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PubMed2003

Ureaplasma parvum and Ureaplasma urealyticum are detected in semen after washing before assisted reproductive technology procedures.

OBJECTIVE: To investigate the prevalence of ureaplasmas in semen and washed semen and to explore their effect on semen andrology variables. DESIGN: Prospective study. SETTING: In vitro fertilization (IVF) unit of a private hospital. PATIENT(S): Three hundred forty-three men participating in an assisted reproductive technology (ART) treatment cycle. MAIN OUTCOME MEASURE(S): The prevalence of ureaplasmas in semen and washed semen tested by culture, polymerase chain reaction assays, and indirect immunofluorescent antibody assays. RESULT(S): Ureaplasmas were detected in 73 of 343 (22%) semen samples and 29 of 343 (8.5%) washed semen samples. Ureaplasmas adherent to the surface of spermatozoa were demonstrated by indirect immunofluorescent antibody testing. Ureplasma parvum serovar 6 (36.6%) and U. urealyticum (30%) were the most prevalent isolates in washed semen. A comparison of the semen andrology variables of washed semen ureaplasma positive and negative groups demonstrated a lower proportion of nonmotile sperm in men ureaplasma positive for washed semen. CONCLUSION(S): Ureaplasmas are not always removed from semen by a standard ART washing procedure and can remain adherent to the surface of spermatozoa.

Cervix Uteri↗
PubMed2003

[Progression of semen cryopreservation and its relationship with assisted reproductive technology].

The aim of semen cryopreservation research is to elevate the proportion of competent spermatozoa after thawing. By means of molecular biology, the research of spermatozoa injury during cryopreservation reaches molecular level. In each stage of cryopreservation, there exists its own optimal condition for cooling. Cryopreservation medium still need to be improved. Men should pay more attention to the field of spermatozoa function. Assisted reproductive technology (ART) has a close relationship with the technology of semen cryopreservation. The latter's development will improve the former.

Animals↗
PubMed1993

The use of surrogate gestational carriers for assisted reproductive technologies.

OBJECTIVES: We determined the effect of embryo transfer, zygote intrafallopian transfer, and frozen embryo transfer on clinical outcomes after surrogate gestational transfers. STUDY DESIGN: Prospective randomization was carried out. RESULTS: Forty-five infertile couples were matched with a gestational surrogate carrier and underwent 81 cycles of embryo transfer with various assisted reproductive technologic procedures. Nineteen cycles produced a clinical pregnancy, with delivery in 15 of 81 cycles (18.5% live-birth rate). Fifteen of the 45 couples (33%) had a child from the surrogate gestational carrier program. CONCLUSION: No significant differences in clinical outcome were observed on the basis of the type of procedure performed or the age of the patient.

Adult↗
PubMed2005

Role of the mitochondrial genome in preimplantation development and assisted reproductive technologies.

Our fascination for mitochondria relates to their origin as symbiotic, semi-independent organisms on which we, as eukaryotic beings, rely nearly exclusively to produce energy for every cell function. Therefore, it is not surprising that these organelles play an essential role in many events during early development and in artificial reproductive technologies (ARTs) applied to humans and domestic animals. However, much needs to be learned about the interactions between the nucleus and the mitochondrial genome (mtDNA), particularly with respect to the control of transcription, replication and segregation during preimplantation. Nuclear-encoded factors that control transcription and replication are expressed during preimplantation development in mice and are followed by mtDNA transcription, but these result in no change in mtDNA copy number. However, in cattle, mtDNA copy number increases during blastocyst expansion and hatching. Nuclear genes influence the mtDNA segregation patterns in heteroplasmic animals. Because many ARTs markedly modify the mtDNA content in embryos, it is essential that their application is preceded by careful experimental scrutiny, using suitable animal models.

Animals↗
PubMed2003

Partners of men with Klinefelter syndrome can benefit from assisted reproductive technologies.

