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PubMed2006

First- and second-trimester Down syndrome screening markers in pregnancies achieved through assisted reproductive technologies (ART): a FASTER trial study.

OBJECTIVE: To determine whether first- and second-trimester Down syndrome screening markers and screen-positive rates are altered in pregnancies conceived using assisted reproductive technologies (ARTs). METHODS: ART pregnancies in the multicenter FASTER trial were identified. Marker levels were evaluated for five types of ART: in vitro fertilization with ovulation induction (IVF-OI), IVF with OI and egg donation (IVF-OI-ED), IVF with ED (IVF-ED), and intrauterine insemination with OI (IUI-OI) or without OI (IUI). Each group was compared to non-ART controls using Mann-Whitney U analysis. RESULTS: First-trimester marker levels were not significantly different between ART and control pregnancies, with the exception of reduced PAPP-A levels in the IUI-OI group. In contrast, second-trimester inhibin A levels were increased in all ART pregnancies, estriol was reduced and human chorionic gonadotropin (hCG) was increased in IVF and IUI pregnancies without ED, and alpha-fetoprotein (AFP) was increased in ED pregnancies. Second-trimester screen-positive rates were significantly higher than expected for ART pregnancies, except when ED was used. CONCLUSIONS: These data show that ART significantly impacts second-, but not first-, trimester markers and screen-positive rates. The type of adjustment needed in second-trimester screening depends on the particular type of ART used.

Adult↗
PubMed2003

The graduated embryo score predicts the outcome of assisted reproductive technologies better than a single day 3 evaluation and achieves results associated with blastocyst transfer from day 3 embryo transfer.

OBJECTIVE: To evaluate the graduated embryo score (GES) for predicting assisted reproductive technology (ART) outcome compared to a single morphologic evaluation on day 3 of culture (grade A: > or =7 cells; <20% fragmentation). DESIGN: Prospective cohort analysis. SETTING: Private practice. PATIENT(S): Women aged <40 years with a normal uterine cavity treated with ART (n = 106). INTERVENTION(S): Embryos were graded by GES and by day 3 morphologic characteristics alone before ET. Cycle outcomes were compared with embryo grade. MAIN OUTCOME MEASURE(S): Ongoing gestation and implantation rates. RESULT(S): Overall ongoing gestation and implantation rates were 48% and 26%, respectively. With 1+ embryo GES > or =70 (n = 77), the rates were 62% and 36%, respectively, which were significantly higher than for those with 0 embryos GES > or =70 (n = 29). With 1+ grade A embryo (n = 102), the rates were 50% and 27%, respectively. Transfer of more than one embryo GES > or =70 did not improve the pregnancy rate, but did increase the risk of multiple gestations. A single day 3 evaluation had an extremely low specificity (7%) compared to GES (47%). Graduated embryo scoring (GES) was an excellent predictor of pregnancy and implantation rates from blastocyst transfer. Day of transfer did not affect pregnancy rates, although implantation was higher from day 5 embryo transfer (ET) than from day 3 ET, as fewer embryos were transferred. CONCLUSION(S): Transfer of one or more embryo GES > or =70 predicts pregnancy and implantation rates better than a single morphologic evaluation on day 3 and achieves ART outcomes associated with blastocyst transfer from day 3 ET, making extended culture unnecessary for most patients.

Adult↗
PubMedDate not supplied

[The characteristics of combined genetic screening of the first trimester of pregnancy after use of assisted reproductive technology programs].

Results of comparison of nuchal translucency measurments (NT) and parameters of the biochemical analysis of blood serum of pregnant women in the first trimester and after use of assisted reproductive technologies (in vitro fertilization and cytoplasmic sperm injection (ICSI)) are submitted. It was shown that NT does not differ from those of women with spontaneous pregnancy, and parameters of biochemical markers tend only to change. After ICSI use concentration of free beta-HCG authentically increases.

Adult↗
PubMed2005

Assisted reproductive technology. What is needed in the Kingdom of Saudi Arabia?

In 1978, the first in vitro fertilization baby was born. Since then, we have seen the introduction of several new modalities of assisted reproductive technologies ART, and the spread of ART procedures throughout the world. The number of ART units in the Kingdom of Saudi Arabia is increasing rapidly. The associated complications of ART procedures include fetal, maternal and childhood.

Attitude to Health↗
PubMed1998

Factors affecting pregnancy outcome resulting from assisted reproductive technology (ART).

