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PubMed2003

Should HIV discordant couples have access to assisted reproductive technologies?

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

Child↗

PubMedDate not supplied

Human leukocyte antigen compatibility and failure to achieve a viable pregnancy with assisted reproductive technology.

Many couples fail to achieve a viable pregnancy with multiple attempts of Assisted Reproductive Technology (ART). Immunologic rejection of the embryo may be a factor in these couples. We evaluated shared human leukocyte antigen (HLA) antigenicity in 10 couples who failed multiple ART cycles and compared them with 10 couples who achieved a viable pregnancy with their first ART attempt. Study couples shared a statistically significant greater number of HLA antigens than control couples. Leukocyte immunotherapy is discussed. We conclude that couples who share multiple HLA antigens may have an immunologic basis for failing to achieve a viable pregnancy with multiple ART cycles.

Adult↗

PubMed2001

Ethical regulation and the new reproductive technologies in Sri Lanka: perspectives of ethics committee members.

OBJECTIVE: To report on part of a pilot study done to explore ethical responses to the new reproductive technologies in Sri Lanka. DESIGN: Semi-structured interviews carried out with the members of three committees responsible for ethical review of medical research. Members were asked for their views on the ethical, social and legal implications of the new reproductive and genetic technologies. Members' responses were subject to a simple content analysis. CONCLUSIONS: There was broad acceptance of the new technologies among respondents, but anxieties about potential abuses. Respondents felt that a national committee should regulate practice and monitor future policy.

Attitude↗

PubMed2003

Regulation of assisted reproductive technology: a case study of Japan.

Most studies on the ethics and provision of assisted reproductive technologies (ART) have taken place in the context of the Judaeo-Christian culture of western developed countries. This study looks at ART, its provision and control, in an eastern developed country with a completely different cultural background; Japan. A necessarily brief description of the cultural context of religious belief, the family and reproduction in Japan is followed by a description of the development of ART in Japan together with an analysis of its provision and control.

Abortion, Induced↗

PubMed1992

The de Watteville Memorial Lecture: reproductive technologies and genetic advances in obstetrics and gynecology.

Public fascination with genetics and the new reproductive technologies seem ubiquitious. Although interest in genetic causation for diseases is not new, attention is increasing. There are several predictable reasons for this. One is the overall decrease in deaths due to infection. As a result, genetic factors producing birth defects loom relatively larger. This is also coupled with the public's increased desire for the ideal pregnancy, especially given a decreased population rate. Finally, the public's appetite is whetted by the increasing number of heritable diseases whose molecular basis is being elucidated. We shall focus on three general areas in which genetic technology increasingly impacts upon the obstetrician/gynecologist: genetics of pregnancy losses, genetics of sex determination and the common gynecologic disorders, and finally prenatal genetic diagnosis, particularly in preimplantation genetics and recovering fetal cells from maternal blood. Most of these topics are discussed in a recent text, where extensive references are available.

Abortion, Spontaneous↗

PubMed1999

Tubal surgery in the era of assisted reproductive technology: clinical options.

We reviewed the place of tubal surgery in the era of assisted reproductive technology. Reversal of tubal ligation is one of the main indications for tubal microsurgery. Adhesiolysis has the best results if the adhesion is the only factor responsible for infertility. There are no differences between adhesiolysis by laparoscopy or by laparotomy, and so laparoscopy must be preferred. Proximal tubal obstructions can be successfully treated by microsurgical tubocornual anastomosis. As far as distal tubal lesions are concerned, success rates depend strictly on the pre-existing tubal disease in distal tubal lesions and tubal surgery frequently fails; in-vitro fertilization (IVF) must therefore be considered in such circumstances. In conclusion, we think that IVF and tubal surgery must be considered to be complementary rather than competitive procedures. Adequate selection of patients is crucial to find the best therapeutic approach.

Fallopian Tubes↗

PubMed2006

Ectopic pregnancy risk with assisted reproductive technology procedures.

OBJECTIVE: To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. METHODS: The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression. RESULTS: Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred. CONCLUSION: Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. LEVEL OF EVIDENCE: II-2.

Female↗

PubMed1996

The sperm stress test: a novel test that predicts pregnancy in assisted reproductive technologies.