OBJECTIVE: To report the birth of a healthy female infant from a father with nonmosaic Klinefelter syndrome (KS) and document the experience of men with KS undergoing assisted conception. DESIGN: Retrospective. SETTING: Private IVF center. PATIENT(S): Twelve couples with male factor infertility due to Klinefelter syndrome undergoing assisted reproduction treatment. INTERVENTION(S): Controlled ovarian hyperstimulation, testicular sperm extraction, intracytoplasmic sperm injection (ICSI), round spermatid injection (ROSI), and preimplantation genetic diagnosis. MAIN OUTCOME MEASURE(S): Testicular sperm retrieval rate, fertilization rate, and pregnancy outcome. RESULT(S): There was a sufficient amount of motile sperm for injection into mature oocytes in 6 of the 11 testicular biopsies (54.5%). Fertilization rates for ICSI and ROSI cases were 54.2% and 41.6%, respectively. The pregnancy rate per ET was 27.2%. None of the ROSI cases resulted in pregnancy. Two patients had spontaneous abortions at 8 and 18 weeks of gestation, respectively. Only one patient delivered a healthy female baby after 36 weeks of an uneventful pregnancy. CONCLUSION(S): Men with KS can benefit from assisted reproductive technologies, and the testicular sperm retrieval rate among them is promising. Although sex chromosome aberrations among the embryos from men with KS are not common, couples can be offered preimplantation genetic diagnosis before ET.

Abortion, Spontaneous↗
PubMed2001

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

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

Adoption↗
PubMed2001

Endometriosis and assisted reproductive technologies: are outcomes affected?

The preponderance of recent data suggests that endometriosis does not adversely affect in-vitro fertilization pregnancy rates. However, many studies demonstrate impaired oocyte quality, decreased fertilization, and compromised implantation rates. Such findings give insight into the mechanisms by which endometriosis may impact on fertility, and provide clues as how to focus assisted reproductive technologies in order to overcome these deficiencies. Specifically, extended downregulation protocols, ample use of gonadotropins for ovarian stimulation, and conservative management of endometriomas have all been suggested as means to optimize in-vitro fertilization outcomes for women with endometriosis.

Endometriosis↗
PubMed2000

Artificial reproductive technologies in Australia--legislation for the new millennium?

In Australia there have been 26,818 live births after IVF and other assisted conception treatments up to 1997. The 3,164 births resulting from assisted conception in 1996 accounted for 1.2% of all Australian births in that year. In 1997 the number of births had increased by 9.3% to 3,458. Medical and scientific advances in the area of artificial reproductive technology have resulted in a complexity of moral, medical and legal issues with respect to the infertile couple or person. The following paper attempts to highlight some of these issues, from a social, legal and technological perspective, and then consider the approach taken by governments and regulatory bodies.

Australia↗
PubMed1995

Use of postseparation sperm parameters to determine the method of choice for sperm preparation for assisted reproductive technology.

OBJECTIVE: To evaluate strict sperm morphology after preparation of semen specimens using three different sperm separation techniques, since strict morphology correlates well with IVF. DESIGN: Semen from 30 men were analyzed before and after sperm separation using mini-Percoll gradient, direct swim-up, and SpermPrep filtration column (ZBL, Inc., Lexington, KY) methods. SETTING: Assisted Reproductive Technology laboratory at Sinai Hospital of Baltimore. MAIN OUTCOME MEASURES: Primary end points measured were percent morphologically normal sperm and percent improvement in sperm morphology, using Kruger strict criteria. Secondary factors determined were percent motility, improvement in motility, hypoosmotic swelling, improvement in hypoosmotic swelling, and 24- and 48-hour sperm survival under simulated IVF conditions. RESULTS: Mini-Percoll produced specimens with significantly greater normal sperm morphology, morphology improvement, motility, hypoosmotic swelling, and survival than obtained with the other two separation methods. For 25 of 30 specimens, mini-Percoll yielded the greatest number of morphologically normal, motile sperm that survived for 24 hours. In four instances, mini-Percoll was associated with an increased percentage of acrosomal abnormalities despite an overall improvement in morphology. Hypoosmotic swelling scores were lower in two subjects after mini-Percoll sperm separation and in three subjects for each of the other methods. CONCLUSIONS: Data suggest that mini-Percoll is superior to swim-up or SpermPrep for producing specimens with enhanced morphology, motility, and in vitro survival. However, no single separation technique is always superior, and methodology may induce damage to the acrosome or sperm membranes. Sperm specimens should be evaluated individually to determine the best separation method before actual ART cycles. The technique that yields the most morphologically normal, motile sperm that survive in culture should be used for ART procedures.

