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PubMed1996

What are the chances of infertility and should sperm be banked?

Patients with testicular cancer have an excellent chance of surviving and may very well be interested in future fertility. This future fertility may be complicated by both pretreatment and treatment-related subfertility. The risk of ejaculatory dysfunction from retroperitoneal lymph node dissection (RPLND) for low-stage disease has been nearly erased by nerve-sparing techniques. In those patients with an ejaculation, electroejaculation and artificial insemination is effective. With cisplatinum-based chemotherapy, nearly all patients will become azoospermic with the majority recovering spermatogenesis within four years. Most patients undergoing prophylactic radiation therapy for seminoma will return to baseline semen quality within 2 years. In men with persistent poor semen quality, assisted reproductive technologies may allow having children, even with very low numbers of viable sperm. Assisted reproductive technologies have also greatly improved the chance of pregnancy with cryopreserved sperm. Therefore, prospects for procreation are quite good for men facing treatment for germ cell tumors. In those patients who do not recover spontaneous fertility, semen cryopreservation gives additional hope for having children. Patients should be given the option of semen cryopreservation if any viable sperm are present, even if the specimen is extremely poor.

Adult↗
PubMed1999

The fate of cryopreserved human embryos approaching their legal limit of storage within a West Australian in-vitro fertilization clinic.

Human embryos can only be stored in the first instance for 3 years in Western Australia, according to the West Australian Reproductive Technology Act. Thereafter, an application must be made to the local regulatory body, the Reproductive Technology Council, for an extension. Of the 650 batches of embryos frozen between 8 April 1993 and 31 October 1995, 170 (26.2%) batches were still in storage after 2.5 years. A reminding letter was sent at this time to the couples to whom the embryos belonged, i.e. 6 months before the expiry of the initial storage period, asking for clarification of what was to be done with the embryos. A large proportion of patients (64.7%) chose to either extend the storage period or thaw and transfer the embryos. Curiously, more batches of embryos were discarded (18.8%) than donated to other couples (5.9%). Contact with the patients was lost in a small but significant proportion of cases; more of these had been unsuccessful in their treatment (20.4%) than had achieved a pregnancy (4.3%).

Australia↗
PubMed2001

Can we abandon routine evaluation of serum estradiol levels during controlled ovarian hyperstimulation for assisted reproduction?

OBJECTIVE: To assess whether abandoning measurement of serum estradiol (E2) and spacing ultrasound evaluations at greater intervals had an effect on the results of assisted reproduction technology (ART). DESIGN: A retrospective comparison of two consecutive periods. SETTING: Division of Assisted Reproduction Technology, Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel. PATIENT(S): One thousand nine hundred and eighty-five controlled ovarian hyperstimulation (COH) cycles for ART were initiated during the years 1996 to 1999. INTERVENTION(S): During the first 2 years an intensive follow-up protocol was used that included E2 blood levels measurements. In the next 2 years a less intensive protocol was adopted that did not use E2 measurements. MAIN OUTCOME MEASURE(S): ART results and the rate of ovarian hyperstimulation syndrome (OHSS). RESULT(S): The patients' background characteristics did not differ between the two periods. The cancellation rate was not different (9.8% vs. 7.2%). There was no difference in the duration of stimulation or the amount of gonadotropins used. The number of oocytes retrieved (12.1 +/- 9.3 vs. 9.6 +/- 6.3), fertilization rates (74% vs. 75%), and clinical pregnancy rates (26.2% vs. 27.9%) did not differ. The incidence of severe ovarian hyperstimulation syndrome was not significantly different between the two periods. CONCLUSION(S): Controlled ovarian hyperstimulation for ART can be done reliably without routine, serial serum E2 measurements without compromising the treatment results.

Estradiol↗
PubMed2004

The regulation of science and the Charter of Rights: would a ban on non-reproductive human cloning unjustifiably violate freedom of expression?

Non-Reproductive Human Cloning (NRHC) allows researchers to develop and clone cells, including non-reproductive cells, and to research the etiology and transmission of disease. The ability to clone specific stem cells may also allow researchers to clone cells with genetic defects and analyze those cells with more precisions. Despite those potential benefits, Parliament has banned such cloning due to a myriad of social and ethical concerns. In May 2002, the Canadian Government introduced Bill C-13 on assisted human reproductive technologies. Bill C-13 deals with both the scientific and the clinical use of human reproductive materials, and it prohibits a number of other activities, including NRHC. Although the Supreme Court of Canada has never ruled on whether scientific experiments area form of expression, academic support exists for this notion. The authors go through the legal analysis that would be required to find that scientific experiments are expression, focusing in part on whether NRHC could be considered violent and thus fall outside the protection of section 2(b). The latter question is complicated by the ongoing policy debate over whether an "embryonic cell" is property of human life. The authors then consider whether a ban on NRHC could be justified under section 1 of the Charter. They conclude that both the breadth of the legislative purpose and the proportionality of the measure are problematic. Proportionality is a specific concern because the ban could be viewed as an outright denial of scientific freedom of expression. Although consistent with current jurisprudence on freedom of expression, this paper runs against the flow of government policy in the areas of regulation and prohibition of non-reproductive human cloning. As there has been no Charter litigation to date on whether scientific research is a form of expression, the authors introduce a new way of looking at the legality of the regulation of new reproductive technologies.

