclusion Fertile respondents were statistically more likely to believe that the IVF procedure should be applied only to married couples or women who had a regular partner, the age limit should be defined and the psychological assessment of the couple’s relationship and their readiness for the

  9. Barcode tagging of human oocytes and embryos to prevent mix-ups in assisted reproduction technologies.

    PubMed

    Novo, Sergi; Nogués, Carme; Penon, Oriol; Barrios, Leonardo; Santaló, Josep; Gómez-Martínez, Rodrigo; Esteve, Jaume; Errachid, Abdelhamid; Plaza, José Antonio; Pérez-García, Lluïsa; Ibáñez, Elena

    2014-01-01

    Is the attachment of biofunctionalized polysilicon barcodes to the outer surface of the zona pellucida an effective approach for the direct tagging and identification of human oocytes and embryos during assisted reproduction technologies (ARTs)? The direct tagging system based on lectin-biofunctionalized polysilicon barcodes of micrometric dimensions is simple, safe and highly efficient, allowing the identification of human oocytes and embryos during the various procedures typically conducted during an assisted reproduction cycle. Measures to prevent mismatching errors (mix-ups) of the reproductive samples are currently in place in fertility clinics, but none of them are totally effective and several mix-up cases have been reported worldwide. Using a mouse model, our group has previously developed an effective direct embryo tagging system which does not interfere with the in vitro and in vivo development of the tagged embryos. This system has now been tested in human oocytes and embryos. Fresh immature and mature fertilization-failed oocytes (n = 21) and cryopreserved day 1 embryos produced by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) (n = 205) were donated by patients (n = 76) undergoing ARTs. In vitro development rates, embryo quality and post-vitrification survival were compared between tagged (n = 106) and non-tagged (control) embryos (n = 99). Barcode retention and identification rates were also calculated, both for embryos and for oocytes subjected to a simulated ICSI and parthenogenetic activation. Experiments were conducted from January 2012 to January 2013. Barcodes were fabricated in polysilicon and biofunctionalizated with wheat germ agglutinin lectin. Embryos were tagged with 10 barcodes and cultured in vitro until the blastocyst stage, when they were either differentially stained with propidium iodide and Hoechst or vitrified using the Cryotop method. Embryo quality was also analyzed by embryo grading and time

  10. Framing the ethical and legal issues of human artificial gametes in research, therapy, and assisted reproduction: A German perspective.

    PubMed

    Advena-Regnery, Barbara; Dederer, Hans-Georg; Enghofer, Franziska; Cantz, Tobias; Heinemann, Thomas

    2018-06-01

    Recent results from studies on animals suggest that functional germ cells may be generated from human pluripotent stem cells, giving rise to three possibilities: research with these so-called artificial gametes, including fertilization experiments in vitro; their use in vivo for therapy for the treatment of human infertility; and their use in assisted reproductive technologies in vitro. While the legal, philosophical, and ethical questions associated with these possibilities have been already discussed intensively in other countries, the debate in Germany is still at its beginning. A systematic and detailed analysis of the legal framework in Germany is provided with regard to the three possibilities, including the applicable statutory laws as well as the constitutional law. The question emerges as to whether the statutory laws as well as the constitution justify a distinction to be made between embryos of artificial and natural origin. This question is subject to philosophical analysis, discussing the distinction between person and thing, dignity and price, personality and property, and nature and technique. As a result, the criterion of naturalness alone may not be sufficient to differentiate between embryos of natural and artificial origin, and other criteria need to be identified. © 2018 The Authors. Bioethics Published by John Wiley & Sons Ltd.

  11. Effects of advanced treatments of wastewater effluents on estrogenic and reproductive health impacts in fish.

    PubMed

    Filby, Amy L; Shears, Janice A; Drage, Briane E; Churchley, John H; Tyler, Charles R