Cell Separation↗
PubMedDate not supplied

[Assisted reproductive technologies in urology].

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

Adult↗
PubMed1989

The occurrence of ectopic pregnancy with and without clomiphene citrate use in assisted and nonassisted reproductive technology.

An eleven-year review of treatment records of patients who became pregnant as a result of infertility treatment (n = 3692) was conducted. All records were examined to determine whether clomiphene citrate (CC) was used in the cycle of conception and whether or not an ectopic pregnancy occurred. Data were additionally analyzed for the incidence of ectopic pregnancy with and without assisted reproductive technology (ART). The incidence of ectopic pregnancy was similar between CC (3.4%) and non-CC (3.4%) treatment groups receiving non-ART treatment. For non-ART treatments, tubal disease and severe endometriosis resulted in an increase in ectopic pregnancies independent of CC use. The incidence of ectopic pregnancy in patients receiving CC + human menopausal gonadotropin (hMG) for in vitro fertilization (5.4%) and gamete intrafallopian transfer (3.1%) was similar compared to ART treatments with hMG alone. The incidence of ectopic pregnancy was more closely associated with infertility diagnosis rather than CC use.

Adult↗
PubMed1992

Failed oocyte retrieval after lack of human chorionic gonadotropin administration in assisted reproductive technology.

OBJECTIVE: To document the absence of oocytes in follicular aspirates in women who, during controlled ovarian stimulation with gonadotropin-releasing hormone agonist (GnRH-a) and menotropins, fail to receive human chorionic gonadotropin (hCG) administration. DESIGN: Retrospective analysis of clinical laboratory data. SETTING: Multicentric. PATIENTS: Five women undergoing controlled ovarian hyperstimulation with GnRH-a and menotropins for programs of assisted reproductive technologies. RESULTS: The documented absence of an hCG injection produced "empty follicles" at transvaginal guided aspiration, despite numerous follicular lavages and aspiration of peritoneal fluid. The lack of oocytes and granulosa-cumulus complex in the follicular fluid was reverted in other cycles in the same patients when hCG was properly administered. CONCLUSIONS: (1) This study emphasizes the importance of proper patients' and nurses' instructions for preparation of hCG injections and proper mixture of vehicle and powder before follicular aspiration. (2) In the absence of cumulus-corona-oocyte complex at aspiration, measure serum beta-hCG to ascertain whether hCG injection was administered or not. (3) Routine preoperative beta-hCG levels may be helpful to avoid unnecessary surgeries.

Adult↗
PubMed2000

[Clinical experience with assisted reproductive technology along the development of micro fertilization].

In 1993 we had the first success of micro fertilization in our clinic. The method by partial opening of oocyte zona pellucida initially used achieved a fertilization rate per egg of only 26.7%. Although transfer of sperm under the zona raised the fertilization rate to 39.2%, the new method involved problems such as polyspermy, which represented approximately 30% of the total fertilization rate. In addition, use of this method was limited to patients meeting several conditions. In 1994, we had a successful case of pregnancy after intracytoplasmic sperm injection (ICSI). The ICSI method resulted in a fertilization rate of about 70%, and has solved the problem of polyspermy. Fertilization of eggs has become possible using immotile sperm, and the technique of microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) has been established. Clinical data have confirmed that a fertilization rate by frozen sperms is not lower than that by fresh sperms. Sperm can be stored frozen after MESA or TESE and therefore are surely available when needed, allowing to avoid spoiling retrieved eggs. No difference in fertilization rate was found between conditions needing micro fertilization or sperm recovery methods. No difference in pregnancy rate was shown between treatment cycles. Recent reports show improved pregnancy rates using techniques such as transferring a frozen embryo after endometrical adjustment. Further development in assisted reproductive technology is anticipated.

Female↗
PubMed2007

Psychosocial adjustment during pregnancy for older couples conceiving through assisted reproductive technology.