Biomedical Research↗
PubMed2001

Redefining family: should lesbians have access to assisted reproduction?

The recent Federal Court decision in McBain v. Victoria, which rendered inoperative a Victorian law that restricted assisted reproductive technology to married or heterosexual de facto couples, has raised the issue of whether lesbians should have access to such technology. This article provides an overview of State laws currently regulating lesbian access to assisted reproduction in Australia. It then explores the growing body of empirical research indicating that the welfare of children raised in lesbian households does not differ in any significant respect from the welfare of children raised in comparable circumstances by heterosexual parents. This research undermines the view that children suffer social stigma or experience hardship caused by the lack of a 'father figure.' The 'welfare of child' rhetoric has in fact been used to mask marginalisation of 'alternative' family forms, and the reluctance to extend assisted reproductive technology to lesbians is underpinned by a deep-rooted fear of undermining the traditional heterosexual nuclear family.

Australia↗
PubMed2005

Assisted reproduction for HIV-infected couples.

Many HIV-infected individuals are in relationships with HIV-uninfected partners and desire to have children. This review focuses on the issue of reproductive choices for these couples, in particular assisted reproductive technologies, and summarises the published outcome data currently available. The results thus far from assisted reproductive technologies in optimising pregnancy outcomes and reducing heterosexual and perinatal HIV transmission are promising. In the future, it is essential that there is ongoing reporting of outcome data, publication of methodology and follow-up, and reporting of adverse outcomes.

Disease Transmission, Infectious↗
PubMed2006

Culture without the petri-dish.

Automation of oocyte maturation and embryo production techniques is a new and exciting development in the field of reproductive technologies. There are two areas where increased automation is having an impact: in the area of embryo diagnostics and in the process of embryo production itself. Benefits include decreased staffing and skill requirements for production and assessment of embryos, as well as increasing quality management systems by removing the "human" factor. However, the uptake of new technologies is likely to be slow, as costs and the conservative nature of the Assisted Reproduction Technology industry to adopt new techniques.

Animals↗
PubMed1998

Manipulation of the fertility of marsupials for conservation of endangered species and control of over-abundant populations.

Marsupials present a dichotomy in population management; the numbers of many Australian marsupial species have declined due to loss of habitat, competition from introduced herbivores and predation by introduced carnivores, but other species have become locally overabundant in Australia or are introduced pests in New Zealand. The manipulation of reproduction offers the means to increase or decrease productivity; however, considerable fundamental research is required before reproductive technologies can be applied to marsupials. Marsupials differ from eutherian mammals in several aspects of their reproduction including sex differentiation, gamete function and endocrinology, as well as in the relative lengths of gestation and lactation. Although these differences present unique problems in the application of reproductive technologies to marsupials, they also present unique opportunities for marsupial-specific fertility control. This paper summarises the assisted breeding technologies currently being applied to marsupials including superovulation, artificial insemination, in vitro fertilization and gene banking; unique marsupial targets for contraceptive intervention including gamete production, sperm capacitation, gamete surface antigens and embryonic development; and some options for the delivery of contraceptive vaccines to marsupial populations.

Animals↗
PubMed2006

Chance, choice and control: lay debate on prenatal social sex selection.

Assisted reproductive technologies are typically positioned as increasing the range of choices open to the healthcare consumer, thereby enhancing 'reproductive freedom'. In this paper, we question the equivalence of reproductive choice and personal freedom in ethical theory, using results from a project investigating how lay people make ethical evaluations about the new genetic and reproductive technologies. We took the topic of social sex selection by preimplantation genetic diagnosis (PGD), and used group discussions and interviews in the north-east of England to trace how lay people develop and express their ethical evaluations, and to identify the implicit or explicit normative framework that gave rise to their opinions on prenatal sex selection. There was a striking level of ambivalence towards choice in general and reproductive choice in particular. Participants offered few positive statements and numerous reasons why reproductive choice might be problematic. Our participants' argumentation shares with mainstream bioethical analysis the weighing of the possible harms of prenatal sex selection for social reasons against the harm of restricting reproductive freedom. However, unlike most secular-liberal bioethicists, many of our participants concluded that prenatal sex selection is undesirable because it is an expression of parental preference instead of a response to the future child's need. Our interpretation of their reasoning is that they work from an ideal of "good parents", one of the features of which is the relinquishing of control over their children, except to protect them from harm. This voluntary self-limitation does not indicate reduced autonomy, because parental autonomy can only operate within the limits set by this relational framework. We suggest that a model of relational autonomy captures our lay participants' framing of the problem better than a more traditional understanding of autonomy. Our study also shows that in appropriately structured discussion of bioethical issues, lay people can articulate reasons for their opinions that are grounded in sophisticated and morally relevant concepts.