    2010-06-01

    Whether the implementation of additional treatments for the removal of estrogens from wastewater treatment works (WwTWs) effluents will eliminate their feminizing effects in exposed wildlife has yet to be established, and this information is crucial for future decisions on investment into WwTWs. Here, granular activated carbon (GAC), ozone (O(3)), and chlorine dioxide (ClO(2)) were investigated for their effectiveness in reducing steroidal estrogen levels in a WwTW effluent and assessments made on the associated estrogenic and reproductive responses in fathead minnows (Pimephales promelas) exposed for 21 days. All treatments reduced the estrogenicity of the standard-treated (STD) effluent, but with different efficacies; ranging between 70-100% for total estrogenicity and 53-100% for individual steroid estrogens. In fish exposed to the GAC- and ClO(2)- (but not O(3)-) treated effluents, there was no induction of plasma vitellogenin (VTG) or reduction in the weight of the fatpad, a secondary sex character in males, as occurred for fish exposed to STD effluent. This finding suggests likely benefits of employing these treatment processes for the reproductive health in wild fish populations living in rivers receiving WwTW discharges. Exposure of pair-breeding minnows to the GAC-treated effluent, however, resulted in a similar inhibition of egg production to that occurring for exposure to the STD effluent (34-40%). These data, together with a lack of effect on egg production of the estrogen, ethinylestradiol (10 ng/L), alone, suggest that chemical/physical properties of the effluents rather than their estrogenicity were responsible for the reproductive effect and that these factor(s) were not remediated for through GAC treatment. Collectively, our findings illustrate the importance of assessing integrative biological responses, rather than biomarkers alone, in the assessment and improvement of WwTW technologies for the protection of wild fish populations.

  12. National collection of embryo morphology data into Society for Assisted Reproductive Technology Clinic Outcomes Reporting System: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate.

    PubMed

    Racowsky, Catherine; Stern, Judy E; Gibbons, William E; Behr, Barry; Pomeroy, Kimball O; Biggers, John D

    2011-05-01

    To evaluate the validity of collecting day 3 embryo morphology variables into the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS). Retrospective. National database-SART CORS. Fresh autologous assisted reproductive technology (ART) cycles from 2006-2007 in which embryos were transferred singly (n=1,020) or in pairs (n=6,508) and embryo morphology was collected. None. Relationship between live birth, maternal age, and morphology of transferred day 3 embryos as defined by cell number, fragmentation, and blastomere symmetry. Logistic multiple regressions and receiver operating characteristic curve analyses were applied to determine specificity and sensitivity for correctly classifying embryos as either failures or successes. Live birth rate was positively associated with increasing cell number up to eight cells (<6 cells: 2.9%; 6 cells: 9.6%; 7 cells: 15.5%; 8 cells: 24.3%; and >8 cells: 16.2%), but was negatively associated with maternal age, increasing fragmentation, and asymmetry scores. An area under the receiver operating curve of 0.753 (95% confidence interval 0.740-0.766) was derived, with a sensitivity of 45.0%, a specificity of 83.2%, and 76.4% of embryos being correctly classified with a cutoff probability of 0.3. This analysis provides support for the validity of collecting morphology fields for day 3 embryos into SART CORS. Standardization of morphology collections will assist in controlling for embryo quality in future database analyses. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  13. Hochu-ekki-to Treatment Improves Reproductive and Immune Modulation in the Stress-Induced Rat Model of Polycystic Ovarian Syndrome.

    PubMed

    Park, Eunkuk; Choi, Chun Whan; Kim, Soo Jeong; Kim, Yong-In; Sin, Samkee; Chu, Jong-Phil; Heo, Jun Young

    2017-06-13

    The traditional herbal medicine, Hochu-ekki-to, has been shown to have preventive effects on viral infection and stress. This study aimed to evaluate the clinical effects of Hochu-ekki-to on two stress-related rat models of polycystic ovarian syndrome. Female Sprague-Dawley rats were divided into control and treatment groups, the latter of which were subjected to stress induced by exposure to adrenocorticotropic hormone (ACTH) or cold temperatures. After these stress inductions, rats were orally treated with dissolved Hochu-ekki-to once per day for 7 days. Rats subjected to the two different stressors exhibited upregulation of steroid hormone receptors (in ovaries) and reproductive hormones (in blood), and consequent stimulation of abnormal follicle development accompanied by elevation of Hsp 90 expression (in ovaries). Treatment with Hochu-ekki-to for 7 days after stress induction increased immune functions, reduced the stress-induced activation of Hsp 90, and normalized the levels of the tested steroid hormone receptors and reproductive hormones. Our findings suggest that stress stimulations may promote the activation of Hsp 90 via the dysregulation of steroid hormone receptors and reproductive hormones, but that post-stress treatment with Hochu-ekki-to improves reproductive and immune functions in the ovaries of stressed rats.