OBJECTIVE: A retrospective, observational study of pregnancy outcome was performed on variables maintained in an ART database to determine factors that might affect miscarriage rate in pregnancies resulting from assisted reproduction technologies (ART). METHODS: Previously infertile couples, where conception was achieved after ART, were included. Seven hundred and ninety-four consecutive clinical pregnancies, diagnosed by ultrasound documentation of the gestation sac in the first trimester were divided into 2 groups: 'miscarriage' and 'term birth'. Differences between the groups were analysed using crosstable regression analyses or t-test in second yearly cohorts. RESULTS: A statistically significant positive relationship was seen between age and spontaneous abortion rate (p = 0.008) with a major increase after the age of 38 years. There was no significant difference in the mean number of oocytes retrieved between groups (p = 0.17). While there was a significant negative correlation between maternal age and the total number of oocytes collected (p < 0.001), there was no statistical difference between those women who miscarried or delivered a live infant. No relationships were found with any other variables analysed. CONCLUSION: Maternal age is probably the most important factor in pregnancy outcome in ART. This survey could not determine any other variables as being major prognostic determinant for miscarriage once pregnancy was attained.

Adult↗
PubMed1997

Infertility and assisted reproductive technology: the role of the perinatal social worker.

The inability to conceive a pregnancy can cause disruption and anguish to individuals and couples sharing that experience. The treatments for infertility, especially those involving assisted reproductive technology such as in vitro fertilization, can be physically, financially and emotionally stressful for participants. The impact of infertility and its treatment has introduced a new venue for perinatal social worker services to counsel, educate and support these patients.

Couples Therapy↗
PubMed2006

Asian ethnicity is associated with reduced pregnancy outcomes after assisted reproductive technology.

OBJECTIVE: To determine whether success rates were similar in Asian and Caucasian women undergoing infertility treatment. DESIGN: Secondary data analysis and multivariate modeling. SETTING: Clinics reporting to the national Society for Assisted Reproductive Technology registry and a university-based clinic. PATIENT(S): Caucasian and self-identified Asian infertile women undergoing IVF. The study included 25,843 Caucasian and 1,429 Asian patients from the national registry; 370 Caucasian and 197 Asian patients were included from the site-specific clinic. INTERVENTION(S): In vitro fertilization. MAIN OUTCOME MEASURE(S): Pregnancy rate and live-birth rate. RESULT(S): Infertile Asian women differed only minimally from their Caucasian counterparts in baseline characteristics and treatment response. Yet Asian women had a decreased clinical pregnancy rate (odds ratio, 0.71; 95% confidence interval 0.64-0.80) and a decreased live-birth rate (odds ratio, 0.69; 95% confidence interval 0.61-0.77). Subsequent multivariate analysis demonstrated that Asian ethnicity was an independent predictor of poor outcome. CONCLUSION(S): After treatment, infertile Asian women have significantly fewer pregnancies than do Caucasian women. Multivariate analysis indicates that this discrepancy cannot be accounted for by differences in baseline characteristics or by response to current therapeutic interventions.

Adult↗
PubMed2001

Transvaginal ovarian drilling: a new surgical treatment for improving the clinical outcome of assisted reproductive technologies in patients with polycystic ovary syndrome.

OBJECTIVE: To evaluate the efficacy of transvaginal ovarian drilling (TVOD) in patients with polycystic ovary syndrome (PCOS) who were undergoing IVF treatment. DESIGN: Pilot study. SETTING: Reproductive medicine unit. PATIENT(S): Eleven patients with PCOS undergoing treatment with assisted reproductive technology (ART). INTERVENTION(S): Selection criterion for TVOD was repeated poor performance in > or =2 previous IVF cycles. MAIN OUTCOME MEASURE(S): Controlled ovarian hyperstimulation parameters, number of eggs collected, fertilization rate, embryo cleavage rate, implantation rate, pregnancy rate compared with the cycles before TVOD. RESULT(S): In the cycle after TVOD, a significantly higher dosage of FSH was used (33.5 +/- 12 IU vs. 52.2 +/- 15 IU) to collect a higher number of oocytes in the presence of similar E2 values at the day of hCG administration. This resulted in significantly higher fertilization and cleavage rates (27% vs. 66% and 54% vs. 72%, respectively). The pregnancy and the implantation rates after TVOD were similar to those for normovulatory patients undergoing IVF for tubal factor infertility during the study period. CONCLUSION(S): Our data suggest that the TVOD is effective in improving IVF results in difficult to treat patients with PCOS, and it is less invasive and less expensive when compared with laparoscopic ovarian diathermy.

