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PubMed2000

[The current status of assisted reproductive technology].

It has been over two decades since the birth of the first child conceived by in vitro fertilization (IVF). During the intervening years, technology has evolved; however, IVF has not solved the problems concerning sperm. The first successful pregnancies after the intracytoplasmic injection of a single spermatozoon into an oocyte (ICSI) were rapidly followed by the widespread use of this novel technique for the treatment of male factor infertility. Injection of motile (living) spermatozoa into the oocyte is the most important factor in obtaining good results and other sperm parameters, anti-sperm antibodies and sperm origin, i.e., ejaculated, epididymal and testicular, do not have a strong influence on the outcome of ICSI. ICSI has revolutionized the treatment of male infertility and the application of ICSI is rapidly expanding around the world. However, this technique avoids the natural process of sperm selection and fertilization. Therefore, it is of utmost importance to monitor carefully the development, throughout childhood and into adulthood, of individuals born as a result of ICSI in order to assess its safety. ICSI should only be used for specific indications until its safety has been established. In this paper, the current status of two new approaches, ICSI with spermatid and donor oocyte cytoplasm transfusion, is also reviewed.

Female↗
PubMed2002

State secrets: access to information under the Human Reproductive Technology Act 1991 (WA).

Many Australian children have a biological father who gave his sperm so that the child's mother could conceive and raise them. Many of these children, and their parent(s), do not know who that biological father is. However, some want to know. The article examines the Western Australian law on access to information about the identity of parties in these arrangements. It is argued that there is an implied right to access identifying information where all parties consent to the exchange of information; that this right has been ignored in official and medical practice and opportunities for good record-keeping missed; and that the current law allows a parent to give consent to the exchange of identifying information on behalf of their child at any time after the child is conceived.

Access to Information↗
PubMed1992

Epididymal sperm in assisted reproductive technology.

Infertile men with obstructive azoospermia mainly due to congenital absence of the vas deferens (CAVD) now have the option of trying to father their own progeny. In fact, in the last five years epididymal sperm retrieval microsurgically have been successfully used for in vitro fertilisation of human oocytes. In this report the clinical results of 98 consecutive procedures of microsurgical epididymal sperm aspiration (MESA) combined with in vitro fertilisation (IVF) and tubal embryo transfer (TET) are described. An overall fertilisation rate of 17% and a pregnancy rate of 36% per transfer is reported. Five of the 18 pregnancies resulted in abortion (27%) and 13 were delivered at term. Additionally, extra embryos for freezing and potential use for future attempts were made available for 13 couples. Men with CAVD have also allowed the study of spermatogenesis, immunological response and sperm disposal mechanisms in condition of chronic obstruction.

Adult↗
PubMed2005

Assisted reproductive technology (ART) in the upstate: reducing the risks of multiple births.

Multiple pregnancies from ART procedures are all too common. Efforts to reduce high-order multiple pregnancies will require both social and medical reforms. In lieu of a legislative agenda to reduce multiple pregnancies in the United States, efforts must come from the personnel within the individual ART clinics. The approach to the problem includes accepting a lower pregnancy rate than otherwise might be obtainable, if the observed rate of high-order multiple pregnancies is above a certain threshold. Expanding the opportunities for ART reimbursement will ultimately address this problem in the United States, but until then, it is a problem that will not go away without commitment and resolve.

Adult↗
PubMed1991

In vitro fertilization-embryo transfer (IVF-ET) in the United States: 1989 results from the IVF-ET Registry. Medical Research International, Society for Assisted Reproductive Technology, The American Fertility Society.

This is the fourth annual report of the United States Registry of in vitro fertilization-embryo transfer (IVF-ET) and related practices. The present report describes the 1989 experiences of 163 United States member clinics with respect to treatments and outcomes. During 1989, the clinics reported performing 24,183 ovarian stimulation cycles. From all treatments, including frozen ET and IVF with donor oocytes, there were with 4,598 clinical pregnancies and 3,472 live deliveries. Ninety-eight percent of the clinics had at least one delivery, and overall a total of 4,736 babies were born. The overall live delivery rates were 14% for IVF (based on 15,392 retrievals), 23% for gamete intrafallopian transfer (GIFT) (based on 3,652 retrievals), 26% for IVF and GIFT in combination (based on 452 retrievals), and 17% for zygote intrafallopian transfer (ZIFT) and related practices (based on 908 retrievals). In addition to these treatments, results are presented for frozen ETs and IVF of donated oocytes.

Abortion, Spontaneous↗
PubMed1990

In vitro fertilization-embryo transfer in the United States: 1988 results from the IVF-ET Registry. Medical Research International. Society for Assisted Reproductive Technology. American Fertility Society.

This is the third annual report of the U.S. Registry of in vitro fertilization-embryo transfer (IVF-ET) and related practices. The present report describes the 1988 experiences of 135 U.S. member clinics with respect to treatments and outcomes. During 1988 the clinics reported performing 22,649 ovarian stimulation cycles, with 3,508 (15%) resulting in a clinical pregnancy and 2,627 (12%) in a live delivery. Ninety-three percent of the clinics had at least one delivery, and overall a total of 3,427 babies were born. The overall live delivery rates were 12% for IVF (based on 13,647 retrievals), 21% for gamete intrafallopian transfer (GIFT) (based on 3,080 retrievals), and 20% for IVF and GIFT in combination (based on 671 retrievals). In addition to these treatments, detailed results are presented for zygote intrafallopian transfer, frozen embryo transfers, and IVF of donated oocytes.

Embryo Transfer↗
PubMedDate not supplied

Controlled ovarian hyperstimulation for the new reproductive technologies.

The aim of controlled ovarian hyperstimulation (COH) is to induce multiple morphologically and functionally adequate follicles with the aim of harvesting multiple fertilizable oocytes. We compared several treatment regimens with different FSH/LH ratios: group I was the basic 2 human menopausal gonadotropins (2hMG) protocol in which 2 ampules of hMG were administered starting on day 3 of the cycle; group II was the basic 2hMG in which 2 ampules of "pure" follicle stimulating hormone (p-FSH) were added on day 3 and 4; group III was the 2 FSH protocol in which 2 ampules of p-FSH were administered beginning on day 3; finally, group IV was the 4FSH: 4 ampules of p-FSH on day 3 and 4 followed by 2 ampules of p-FSH daily. The reference regimen was the 2hMG. Except for the higher rate of immature oocytes in 2FSH and 2hMG protocols, the number of preovulatory oocytes and fertilization rate were similar in all protocols. No differences occurred in the pregnancy outcome. The low dose Lupron (LDL) stimulation was an experimental protocol applied to two groups of women who had previously failed COH. Eight women who had a premature luteinization and 8 women who showed a low response agreed to participate in the protocol. Ten micrograms of the GnRH agonist leuprolide acetate (Lupron) were injected subcutaneously every 6 hours starting on cycle day 2 and menotropin stimulation was begun on day 3-5, according to individual patient response. The LDL protocol was successful in determining a favourable estradiol pattern and fertilizable oocytes.

Drug Administration Schedule↗