  14. Reproductive Issues in Women with Turner Syndrome.

    PubMed

    Folsom, Lisal J; Fuqua, John S

    2015-12-01

    Turner syndrome is one of the most common chromosomal abnormalities affecting female infants. The severity of clinical manifestations varies and it affects multiple organ systems. Women with Turner syndrome have a 3-fold increase in mortality, which becomes even more pronounced in pregnancy. Reproductive options include adoption or surrogacy, assisted reproductive techniques, and in rare cases spontaneous pregnancy. Risks for women with Turner syndrome during pregnancy include aortic disorders, hepatic disease, thyroid disease, type 2 diabetes, and cesarean section delivery. Providers must be familiar with the risks and recommendations in caring for women with Turner syndrome of reproductive age. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Fresh versus frozen embryo transfers in assisted reproduction.

    PubMed

    Wong, Kai Mee; van Wely, Madelon; Mol, Femke; Repping, Sjoerd; Mastenbroek, Sebastiaan

    2017-03-28

    In general, in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) implies a single fresh and one or more frozen-thawed embryo transfers. Alternatively, the 'freeze-all' strategy implies transfer of frozen-thawed embryos only, with no fresh embryo transfers. In practice, both strategies can vary technically including differences in freezing techniques and timing of transfer of cryopreservation, that is vitrification versus slow freezing, freezing of two pro-nucleate (2pn) versus cleavage-stage embryos versus blastocysts, and transfer of cleavage-stage embryos versus blastocysts.In the freeze-all strategy, embryo transfers are disengaged from ovarian stimulation in the initial treatment cycle. This could avoid a negative effect of ovarian hyperstimulation on the endometrium and thereby improve embryo implantation. It could also reduce the risk of ovarian hyperstimulation syndrome (OHSS) in the ovarian stimulation cycle by avoiding a pregnancy.We compared the benefits and risks of the two treatment strategies. To evaluate the effectiveness and safety of the freeze-all strategy compared to the conventional IVF/ICSI strategy in women undergoing assisted reproductive technology. We searched the Cochrane Gynaecology and Fertility Group Trials Register, the Cochrane Central Register of Studies (CRSO), MEDLINE, Embase, PsycINFO, CINAHL, and two registers of ongoing trials in November 2016 together with reference checking and contact with study authors and experts in the field to identify additional studies. We included randomised clinical trials comparing a freeze-all strategy with a conventional IVF/ICSI strategy which includes fresh transfer of embryos in women undergoing IVF or ICSI treatment. We used standard methodological procedures recommended by Cochrane. The primary review outcomes were cumulative live birth and OHSS. Secondary outcomes included other adverse effects (miscarriage rate). We included four randomised clinical trials analysing a total

  16. The association of placenta previa and assisted reproductive techniques: a meta-analysis.

    PubMed

    Karami, Manoochehr; Jenabi, Ensiyeh; Fereidooni, Bita

    2018-07-01

    Several epidemiological studies have determined that assisted reproductive techniques (ART) can increase the risk of placenta previa. To date, only a meta-analysis has been performed for assessing the relationship between placenta previa and ART. This meta-analysis was conducted to estimate the association between placenta previa and ART in singleton and twin pregnancies. A literature search was performed in major databases PubMed, Web of Science, and Scopus from the earliest possible year to April 2017. The heterogeneity across studies was explored by Q-test and I 2 statistic. The publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) and relative risk (RR) estimates with its 95% confidence intervals (CI) using a random-effects model. The literature search yielded 1529 publications until September 2016 with 1,388,592 participants. The overall estimate of OR was 2.67 (95%CI: 2.01, 3.34) and RR was 3.62 (95%CI: 0.21, 7.03) based on singleton pregnancies. The overall estimate of OR was 1.50 (95%CI: 1.26, 1.74) based on twin pregnancies. We showed based on odds ratio reports in observational studies that ART procedures are a risk factor for placenta previa.

  17. Internet treatment for generalized anxiety disorder: a randomized controlled trial comparing clinician vs. technician assistance.

