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PubMed2000

Outcome of assisted reproductive technology in women over the age of 41.

OBJECTIVE: To analyze the results of ongoing pregnancies and deliveries after assisted reproductive technology (ART) in women aged >/=41 years, stratified by year of age. DESIGN: Retrospective study. SETTING: University hospital, IVF unit. PATIENT(S): A total of 431 IVF and intracytoplasmic sperm injection (ICSI) cycles were initiated in women >/=41 years of age. INTERVENTION(S): Medical files of ART patients and pregnancy outcomes were reviewed. MAIN OUTCOME MEASURE(S): Oocytes retrieved, embryos developed, and clinical pregnancy and delivery rates. RESULT(S): Of the 431 started cycles, 376 (87%) reached the oocyte retrieval stage. The mean number of oocytes aspirated per patient was 5.4 +/- 0.9 and 6.7 +/- 1.2 in the IVF and ICSI cycles, respectively, and the number of embryos obtained was 2.3 +/- 1.3 and 2.8 +/- 1.6 in the IVF and ICSI cycles, respectively. The number of transferable embryos was 2.0 +/- 1.2 and 2.5 +/- 0.8. The pregnancy rate per oocyte pickup (OPU) was 12.4%; however, the delivery rate per OPU was 4.5%. The mean delivery rate per OPU among women aged 41-43 years was 2%-7%. There were no deliveries aged >/=44 years and no pregnancies at the age of 45 years. The pregnancy and delivery rates of the ICSI and IVF patients were similar after stratification by age. CONCLUSION(S): In our studies, ART performed with homologous oocytes, whether by IVF or ICSI, yielded no clinical pregnancies among women aged >/=45 years and no deliveries aged >/=44 years. The mean delivery rate per oocyte retrieval among women aged 41-43 years varied between 2% and 7%.

Aging↗
PubMed2001

Assisted reproductive technologies in conjunction with conservatively treated endometrial adenocarcinoma. A case report.

This case report illustrates the successful use of assisted reproductive technologies (ARTs) in a patient receiving conservative treatment for endometrial adenocarcinoma. A 31-year-old infertile woman, diagnosed as FIGO stage Ia endometrial adenocarcinoma (grade 1), received oral medroxyprogesterone acetate 400 mg/day for 12 weeks. Endometrial curettage was performed and the absence of endometrial carcinoma was confirmed. A single pregnancy was achieved with in vitro fertilization and embryo transfer. A healthy female infant was born via cesarean section at 42 weeks' gestation. The carcinoma has not recurred, and the patient now desires a second child. We conclude that ART combined with progesterone treatment might be a powerful option for the treatment of infertile patients with early stage, well-differentiated endometrial adenocarcinoma.

Adenocarcinoma↗
PubMed2001

The successful use of hatched blastocysts in assisted reproductive technology.

This retrospective study was undertaken to determine the value of blastocyst culture and transfer as a tool in assisted reproductive technology. Six hundred and fifty-five cycles in patients undergoing IVF treatment for infertility were involved. All patients were aged < 40 years. Day-2 embryos were transferred to 427 (group 1) and day-6 embryos (blastocysts) were transferred to 228 patients (group 2). Pronucleate oocytes obtained from IVF were cultured in vitro for 2 or 6 days. One to five embryos were transferred. A total of 10,146 oocytes were retrieved, 6,105 oocytes were fertilized, 2,222 embryos were transferred and 197 clinical pregnancies were achieved in all groups. Blastocystes were transferred to almost 90% of group 2 patients. The pregnancy rate per cycle and implantation rate per transferred embryo was 42.1% and 19.4%, respectively, in the blastocyst group compared to 23.6% and 8.6%, respectively, when embryos were transferred on day 2. Even though in the blastocyst group there was an increased number of oocytes fertilized at the same time there was a significant reduction in the number of embryos being replaced (3.2 vs 3.8). This study demonstrate that transfer of blastocysts increases the success of IVF when compared with day-2 transfers and reduces the number of embryos to be transferred.

Adult↗
PubMed1987

Reproductive technology and the commodification of life.

This paper suggests that the key unifying concept in the development and application of new reproduction technology has been the increasing commodification of life--treating people and parts of people as marketable commodities. This commodification process is made most dramatically clear in (1) prenatal diagnosis, in which the fetus is treated as a product subject to quality control measures and women are treated as producers without emotional tie to their products and (2) in so-called "surrogacy" arrangements in which an actual price tag is placed on pregnancy, and women sell both their "labor" and their "product."