Adolescent↗
PubMed1993

Challenges to dairy cattle management: genetic considerations.

Several new technologies will be used to produce continued genetic change in dairy cattle. These technologies are categorized broadly as 1) improved modeling, selection, and evaluation methods; 2) use of new and improved reproductive technologies; 3) new developments in molecular genetics; and 4) new developments in immunogenetics. Improvements in evaluation will continue as computers become faster and have more storage capabilities. Improved mathematical models that more nearly describe the biology of lactation will maximize estimation of genetic differences and reduce residuals. New reproductive technology could allow reduction of generation intervals two- to fivefold compared with present generation intervals and, combined with genetic markers, could markedly accelerate progress. Health problems in dairy cattle are expected to increase as production increases. Thus, selection for decreased incidences of health disorders will be needed, probably by selection of sires with improved general immunocompetence. Research is in the early stages of application of techniques of molecular genetics to animal breeding. Early uses will allow detection and alleviation of genetic defects. Eventually, marker genes that directly affect production and metabolic pathways that also affect production will be subjected to selection. The ability to foresee new and potentially useful techniques will be determined by scientific advancement of areas in which researchers are engaged; thus, accurate prediction far into the future cannot be expected.

Animals↗
PubMed1996

Endometriosis: medical and surgical intervention.

Pregnancy rates with endometriosis-associated infertility may be improved by laparoscopic surgery or laparotomy for moderate to severe disease. Surgery for minimal to mild disease does not increase pregnancy rates. Medical treatment has not been shown to increase fecundity for any stage of the disease. Pregnancy rates with assisted reproductive technology for endometriosis appear to be comparable with those for tubal disease that are also treated with assisted reproductive technology. Medical and surgical treatments for pelvic pain with endometriosis are both effective, but surgery avoids the side-effects associated with drugs and may result in a lower recurrence rate.

Combined Modality Therapy↗
PubMed2004

Attitudes towards preconception sex selection: a representative survey from Germany.

Within the next parliamentary term, the German government is expected to replace the current Embryo Protection Act with a new Human Reproductive Technology Act. Before introducing new legislation, policy makers may want to survey public attitudes towards novel applications of reproductive technology. In order to assess opinions and concerns about preconception sex selection for non-medical reasons, a social survey has been conducted in Germany. As a representative sample of the German population, 1005 men and women 18 years and older were asked whether or not preconception sex selection should be made available. Of the respondents, 32% held that sex selection should be strictly prohibited, be it for medical or non-medical reasons, and 54% accepted the use of preconception sex selection for medical purposes. Only a minority of 11% approved of the use of preconception sex selection for non-medical reasons. The widespread opposition to a freely available service for non-medical sex selection is based on several claims: 87% of respondents hold that 'children are a gift and deserve to be loved regardless of any characteristics such as beauty, intelligence or sex'; 79% argue that choosing the sex of children is 'playing God'; 76% are opposed because it is seen as 'unnatural'; 49% are afraid that it is 'skewing the natural sex ratio'; and 40% consider it to be 'sexist'.

Adult↗
PubMed1998

Confirmation of the beneficial effects of brief coincubation of gametes in human in vitro fertilization.

OBJECTIVE: To confirm whether brief exposure of human oocytes to spermatozoa in vitro results in equivalent fertilization rates and possibly better quality embryos than overnight coincubation and to determine if there was a difference in outcome with regard to the type of culture medium used. DESIGN: Prospective distribution of gametes between treatments in sequential patients. SETTING: Assisted reproductive technology program in private hospital. PATIENT(S): Consecutively treated subfertile couples entering an infertility program. INTERVENTION(S): Assisted reproductive technology treatment for infertility involving oocyte retrieval and in vitro fertilization. MAIN OUTCOME MEASURE(S): When possible, the outcome of fertilization and embryo quality were compared when gametes were coincubated for 1 hour or overnight. Two different formulations of human tubal fluid were compared in some cases. RESULT(S): There was no statistically significant difference in fertilization rates between a brief or overnight coincubation of gametes or between the two treatment groups with regard to the type of culture medium used. The quality of the embryos was significantly better in the 1-hour exposure group. The embryos in Basal XI human tubal fluid medium were of significantly better morphological quality than their siblings in D3+ human tubal fluid medium. CONCLUSION(S): Coincubation of oocytes and spermatozoa for a shorter period produced embryos of superior morphological quality than the generally accepted overnight protocol. A simple glucose and phosphate-free human tubal fluid medium resulted in early cleavage embryos of better morphological quality than a medium supplemented with glucose, taurine, and glutathione.

