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The fields of reproduction and immunology are now interfacing to enhance the ability of women to achieve their desired family size. Much work needs to be done to understand the role of immunologic processes in both fertilization, implantation, and maintenance of a healthy pregnancy.
Legislation in the area of assisted reproduction has been a slow process and one dogged by conflicting ethical views. Where legislation has been introduced in Europe it has not been consistent, representing the different cultural environments of the countries concerned and in a number of countries legislation has still not been introduced. Although the 1997 European Convention on Human Rights and Biomedicine represented a landmark in trying to introduce an international consensus on embryo research and its control, there is little or no regulation of assisted reproduction services even in those countries where legislation has been introduced. This may not be in the best interest of patients, particularly where a new technique is being introduced. A survey of those providing assisted reproduction services has indicated support for some form of technical standardization within Europe.
The recent introduction of more invasive assisted reproductive techniques offers the possibility to provide a wider treatment profile to patients. However, some of these technologies are of considerable concern as they are fraught with the possible transmission of genetic abnormalities to the offspring they create. To date, much analysis of these technologies has been conducted at the chromosomal DNA level. While some analysis has been conducted on the extranuclear, mitochondrial genome (mtDNA), this has been mainly descriptive. In the vast majority of cases, it appears that mtDNA is maternally inherited. The impact that leakage of sperm mtDNA transmission might have for the offspring is discussed in the light of the recent identification of sperm mtDNA presence in a patient with mtDNA disease. The implications of introducing donor mtDNA into a recipient oocyte through both cytoplasmic and nuclear transfer are also discussed. Again, the implications for offspring survival are discussed and suggestions made as to why the techniques might provide valuable insights into mtDNA transmission, replication and transcription. In order to be confident that patients and their offspring are being offered safe treatment, it is argued that potentially some of these treatments may be of considerable benefit in the future but significant scientific research is required before these treatments can be effectively employed in the clinic.
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Among the most popular techniques of assisted reproduction for the treatment of male subfertility and infertility are intrauterine insemination, in vitro fertilization and intracytoplasmic sperm injection. The objective of these techniques is to bring more functional spermatozoa closer to the oocyte in order to promote fertilization. These techniques are thus not a cure per se and are only indicated when no specific or effective treatment is available for the male partner, when this treatment has failed or when the improvement of the female fertility status has also failed. While for moderate oligoasthenozoospermia, intrauterine insemination has proved to be a valid treatment, the outcome after conventional in vitro fertilization is limited because of a high incidence of complete fertilization failure. Since the introduction of intracytoplasmic sperm injection, a reliable method has become available in order to achieve fertilization in vitro. Apart from well from ejaculated spermatozoa, epididymal or testicular spermatozoa too can be used successfully for intracytoplasmic sperm injection. The surgical retrieval of spermatozoa for intracytoplasmic sperm injection has therefore become a routine technique in clinical andrology. Although these techniques have been implemented in everyday infertility practice within a few years of their introduction, many concerns about safety continue to exist. Intracytoplasmic sperm injection must be applied with caution, only when no other treatment option is available and when an appropriate prospective follow-up of the offspring is available.
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European results of assisted reproductive techniques from treatments initiated during 1998 are presented in this second ESHRE report. Data was collected from 18 European countries usually from pre-existing national registers. A total of 521 clinics from these 18 countries reported 232 443 cycles: IVF 103 919 intracytoplasmic sperm injection (ICSI) 89 192 unclassified fertilization method 667 frozen embryo replacement (FER) 34 03 oocyte donations (OD) 4629. In nine countries where all clinics reported to the register a total of 128 801 cycles were performed in a population of 165 million corresponding to 781 cycles per million inhabitants 3.2 cycles per 1000 women aged 15-49 years. After IVF ICSI the distribution of transfer of 1, 2, 3 > or =4 embryos was 11.5, 37.2, 42.0 and 9.4% respectively. Huge differences existed between countries. For IVF the clinical pregnancy rate per aspiration per transfer was 23.2% 27.0% respectively. For ICSI the corresponding rates were 24.8% 26.8%. The distribution of singleton, twin, triplet, quadruplet deliveries for IVF and ICSI combined was 73.7, 23.9, 2.3 and 0.1%. This gives a total multiple delivery rate of 26.3%. The range of triplet deliveries after IVF and ICSI differed from 0.2-5.3% between countries. Compared with 1997, the number of reported cycles has increased by 14% and the number of reporting clinics by 8%. The clinical pregnancy rate per transfer increased from 26.1 to 27.0% after IVF and from 26.4 to 26.8% after ICSI. Multiple deliveries after IVF and ICSI decreased from 29.6 to 26.3%.
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This article critically evaluates the central claims of the various feminist responses to new reproductive arrangements and technologies. Proponents of a "progressivism" object to naive technological optimism and raise questions about the control of such technology. Others, such as the FINRRAGE group, raise concerns about the potentially damaging consequences of the new technologies for women. While a central concern is whether these technologies reinforce harmful biologically determinist stereotypes of women, it may be that these critiques function with a devastating gender blindness that puts women at risk in other, heretofore unnoticed, ways.
The rapid advance of the World Wide Web presents significant challenges for ensuring quality of health care information presented to a global audience. Using American Medical Association guidelines, Huang and co-authors have issued a report card for Society for Assisted Reproductive Technology-affiliated websites, indicating much room for improvement.
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