BACKGROUND: The trend to older maternal age at first birth is well established in Western countries and biological risk factors, particularly declining fertility, are well documented. Less is known, however, about the psychosocial well-being of older first time parents. This study explores differences in psychosocial adjustment during pregnancy in older (maternal age >or= 38 years) and younger (maternal age < 35 years) couples after assisted reproductive technology (ART) conception. METHODS: Questionnaire data were collected from a consecutive cohort of pregnant nulliparous women and their partners recruited over a 12-month period from ART clinics in Sydney, Australia. RESULTS: There were more similarities than differences when comparing older and younger couples. Older couples took longer to conceive and were more likely to use donor eggs. Older pregnant women scored higher on a measure of psychological hardiness/resilience and reported a lower identification with motherhood compared with younger pregnant women. Older men differed only in reporting a less satisfying social orientation during pregnancy (lower satisfaction with sex life, relationship with partner and social life). CONCLUSIONS: Findings do not indicate problematic adjustment during pregnancy in older couples, but differences found need further investigation using larger samples and prospective designs.

Adult↗
PubMed2006

Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology.

BACKGROUND: Recently, a new marker, the anti-Müllerian hormone (AMH), has been evaluated as a marker of ovarian response. Serum AMH levels have been measured at frequent time-points during the menstrual cycle, suggesting the complete absence of fluctuation. The aim of this study was to evaluate whether serum AMH measurement on any day of the menstrual cycle could predict ovarian response in women undergoing assisted reproductive technology (ART). METHODS: This study included 48 women attending the IVF/ICSI programme. Blood withdrawal for AMH measurement was performed in all the patients independently of the day of the menstrual cycle. RESULTS: Women in the lowest AMH quartile (<0.4 ng/ml) were older and required a higher dose of recombinant FSH than women in the highest quartile (>7 ng/ml). All the cancelled cycles due to absent response were in the group of the lowest AMH quartile, whereas the cancelled cycles due to risk of ovarian hyperstimulation syndrome (OHSS) were in the group of the highest AMH quartile. This study demonstrated a strong correlation between serum AMH levels and ovarian response to gonadotrophin stimulation. CONCLUSION: For the first time, clinicians may have a reliable serum marker of ovarian response that can be measured independently of the day of the menstrual cycle.

Adult↗
PubMed2001

'Not so wrong that we are prepared to threaten the entire service': the regulation of reproductive technologies in the UK.

In the UK human embryo research and infertility treatments are regulated by the Human Fertilisation and Embryology Authority (HFEA), a national statutory body set up in 1991. Clinics are required by law to be licensed by the HFEA and open to inspection. In 1999 there were 107 clinics licensed to carry out IVF and/or donor insemination. There are regional variations in National Health Service funding and seventy-five percent of those treated pay for most of their treatment, usually to avoid long waiting lists or because they do not meet the eligibility criteria set by their local health authority. Having described the code of practice laid down by the HFEA the paper discusses the implications of new reproductive technologies from a social science perspective, focusing on three topics which continue to be debated by the media, the regulatory authorities, health professionals and 'lay' people. First, age limits and other criteria for assisted reproduction which raise the question 'who should be allowed to reproduce?' Second, donor anonymity and the question of payment for donors. Finally, the screening and selection of embryos for implantation and the recurring theme in the media of 'designer babies'. The HFEA can be seen to fulfill its intended role, mediating between the infertility professionals, patients and the wider general public. It seeks to allay public fears while supporting professionals by avoiding restrictions on research and treatment and by consulting with the public as to when extensions to research will be acceptable.

Confidentiality↗
PubMed2005

An update on embryo culture for human assisted reproductive technology: media, performance, and safety.

Several culture medium formulations are now available for the successful production and propagation of viable human embryos. In the most popular format, nutrients are provided in a temporal sequence that matches metabolic and amino acid composition with the requirements of specific developmental stage. An alternative philosophy, that all nutritional requirements for preimplantation embryogenesis can be met with a single medium formulation, is represented in commercially available formulations as well. Regardless of format employed, it is not widely appreciated in assisted reproductive technology laboratories that medium performance is strongly influenced by other components of the culture system, such as transitional conditions employed during the retrieval, pH, gas phase, and patient-specific characteristics. There is now further concern that in vitro culture, in general, modifies normal embryonic epigenetic processes and gene expression, genetic changes that may relate to specific ingredients of culture media.

Animals↗