OBJECTIVE: To develop a reliable sperm test that would predict pregnancy rate in assisted reproductive technologies. DESIGN: Blind prospective cohort study. SETTING: Tertiary-care, university hospital-affiliated IVF program. PATIENTS: One hundred nineteen sperm samples were obtained from 110 males from couples undergoing IVF or GIFT (ART). Sperm samples were washed by Percoll, incubated at 24 degrees C for 4 hours, and an aliquot of the same sperm suspension was used for ART incubated at 40 degrees C for 4 hours (stress test). Stress test scores are expressed as the ratio of final to initial motility. RESULTS: Of 119 ART cycles, 24 resulted in pregnancy. Of 24 pregnancies, 23 occurred in cycles that used sperm samples with stress test scores > or = 0.75 and only one with a stress test score < 0.75. The negative predictive value of the test, defined as the absence of pregnancy with scores < 0.75, was 98% and the positive predictive value, defined as the occurrence of pregnancy with scores > or = 0.75, was 36%. Logistic regression analysis indicated that the stress test score alone was correlated significantly with pregnancy after ART. CONCLUSION: These results indicate that stress test scores < 0.75 are predictive of poor pregnancy outcome in ART.

Adult↗

PubMed2006

Practitioner reporting of birth defects in children born following assisted reproductive technology: Does it still have a role in surveillance of birth defects?

BACKGROUND: National assisted reproductive technology (ART) data collections that rely on practitioners' reports of birth defects have consistently reported lower proportions of children with birth defects than record linkage studies that link ART infants to birth and malformation registers. METHODS: We compared the birth defect data reported to the national Australian Assisted Conception Data Collection (ACDC) by practitioners at three Western Australian ART clinics with the birth defect data identified on the Western Australian Birth Defects Registry (WABDR) through record linkage of all the pregnancies conceived at these clinics to the WABDR. Cases are reported to the WABDR by multiple statutory and voluntary sources. RESULTS: We found that the national ACDC significantly underestimated the prevalence of birth defects in WA-born ART infants. Less than one-third of ART children identified with a major birth defect on the WABDR were reported to the ACDC. CONCLUSIONS: Although national ART data collections provide valuable information on pregnancy rates and short-term pregnancy outcomes such as multiple birth and birth weight, we strongly recommend that birth defect information used for patient counselling is preferentially drawn from large studies that have used record linkage to high-quality birth defect registers.

Congenital Abnormalities↗

PubMed2004

The risk of birth defects in dichorionic twins conceived by assisted reproductive technology.

The purpose of this study was to examine whether dichorionic twins conceived by assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI], in vitro fertilization [IVF], gamete-intrafallopian tube transfer [GIFT]) have a higher risk of birth defects compared to dichorionic twins conceived naturally. We reviewed the medical records of 406 mothers with dichorionic twin pregnancies, who received continuous antenatal care from < or = 20 weeks of gestation and gave birth to infants after > or = 24 weeks of gestation in our institute. Birth defects were diagnosed at the time of hospital discharge according to the International Classification of Diseases, 10th Revision. Occurrence of birth defects was compared between twins conceived by ART and those conceived naturally using logistic regression analysis. Overall, 51 of 812 infants (51/812 = 6.2%) had birth defects. The incidence of birth defects in ART-conceived twins was significantly higher than that of naturally conceived twins with an odds ratio of 6.9 (95% confidence interval [CI] 2.1, 22.5), 3.7 (95% CI 1.2, 12.0), and 4.3 (95% CI 1.4, 14.3) for ICSI, IVF, and GIFT, respectively. The higher frequency of birth defects in ART-conceived twins was still significant after adjusting for higher maternal age in the ART group, with an adjusted odds ratio of 6.7 (95% CI 2.1, 21.9), 3.6 (95% CI 1.1, 11.5), and 3.7 (95% CI 1.2-11.8) for ICSI, IVF, and GIFT, respectively. Dichorionic twins conceived by ART, compared to dichorionic twins conceived naturally, had a much higher risk for birth defects diagnosed at hospital discharge.

Congenital Abnormalities↗

PubMed2003

Trends in multiple births conceived using assisted reproductive technology, United States, 1997-2000.