Attitude to Health↗
PubMed2003

Epigenetic risks related to assisted reproductive technologies: epigenetics, imprinting, ART and icebergs?

Recently, a series of case reports and small studies has suggested that births involving assisted reproductive technology (ART) may have an increased risk of imprinting disorders such as Beckwith-Wiedemann syndrome and Angelman syndrome. Herein, the significance and implications of these findings are discussed. It is speculated that, although such imprinting disorders may be shown to be only rare complications of ART, epigenetic errors might account for a much wider spectrum of ART-related complications than is recognized currently. Addressing these questions should be a priority for research on cohorts of ART children.

Angelman Syndrome↗
PubMed2005

Assisted reproductive technologies and multiple gestations.

Since the first in vitro fertilization infant was born in England in 1978, the practice of assisted reproductive technology (ART) has steadily increased as the technology and success rates have improved. The incidence of multiple gestations has also increased, primarily owing to the practice of transferring multiple embryos during an ART cycle. Guidelines for infertility clinics have been outlined, along with strategies to limit the number of embryos transferred (depending on the age of the patient) to achieve a lower risk of multiple births. Since 1997, a decrease has occurred in the number of embryos transferred and the percentage of gestations with three or more fetuses, accompanied by a steady increase in the percentage of live births per cycle.

Age Factors↗
PubMed1994

Endometrial receptivity in the light of modern assisted reproductive technologies.

OBJECTIVE: To review the different aspects of endometrial receptivity as it is reflected in the various modalities of modern assisted reproductive technologies. DESIGN: The importance of endometrial receptivity and the factors that affect it such as the type of treatment, age, and ovarian function are discussed in this review. Novel approaches to determine receptivity such as Doppler ultrasonography and molecular biology are considered; assisted hatching is also discussed. CONCLUSIONS: Endometrial receptivity cannot, as yet, be directly assessed. Circumstantial evidence suggests that receptivity declines with age, is adversely affected by controlled ovarian hyperstimulation, and is possibly affected by ovarian function. Future studies will have to focus on molecular cell biology and physiology of the endometrium.

Aging↗
PubMed2004

Assisted reproductive technologies and the risk of birth defects--a systematic review.

BACKGROUND: The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF infants compared to spontaneously conceived infants have serious methodological limitations; despite this, most researchers have concluded that there is no increased risk. METHODS: We carried out a systematic review to identify all papers published by March 2003 with data relating to the prevalence of birth defects in infants conceived following IVF and/or ICSI compared with spontaneously conceived infants. Independent expert reviewers used criteria defined a priori to determine whether studies were suitable for inclusion in a meta-analysis. Fixed effects meta-analysis was performed for all studies and reviewer-selected studies. RESULTS: Twenty-five studies were identified for review. Two-thirds of these showed a 25% or greater increased risk of birth defects in ART infants. The results of meta-analyses of the seven reviewer-selected studies and of all 25 studies suggest a statistically significant 30-40% increased risk of birth defects associated with ART. CONCLUSIONS: Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions. This information should be made available to couples seeking ART treatment.

Congenital Abnormalities↗
PubMed1992

The use of luteinising hormone releasing hormone agonists for ovarian stimulation in assisted reproductive technology.

Although the use of luteinising hormone releasing hormone (LHRH) agonists and human menopausal gonadotrophin (hMG) for ovarian stimulation in assisted reproductive technology has gained wide-spread popularity, a number of major issues regarding their use remain unresolved. In this paper, we examine some of these issues in the light of the results of our own studies. We have found that although the use of LHRH agonists may be advantageous for some patients, its routine use for all patients produces no significant medical advantage compared with conventional stimulation regimens. In a number of prospective randomised studies, we have found that the long protocol of LHRH agonist administration is superior to the short and ultrashort protocols and the administration of glucocorticoids to patients at high risk of developing ovarian hyperstimulation syndrome does not reduce the incidence of this complication. Finally, we have found that when the long protocol of LHRH agonist administration is used, precise timing of human chorionic gonadotrophin administration (hCG) is not important. There are no significant differences in oocyte recovery, fertilisation and cleavage rates, or in pregnancy rates when the results of standard timing of hCG administration are compared with delayed administration. It would, therefore, appear that the major advantage of the routine use of LHRH agonists is for practical, rather than medical reasons.

Buserelin↗
PubMed2005

Assisted reproductive technologies and birth outcomes: overview of recent systematic reviews.