Embryo Transfer↗
PubMed1997

Advanced maternal age and perinatal outcome: oocyte recipiency versus natural conception.

OBJECTIVE: To compare perinatal outcome in older oocyte recipients with that in women of advanced maternal age who conceived without assisted reproductive technologies. METHODS: We performed a retrospective cohort study of 46 oocyte recipients and 49 women who conceived without assisted reproductive technologies. The obstetric courses in singleton and multiple gestations in the two groups of women were compared. RESULTS: Among singleton pregnancies, a comparable obstetric course was noted between the groups. Fifty percent of the oocyte recipients experienced multiple gestations, resulting in an increased risk for placenta previa, premature rupture of membranes, preterm labor and delivery, glucose intolerance of pregnancy, pregnancy-induced hypertension, and cesarean delivery. However, only the risks for pregnancy-induced hypertension and cesarean delivery were significantly increased in the pregnancies of oocyte recipients with multiple gestations. CONCLUSIONS: Perinatal complications in women receiving oocyte donation may be related to their higher incidence of multiple gestation.

Age Factors↗
PubMed2005

Perinatal complications of assisted reproduction.

The main perinatal complications of assisted reproduction include congenital malformation, chromosomal aberrations, multiple pregnancy, and prematurity. Earlier studies and in vitro fertilization (IVF) registries showed that there was no increased incidence of congenital malformations in children conceived by IVF/intracytoplasmic sperm injection (ICSI). However, a large Australian study has found that by one year of age, the incidence of congenital malformations in IVF/ICSI children is increased in comparison with those naturally conceived. Several investigators found a slight but increased risk of chromosomal aberrations in ICSI children. Multiple pregnancy is a major cause of increased perinatal mortality due to increased incidence of both prematurity and congenital malformations. Even in singleton pregnancies conceived by assisted reproductive technologies, the risk of prematurity and newborns small for gestational age is increased. In this article, recently published work on perinatal complications associated with assisted reproductive technologies is reviewed.

Chromosome Aberrations↗
PubMed2005

Assisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties.

OBJECTIVE: To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. DESIGN: Systematic audit of consecutive medical records. SETTING: Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia. PATIENT(S): Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birth weight, and Edinburgh Postnatal Depression Scale scores. RESULT(S): A total of 745 records were audited, and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45/745) of the admitted infants had been conceived through assisted reproductive technologies compared with 1.52% in the general population (relative risk 4.0; 95% confidence interval, 3.0-5.4). Mothers who had conceived with assisted reproductive technologies were older and more likely to have had cesarean and multiple births than those who conceived spontaneously. CONCLUSIONS: Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support before and after their babies are born.

Adult↗
PubMed1998

Exploring male fertility options after spinal cord injury: the role of the nurse clinician.

Male sexual function and fertility are important areas that need to be addressed for men undergoing spinal cord injury (SCI) rehabilitation. Rehabilitation nurses need to understand what fertility after SCI involves. Significant advances in the areas of sperm retrieval and advanced reproductive technologies have made biological parenthood for many men with SCI a viable option. This article reviews the various sperm retrieval techniques and advanced reproductive technologies available today. It also describes the unique role of a nurse clinician working in a fertility clinic designed specifically to address the fertility concerns of men and their partners after SCI.

Critical Pathways↗
PubMed2002

Application of electronic estrus detection technologies to reproductive management of cattle.

Artificial insemination and embryo transfer programs are dependent on efficient and accurate detection of estrus. Visual observation is accurate at detecting animals in estrus, but efficiency ranges from approximately 50 to 70%. Electronic technologies have been developed in attempts to improve estrus detection efficiency. Commercially available electronic devices for estrus detection are based on changes in physical activity (pedometers), changes in electrical resistance of reproductive tract secretions (intravaginal resistance probes) or mounting activity (mount detectors). All of the commercially available electronic estrus detection devices can improve the efficiency of estrus detection in cattle. Pedometers are most applicable to lactating dairy cattle and have greater accuracy and efficiency when combined with visual observation. Intravaginal resistance measurement is perhaps the least practical method of estrus detection because of labor and animal handling requirements. Individual resistance measurement may have practical application for confirming other inconclusive signs of estrus. Mount monitors have the broadest application to beef and dairy cattle. HeatWatch, the only real-time radiotelometric system available, requires the least labor and animal handling and provides data on the time and duration of each mount. The less expensive stand-alone mount monitors also provide the necessary information for optimum timing of insemination and embryo transfer, but are more labor intensive.

Animals↗