OBJECTIVE: To examine trends in multiple births conceived using assisted reproductive technology (ART) in the United States between 1997 and 2000 and to estimate the proportion of all US multiple births attributable to ART use. METHODS: We analyzed population-based data of 109 519 live-born infants who were conceived in the United States using ART and born between 1997 and 2000 and population-based data of 15 856 809 live-born infants who were delivered in the United States between 1997 and 2000. Multiple birth rates (the number of live-born infants delivered in multiple gestation pregnancies per 1000 live births) and the proportion of all US multiple births attributable to ART were evaluated. RESULTS: The twin rate for ART patients increased between 1997 and 2000, reaching 444.7 per 1000 live births in 2000, whereas the triplet/+ rate declined substantially from 134.3 to 98.7 per 1000 live births from 1997-2000. From 1997-2000, the proportion of multiple births in the United States attributable to ART increased from 11.2% to 13.6%, whereas the proportion attributable to natural conception decreased from 69.9% to 64.5%. In 2000, the proportion of triplet/+ births attributable to ART and to natural conception was 42.5% and 17.7%, respectively. The contribution of ART to multiple births increased substantially with maternal age, from 11.6% for triplet/+ infants born to women aged 20 to 24 to 92.8% for women aged 45 to 49 years. CONCLUSIONS: The contribution of ART to twin birth rates continues to increase, but the contribution of ART to triplet/+ birth rates has declined.

Adult↗

PubMed2005

Hormonal effects in infants conceived by assisted reproductive technology.

OBJECTIVE: The purpose of this report is to describe 7 infants conceived by assisted reproductive technology (ART) who presented with breast development and/or pubic hair. The clinical presentation in these infants raises awareness that an altered intrauterine hormonal milieu may impact the fetal and infant stages of children conceived by ART. METHODS: Between May 2001 and April 2004, 7 children between the ages of 5 and 21 months conceived by ART were referred by their pediatricians to the Division of Pediatric Endocrinology at the New York University School of Medicine for evaluation of possible precocious puberty. Patients were evaluated for the possibility of centrally mediated precocious puberty and pseudoprecocious puberty, with a possible ovarian or adrenal origin. RESULTS: Endocrine evaluation in all patients indicated sex-steroid and hormone levels in the prepubertal range; pelvic sonography confirmed prepubertal ovaries with unstimulated uteri. Clinical follow-up of our patients thus far has not revealed progression of breast development, pubarche, or elevation in sex steroids. CONCLUSIONS: It is well established that the developing endocrine system in the fetus and maturation of endocrine-control systems are influenced by hormone concentrations in the fetus. Whether ART alters the intrauterine hormonal milieu for the growing fetus conceived by ART is as yet unknown and is an area of ongoing investigation. Patients conceived through ART, including our patients who presented with hormonal manifestations, will need to be monitored throughout childhood and into adolescence and adulthood to determine if any perturbation exists on the timing of puberty and later fertility.

17-alpha-Hydroxyprogesterone↗

PubMed2006

Assisted reproductive technologies in South Dakota: the first ten years.

One in six couples experience infertility. New assisted reproductive technologies such as in vitro fertilization (IVF) have helped thousands of couples worldwide to have a family. IVF has been available in South Dakota for the past ten years. Improvements in the clinic and laboratory have led to better live birth rates and lower incidences of multiple pregnancies. Advances in technology will help even more people overcome fertility problems in the near future.

Embryo Transfer↗

PubMed1992

In vitro fertilization-embryo transfer (IVF-ET) in the United States: 1990 results from the IVF-ET Registry. Medical Research International. Society for Assisted Reproductive Technology (SART), The American Fertility Society.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States in 1990. DESIGN: The registry follows a prospective study format. PARTICIPANTS: One hundred eighty clinics submitted data on their ART treatments to the In Vitro Fertilization (IVF) Registry. MAIN OUTCOME MEASURES: The outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, chromosomal abnormalities, and congenital defects. RESULTS: During 1990, the clinics reported performing 25,744 ovarian stimulation cycles. From all ART treatments there were 5,150 clinical pregnancies and 3,951 live deliveries. The overall live delivery rates were 14% for IVF (based on 16,405 retrievals), 22% for gamete intrafallopian transfer (based on 3,750 retrievals), and 16% for zygote intrafallopian transfer and related practices (based on 1,370 retrievals). The delivery rates for frozen embryo transfer cycles and IVF with donor egg cycles were 9% and 22%, respectively. CONCLUSIONS: The 1990 results indicate an increase in the use of gonadotropin-releasing hormone analogs and an increase in the number of embryos being transferred per cycle, along with no important changes in clinical pregnancy and delivery rates. In addition, there was an increase in both numbers of frozen embryo transfers and IVF cycles with donor oocytes.