Several systematic reviews have been published recently on birth outcomes of infants conceived through assisted reproductive technologies (ART), compared with infants conceived spontaneously. These outcomes include perinatal mortality, preterm birth, low birthweight and birth defects. Methodological limitations of many of the individual studies (including small sample size, potential for bias in ascertainment of outcomes and considering singletons and multiples together) were obviated in these reviews by excluding studies where methods were considered inadequate, by conducting meta-analyses using data from all methodologically sound studies (small and large) and by examining singletons separately. Overall, the reviews indicate few differences between outcomes in ART twins compared with twins conceived spontaneously. However, in singleton ART infants, there are around two-fold increases in risk of perinatal mortality, low birthweight and preterm birth, about a 50% increase in small for gestational age and a 30-35% increase in birth defects, compared with singletons conceived spontaneously. Couples considering ART should be counselled about the increased risk of adverse outcomes. Epidemiologists, in conjunction with clinical and laboratory colleagues, should now focus on large, methodologically sound studies with long-term follow up that seek to identify the reasons for these increased risks and their long-term consequences, whether they are associated with particular technologies and causes of infertility, and how they might be reduced.

Birth Weight↗
PubMed1990

Future of assisted reproductive technologies.

Within a decade, from the birth of Louise Brown in 1978, there has been tremendous advances in the field of assisted reproduction. These advances are the collective result of techniques known as Assisted Reproductive Technologies (ART). ART is defined as techniques in which the oocyte is handled in-vitro before replacement either as oocytes or embryos. The techniques in ART include in-vitro fertilisation and embryo replacement (IVF-ER), gamete intra-fallopian transfer (GIFT), tubal embryo (TET), donor oocytes and embryos, and freezing of embryos and oocytes. The most recent has been assisting fertilisation by micro-manipulation, including zonal procedures and micro-insemination, e.g. micro-insemination sperm transfer (MIST). There has also been many ethical issues in ART, and little advance in the "take home" baby rate. There is now major interest in co-culture of embryos with ampullary, endometrial and fibroblast mono-layers, to improve the quality of these embryos before their return into the mother. Because of the public's interest in ART, its usefulness has been "oversold". In time to come, ART may be limited to patients who really need it.

Forecasting↗
PubMed2005

Assisted reproductive technologies and equity of access issues.

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

Attitude of Health Personnel↗
PubMed1992

Male factor infertility and assisted reproductive technologies.

Male infertility has many facets that need to be evaluated in an initial screening. Once these are known, recommendations become clearer for aggressively pursuing assisted reproductive techniques. Progress has been made in defining more clearly the severe male factor: concentration less than 5 x 10(6) sperm/mL, motility less than 10%, morphology less than 4% normal forms (by strict criteria), and recovered swim-up sperm less than 1.5 x 10(6). Sperm preparation techniques may be improved by use of Percoll separation medium, and morphology may be used in prediction of cleavage rate in in vitro fertilization. Hopefully, these techniques will lead to more specific guidelines for successful use of assisted reproductive technology in male factor patients.

Female↗
PubMed2003

Obstetric and neonatal risk of pregnancies after assisted reproductive technology: a matched control study.

BACKGROUND: The aim of the study was to evaluate the obstetric and neonatal outcome of pregnancies after assisted reproduction technology (ART) in comparison with matched controls from spontaneous pregnancies. METHODS: A total of 12 920 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, from 1 January 1995 to 31 December 2001 were subjected to retrospective analysis. Two hundred and eighty-four singleton, 75 twin and 17 triplet pregnancies after ovulation induction (n = 114; 30.3%), intrauterine insemination (n = 33; 8.8%) and in vitro fertilization (n = 229; 60.9%) were evaluated. The pregnancy outcome of the singleton and twin pregnancies was compared with that for controls matched with regard to age, gravidity and parity and previous obstetric outcome after spontaneous pregnancies. RESULTS: Twenty-four percent of the assisted reproductive pregnancies were multiple pregnancies. The incidences of singleton intrauterine growth retardation (IUGR) and preterm birth were reasonably similar to those among the controls (IUGR: 6.3% vs. 4.2%; preterm births: 13.0% vs. 9.9%, for the cases and the controls, respectively). As compared with the controls, there was an increased incidence of cesarean section among the singleton (41.2% vs. 34.5%, p = 0.12; OR 1.33; 95% CI 0.95-1.87) and twin assisted reproduction pregnancies (66.7% vs. 60.0%), but without significant differences. CONCLUSIONS: Increased obstetric risk could be observed concerning threatened preterm delivery and cesarean section rate in the study group. The perinatal outcome of singleton and twin pregnancies following assisted reproductive techniques is comparable with that of spontaneously conceived, matched pregnancies.