    PubMed

    Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

    2010-06-03

    Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (p<0.001) and GAD-7 (p<0.001) compared to the delayed treatment group, but did not differ from each other. Within group effect sizes on the PSWQ were 1.16 and 1.07 for the clinician- and technician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not improve. These results provide

  18. Internet Treatment for Generalized Anxiety Disorder: A Randomized Controlled Trial Comparing Clinician vs. Technician Assistance

    PubMed Central

    Robinson, Emma; Titov, Nickolai; Andrews, Gavin; McIntyre, Karen; Schwencke, Genevieve; Solley, Karen

    2010-01-01

    Background Internet-based cognitive behavioural therapy (iCBT) for generalized anxiety disorder (GAD) has been shown to be effective when guided by a clinician. The present study sought to replicate this finding, and determine whether support from a technician is as effective as guidance from a clinician. Method Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program and 150 participants with GAD were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for GAD comprising six online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 10 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Penn State Worry Questionnaire (PSWQ) and the Generalized Anxiety Disorder-7 Item (GAD-7). Completion rates were high, and both treatment groups reduced scores on the PSWQ (p<0.001) and GAD-7 (p<0.001) compared to the delayed treatment group, but did not differ from each other. Within group effect sizes on the PSWQ were 1.16 and 1.07 for the clinician- and technician-assisted groups, respectively, and on the GAD-7 were 1.55 and 1.73, respectively. At 3 month follow-up participants in both treatment groups had sustained the gains made at post-treatment. Participants in the clinician-assisted group had made further gains on the PSWQ. Approximately 81 minutes of clinician time and 75 minutes of technician time were required per participant during the 10 week treatment program. Conclusions Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment/control group did not

  19. Assisted Reproductive Technology Surveillance - United States, 2015.

    PubMed

    Sunderam, Saswati; Kissin, Dmitry M; Crawford, Sara B; Folger, Suzanne G; Boulet, Sheree L; Warner, Lee; Barfield, Wanda D

    2018-02-16

    Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to deliver multiple-birth infants. Multiple births pose substantial risks for both mothers and infants, including obstetric complications, preterm delivery (<37 weeks), and low birthweight (<2,500 g) infants. This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2015 and compares birth outcomes that occurred in 2015 (resulting from ART procedures performed in 2014 and 2015) with outcomes for all infants born in the United States in 2015. 2015. In 1995, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). Data are collected through the National ART Surveillance System, a web-based data collection system developed by CDC. This report includes data from 52 reporting areas (the 50 states, the District of Columbia, and Puerto Rico). In 2015, a total of 182,111 ART procedures (range: 135 in Alaska to 23,198 in California) with the intent to transfer at least one embryo were performed in 464 U.S. fertility clinics and reported to CDC. These procedures resulted in 59,334 live-birth deliveries (range: 55 in Wyoming to 7,802 in California) and 71,152 infants born (range: 68 in Wyoming to 9,176 in California). Nationally, the number of ART procedures performed per 1 million women of

  20. Socioeconomic profile of couples seeking the public healthcare system (SUS) for infertility treatment

    PubMed Central

    Tavares, Rachel; Cunha, Gisele; Aguiar, Lilian; Duarte, Shaytner Campos; Cardinot, Nilza; Bastos, Elizabeth; Coelho, Francisco

    2016-01-01

    Objective The number of couples seeking assisted reproduction services in pursuit of the dream of conceiving a child is growing. In developing countries 10 to 15% of couples of childbearing age cannot bear a child by natural means and the impossibility of conceiving a child has a significant impact on the health and well-being of the couple. The aim of this study was to evaluate the socioeconomic profile and the main causes of infertility of couples seeking assisted reproduction treatment through the public healthcare system. Methods We analyzed 600 medical records of couples who sought infertility treatment at the public healthcare system, and we divided them into three groups according to age: 35 years, 35 to 39, and 40 years or more. In each group we analyzed the cause of infertility, the number of children of the spouses, the education level and family income. Results The main cause of infertility was male-related in 34%, followed by tubal factor in 31.5%. We found that 56% of the women were less than 35 years old and 58% of the couples earned less than 3 minimum wages. Conclusion The profile of the couples was: low-income, low education and less than 35 years of age. The cost of assisted reproductive treatment is still high, being restricted to couples of higher socioeconomic statuses. An effective public healthcare policy could minimize this problem by improving the quality of care for couples seeking infertility treatment at the public healthcare system. PMID:27584602