Abortion, Spontaneous↗

PubMed1987

Women and reproductive technologies: a partially annotated bibliography.

This bibliography is a resource for further information about Women and Reproductive Technologies. The references are categorized as General Information, Law and Policy Considerations, and Information about Specific Technologies. It also lists periodicals, organizations, and other bibliographies relating to this subject and is current through March 1986.

Bibliographies as Topic↗

PubMed2005

Luteal phase support in assisted reproductive technology.

PURPOSE OF REVIEW: The purpose of this review is to discuss luteal support in assisted reproduction and to provide an evidence-based overview of the current options available. RECENT FINDINGS: The luteal phase has been found to be defective in virtually all of the stimulation protocols used for in-vitro fertilization. Common mechanisms such as supraphysiological levels of estradiol, decreased output of luteinizing hormone, inhibition of the corpus luteum and asynchronization of estradiol and progesterone may be involved in insufficient function of the corpus luteum in assisted reproductive technology. SUMMARY: Gonadotropin releasing hormone agonist undoubtedly provides benefits in stimulated cycles, however it also has adverse effects, inhibition of the corpus luteum together with supraphysiological hormonal profiles finally leading to luteal phase defects. Luteal phase support with human chorionic gonadotropin or progesterone after assisted reproduction results in increased pregnancy rates. The role of luteal phase support in these cycles has also been recently elucidated. Use of human chorionic gonadotropin for luteal phase support is associated with a marked increase in the risk of ovarian hyperstimulation syndrome, therefore progesterone is the preferred choice. Data on the benefits of estrogen supplementation are conflicting. Among the routes of progesterone administration, reductions in pregnancy rates are noted on oral administration. In spite of a lack of statistical significance, the intramuscular route seems to be more beneficial than the vaginal route when considering rates of ongoing pregnancy and live birth. Further clarification is needed on the ideal dose, the optimal route and the duration of progesterone administration in assisted reproduction.

Administration, Intravaginal↗

PubMed2026

A Comprehensive Survey and Evaluation of Preimplantation Genetic Testing Practices in Canadian Assisted Reproductive Technology Clinics.

OBJECTIVES: In Canada, access to provincial funding for fertility treatments, such as in vitro fertilization (IVF) and preimplantation genetic testing (PGT), vary significantly. Despite rising demands, the lack of data on current practices across Canadian assisted reproductive technology (ART) clinics has contributed to the absence of standardized guidelines to support clinics offering these services. This pilot study surveys fertility clinics to examine current demands and practices related to PGT, while also exploring providers' perspectives on its implementation and future applications. METHODS: A 40-question survey was distributed to Canadian ART clinics offering IVF and PGT services. RESULTS: The responses confirm that there is a high demand for IVF and PGT services. Although clinical criteria for PGT for aneuploidy (PGT-A) were generally consistent across clinics, views on its effectiveness and eligibility for public funding varied. PGT for monogenic disorders (PGT-M) appears to be widely available, and respondents showed strong support for public funding in cases involving serious heritable conditions. CONCLUSIONS: This study outlines current practice and highlights variations across clinics, while also presenting the perspectives of providers of ART clinics throughout Canada. It also provides a degree of foresight as to the direction the PGT practice may take in the coming years.

assisted reproductive technology↗

PubMed1994

[Maternity, sterility and reproduction technology].

The idea of maternity--and paternity as well--reaches far beyond the field of biological reproduction inasmuch as it implies a subject's desire, besides being regulated by the symbolic order: Language, myths, patterns and values of a given culture. From this point of view, infertility cannot be considered as a mere somatic illness, but as a human problem implying psychological and social aspects that require a search for solutions unlikely to be reduced to a sole medical operation. The development of the new reproductive technology is in keeping with the increasing medicalization of human lives, human sexuality, and human bodies.

Adult↗