Adult↗
PubMed1997

Patient dropout in an assisted reproductive technology program: implications for pregnancy rates.

OBJECTIVE: To study patient dropout and its impact on crude and cumulative pregnancy rates (PRs) after assisted reproductive technology (ART). DESIGN: Retrospective cohort study. SETTING: University hospital-based tertiary care fertility clinic. PATIENT(S): Two hundred two couples applying for their first ART treatment cycle. MAIN OUTCOME MEASURE(S): Drop-out rate and PR per cycle, cumulative drop-out rate and cumulative PR. RESULT(S): After three treatment cycles, the cumulative drop-out rate was 126 of 202 (62.4%); 13.9% (n = 28) was due to active censoring. Active censoring was shown to flatter cumulative PRs by life-table analysis. CONCLUSION: Dropout from ART is high, even when ART costs are covered by health cost insurance. Life-table analysis overestimates cumulative PRs in ART.

Cohort Studies↗
PubMed2004

Follicle-stimulating hormone and estradiol levels independently predict the success of assisted reproductive technology treatment.

OBJECTIVE: To evaluate the relationship between early follicular phase levels of FSH and E(2) and outcomes of therapy with assisted reproductive technologies (ART). DESIGN: Retrospective cohort study. SETTING: ART centers in the United States. PATIENT(S): Women receiving 19,682 ART procedures performed in 135 clinics. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of clinical pregnancy, live birth delivery, and high ovarian response (>/=10 oocytes retrieved after stimulation). RESULT(S): The ratio of each FSH or E(2) value to the respective upper limit of normal value for the clinic was computed. Within each age group, rates of pregnancy, live birth, and high ovarian response decreased linearly as FSH levels increased. For example, among women 35 years of age and younger, pregnancy rates (PR) ranged from 41.1% (FSH ratio 0-0.5) to 18.5% (FSH ratio >2.0). The three outcomes exhibited a similar downward trend as E(2) ratios increased. When both hormone ratios were elevated, outcomes were least favorable. These relationships remained statistically significant after we adjusted for diagnosis, number of embryos transferred, previous births, previous ART therapy, and use of GIFT, zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), or assisted hatching. CONCLUSION(S): The FSH and E(2) ratios predict ART success independent of age and other clinical prognostic factors.

Adult↗
PubMed2006

Comparison of assisted reproductive technology utilization and outcomes between Caucasian and African American patients in an equal-access-to-care setting.

OBJECTIVE: Racial disparity in assisted reproductive technology (ART) outcomes has been reported but remains controversial. Reasons for the disparity are unclear, and access to care has been suggested as a causative factor. In this study, we sought to examine minority utilization of ART in the Department of Defense (DoD) compared with minority utilization in the U.S. ART population. Outcomes from ART were compared between Caucasian (Cau) and African American (AA) patients, and etiologies of disparity were examined. DESIGN: Retrospective cohort study. SETTING: University-based ART program. PATIENT(S): A total of 1,457 patients undergoing first-cycle fresh, nondonor ART. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate, live birth rate, implantation rate, spontaneous abortion rate. RESULT(S): Within the DoD population, AA women had a fourfold increase in utilization of ART services relative to the U.S. ART population. In this equal-access-to-care setting, AA women experienced a clinically significant decrease in live birth rate that did not reach statistical significance (29.6% vs. 35.8%, risk ratio [RR] 0.83, 95% confidence interval [CI] 0.67-1.02) and a statistically significant increase in spontaneous abortions compared with Cau women (25% vs. 15.9%, RR 1.57, 95% CI 1.05-2.36). This might be explained, in part, by a higher prevalence of uterine leiomyomas in AA women (30.8% AA vs. 10.7% Cau, RR 2.85, 95% CI 2.06-3.95). For both AA and Cau women, the presence of fibroids at baseline ultrasound was associated with reductions in clinical pregnancy rates (35% with leiomyomas vs. 43.2% without leiomyomas, RR 0.74, 95% CI 0.51-0.98), live birth rates (26.2% vs. 36.0%, RR 0.63, 95% CI 0.44-0.90), and implantation rates (25.6% vs. 31.1% RR 0.82, 95% CI 0.69-0.98). CONCLUSION(S): Utilization of ART services among AA women increased when access to care was improved. A clinically significant reduction in live birth rate and statistically significant increase in spontaneous abortion rate was observed in AA women compared with Cau women. Leiomyomas were three times more prevalent in AA women and reduced ART success, regardless of race. The persistence of racial differences in an equal-access-to-care environment might be explained, in part, by the increased prevalence of leiomyomas in AA women.

Adult↗