Adult↗
PubMedDate not supplied

Newborn outcome after assisted reproductive technology: experiences and reflections from Poland.

In spite of much ethical uncertainty and wide variations in obstetric and neonatal outcomes reported in the literature, we have studied the outcome of Polish newborns after assisted reproductive technology (ART). In all of our patients, both obstetrics and neonatal care were performed in the Level Three Center in Poznan, Poland. A total of 45 and 82 newborns were analyzed from the ART and the control group, respectively. We analyzed gestational age, birth weight, Apgar score, duration of hospitalization, newborn mortality, and congenital malformations. We found a far higher rate of mothers over 35 years and with university education in ART compared to controls. The incidence of cesarean section and birth weight <1,500 g was much higher in ART. Newborn mortality was much higher among ART newborns compared to controls and was related to premature delivery of triplet pregnancy. The most important factor resulting in high neonatal mortality in our study group was multiple pregnancy. We consider the lack of regulation in Poland concerning the number of replaced embryos as a main factor influencing newborns' outcome after ART.

Adult↗
PubMed2002

Early follicular serum müllerian-inhibiting substance levels are associated with ovarian response during assisted reproductive technology cycles.

OBJECTIVE: To test the hypothesis that the concentration of early follicular phase serum müllerian-inhibiting substance (MIS) is associated with ovarian response in women undergoing ovulation induction in preparation for assisted reproductive technology (ART). DESIGN: Retrospective analysis of frozen day 3 serum samples. SETTING: Academic ART program. PATIENT(S): One sample of frozen day 3 serum from women with < or = 6 retrieved oocytes (n = 28) compared with women with > or = 11 oocytes retrieved (n = 79) in preparation for IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Comparison of day 3 serum MIS levels between two groups of women. Other comparisons included maximum serum E(2) concentrations, number of retrieved oocytes, and percentage of mature oocytes between groups. RESULT(S): Mean serum MIS concentrations were 1.0 +/- 0.4 ng/mL compared with 2.5 +/- 0.3 ng/mL, or more than a 2.5-fold greater serum concentration of MIS in the group with > or = 11 oocytes retrieved compared with in the group with < or = 6 retrieved oocytes. CONCLUSION(S): These data demonstrate an association between early follicular phase serum MIS and the number of retrieved oocytes. Higher day 3 serum MIS concentrations were associated with greater number of retrieved oocytes.

Adult↗
PubMed2000

Investigation of the infertile couple: investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal.

At present, several of the elements in widespread use in basic infertility testing are in dispute, marked variability exists in the work-up among specialists, and practice patterns are influenced both by modern assisted reproductive technologies (ART) and the increasing age of couples seeking help for infertility. This article is intended to stimulate the debate on a possible (lack of) usefulness of conventional methods of infertility evaluation in relation to both the modern techniques of assisted reproduction and the woman's age.

Coitus↗
PubMed2006

The legal status of embryos and implications for reproductive technologies and biotechnology research.

The legal status of embryos in American law is changing. At present, most states do not afford embryos the same protections as a born person, but some states are attempting to change this standard. Granting embryos the same legal status as born human beings poses a significant problem for industries that work with embryos, especially fertility treatment facilities and scientists researching stem cell and gene therapy technologies. This paper describes the methods of defining embryos in American law, and discusses the implications of granting embryos the same rights as born persons for the reproductive technology and scientific research industries.

Adult Stem Cells↗
PubMed1992

Reproductive technology: drawing the line.

An anonymous survey was administered to clinical clerks rotating through obstetrics and gynecology during weekly ethics rounds. Students were asked to judge the moral acceptability as participants and as referring physicians of 11 reproductive technology scenarios ranging from artificial insemination using a husband's sperm in a conjugal relationship to instances involving in vitro fertilization, uterine donation, surrogacy contracts, self-insemination, and single or lesbian parenthood. Positive judgments regarding personal moral acceptability ranged from 30-100% and as a referring physician from 36-99%. Though most students were consistent in their judgments about personal and professional moral acceptability, some (1-15%) could see themselves acting as referring physicians for something they personally found morally unacceptable. Those students who were opposed to contracting for children (more women than men) were more likely to find the reproductive scenarios morally unacceptable. This survey seemed to be a useful tool for discussing where students draw the line morally and why, and whether they would distance themselves from actions they found morally unacceptable. This technique for teaching applied analytic ethics is especially applicable to obstetrics and gynecology because it addresses fundamental questions involving day-to-day practice in the specialty.

Attitude↗
PubMed1995

Use of pentoxifylline in assisted reproductive technology.

Methods for improving the fertilizing potential of the spermatozoa in human in-vitro fertilization (IVF) include the stimulation of sperm function in vitro. Metabolic stimulation in vitro has become a major issue in assisted reproductive technology (ART). Here, we review our research on the unselective use of pentoxifylline in IVF for male-factor infertility. Data from our controlled studies indicate that an indiscriminate use of 3.6 mM pentoxifylline, alone or in combination with 3.0 mM 2-deoxyadenosine, is not beneficial in enhancing fertilization rates in zero and poor in-vitro fertilizers or in the presence of antisperm antibodies. An assessment of the effects of pentoxifylline on sperm function prior to IVF may ensure a more rational use of these compounds in selected cases undergoing ART. At present, however, controlled studies in subgroups of patients selected by functional testing are still lacking.

Animals↗
PubMed2001

Effect of fibroids on cumulative probability of pregnancy in women taking follicle maturing drugs without assisted reproductive technology.

PURPOSE: To determine if the presence of uterine fibroids adversely affect in vivo conception rates. METHODS: Pelvic ultrasound evaluation of the presence or absence of fibroids in consecutive infertility patients not treated with assisted reproductive technology in a two-year period. Conception outcome noted. Data analyzed according to the presence or absence of fibroids. RESULTS: No difference in cumulative probability of pregnancy after five months was seen in patients with or without the presence of fibroids. There were no confounding variables found that could have skewed the pregnancy rates in one direction or the other. CONCLUSION: In general the presence of fibroids do not adversely affect conception outcome for in vivo pregnancies. However, since the majority of the fibroids were small (< 6 cm) and were not submucosal and did not compress the endometrial cavity, larger studies are needed to address specific subtypes and circumstances on pregnancy outcome.

Adult↗
PubMed1991

Assisted reproductive technologies for male factor infertility.

Experience in the diagnosis and treatment of infertility has led to an increased understanding of the prominent role male factors play in many couples' inability to conceive. While many forms of male factor infertility are amenable to treatment, for some patients there is no corrective therapy available. For this reason, a great deal of attention has been focused on developing technologies for semen processing and sperm utilization in cases of decreased semen quality. One area of research is the development of more sophisticated methods of assessing sperm function, as well as methods of sperm preparation. Progress is also being made in the application of technologies such as intrauterine insemination and in vitro fertilization in the treatment of male factor infertility. Such developments have improved prospects for fertility among patients suffering from decreased semen quality, as well as those suffering from such disorders as ejaculatory failure and congenital vasal agenesis. Current research also offers promise for future applications such as gamete micromanipulation. This technology holds potential for improving fertility even among patients suffering from profound male factor disorders. The following is a summary of recent publications pertaining to the application of these assisted reproductive technologies in the management of male factor infertility.

Fertilization in Vitro↗
PubMed2006

A comparison of heterotopic and intrauterine-only pregnancy outcomes after assisted reproductive technologies in the United States from 1999 to 2002.

OBJECTIVE: To compare the risk for adverse outcomes of pregnancies between heterotopic (defined as a simultaneous intrauterine and ectopic pregnancy) and intrauterine-only pregnancies achieved through assisted reproductive technologies (ARTs). DESIGN: Retrospective cohort study. SETTING: ART centers in the United States. PATIENT(S): Patients were studied in terms of cycles reported to the population-based United States ART Registry, which included 207 heterotopic and 132,660 intrauterine-only pregnancies reported from 1999 to 2002. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Outcomes of heterotopic and intrauterine-only pregnancies and deliveries (spontaneous abortion, induced abortion, still birth, and live birth). Perinatal outcomes (preterm, low birth weight [LBW], preterm LBW, and term LBW) for live-birth deliveries were also assessed. RESULT(S): Heterotopic pregnancies were more likely to end in spontaneous (relative risk = 2.05; 95% confidence interval, 1.67-2.51) or induced (relative risk = 10.28, 95% confidence interval, 6.76-15.65) abortions than were intrauterine-only pregnancies. There was no significant difference in perinatal outcomes studied, regardless of adjustment for maternal age, infertility diagnosis, previous live births, and type of ART procedure. CONCLUSION(S): Heterotopic pregnancies were more likely to result in spontaneous or induced abortions than were intrauterine-only pregnancies. There was no difference in perinatal outcomes between heterotopic and intrauterine-only pregnancies progressing to live birth.

Adult↗