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PubMed1999

Access to donor insemination: Canadian ideals--UK law and practice.

Reproductive technology has made a huge impact on society, exposing many long-standing, unresolved anomalies in our values and traditions. Access to medically assisted reproduction is particularly controversial, raising medical, legal and ethical issues. The 1980s saw increasing demands across several jurisdictions for clear legal rules, the hope being expressed in Canada that "the law may reflect the community's level of tolerance; but...also stretch or fashion it in the interests of a worthy goal." The Canadian Law Reform Commission recommended that, with regard to donor insemination, "protection for the traditional family should not be incorporated in legislation" and that "access should be limited only in terms of the cost and scarcity of resources", selection not being based on "family status, sexual orientation and so on". This paper attempts a comparative examination of UK legislation on reproductive technology in this light, with particular focus on the rationing of access to donor insemination.

Canada↗
PubMed2005

[Endometriosis and infertility].

Endometriosis seems to be a common fertility barrier which is affected by immunological and local mechanical factors. The established use of assisted reproductive technologies (ART) provides increasing knowledge about folliculogenesis, fertilization, embryo development and pregnancy rates. Nevertheless, controversial discussion about the success of ART in endometriosis exists although the progress of reproductive technologies is improving constantly in many ways. Despite all discussions the question remains still to be unanswered, whether or not endometriosis is indeed limiting the success in reproductive medicine.

Endometriosis↗
PubMed2002

Gender selection: ethical, scientific, legal, and practical issues.

PURPOSE: This work offers an overview of the technology available and assisted reproductive technology (ART) practitioner attitudes to human reproductive sex preselection in either sperm with the use of flow cytometry (FC) or in embryos by means of preimplantational genetic diagnose (PGD) together with an analysis of Spanish legal environment. METHODS: A review of the legal, ethical and technical literature of the methods to select the sex in the offspring is performed. RESULTS: Sex selection in humans has different utilities to be employed depending on each country's law. Moreover, different ethical concerns are raised depending on the type of sex selection, in sperm or embryos. Both methodologies to pre-select the sex are trustworthy, with a high predictive power in the determination of the sex, but nevertheless, PGD is better than FC selection in this aspect. CONCLUSIONS: After a careful analysis of ethical, legal, and scientific features of gender selection, FC combined with PGD appears to be the most acceptable way to select the sex of the progeny whatever the circumstances are.

Female↗
PubMed2005

Controlling birth: science, politics, and public policy.

Reproductive technologies raise a host of social and legal issues that challenge basic values and create intense controversy. If researchers wish to inform public policies related to reproductive technologies, they must understand how the scientific enterprise is being manipulated and research findings are being misrepresented to justify a particular social agenda and restrict access to contraception and abortion. To counter these distortions, scientists must defend the science advisory process, be involved in dissemination of their research findings beyond simply publication in scientific journals, and actively work to ensure that the findings are not misrepresented to the public.

Abortion, Induced↗
PubMed2005

Risk of cerebral palsy in multiple pregnancies.

Multiple compared with singleton gestations have a five- to tenfold increased risk of CP. The increased risk associated with MC placentation has been variously ascribed to transfer of thromboplastin or thromboemboli from the dead to the surviving fetus, exsanguination of the surviving fetus into the low pressure reservoir of the dead fetus, or hemodynamic instability with bidirectional shunting of blood between the two fetuses. An increased risk of CP in assisted reproductive technology gestations is to be expected because of the higher proportion of preterm births. The increase in risk of CP associated with monochorionic placentation will not be observed except for the minority of assisted reproductive technology gestations that undergo monozygotic splitting.

Birth Weight↗
PubMed2005

Encouraging results despite complexity of multidisciplinary care of HIV-infected women using assisted reproduction techniques.

BACKGROUND: Assisted reproduction technologies can treat infertility for human immunodeficiency virus (HIV) seropositive women. We assessed the efficacy of these techniques in the results and difficulties encountered while conducting our assisted reproduction programme for 49 couples in which at least the woman had HIV infection that was currently under control. METHODS: Treatments included intrauterine insemination (IUI), IVF and ICSI, with ovarian stimulation. Embryos were transferred on day 3 after oocyte retrieval. An elective single transfer was performed, except for patients aged > or = 40 years. RESULTS: The median age of the women was 36 years. Ten IUI, nine IVF, 53 ICSI and 10 frozen-thawed embryo transfers have been performed. No pregnancy occurred following the IUI trials but for the couples with IVF and ICSI attempts the clinical pregnancy rate per embryo transfer was 23.9%. Eight babies have been born leading to a 22.2% take home baby rate per treated couple. Contamination was not observed in any newborn. CONCLUSIONS: Assisted reproduction technologies and particularly ICSI can provide HIV seropositive women with a safe means of mothering children. Results are encouraging when considering the age of the patients and a preferential single embryo transfer.

Adult↗
PubMed2005

Embryonic loss in iatrogenic multiples.

Spontaneous reduction of multiple gestational sacs occurs less often in pregnancies conceived as a result of ovulation induction and assisted reproductive technology compared with spontaneously conceived multiple pregnancies. Whereas most spontaneous multiple pregnancies are twin gestations, a higher proportion of multiple pregnancies that result from ovulation induction and assisted reproductive technology are triplet and higher-order gestations. Recent evidence, described in this article, indicates that although twin and higher-order multiple gestations found on initial ultrasound subsequently may undergo spontaneous reduction to singletons or twins, there may be important consequences for the outcome of the surviving fetus or fetuses.

Birth Weight↗
PubMed2006

Risk of cerebral palsy in multiple pregnancies.

Multiple compared with singleton gestations have a five- to tenfold increased risk of CP. The increased risk associated with MC placentation has been variously ascribed to transfer of thromboplastin or thromboemboli from the dead to the surviving fetus, exsanguination of the surviving fetus into the low pressure reservoir of the dead fetus, or hemodynamic instability with bidirectional shunting of blood between the two fetuses. An increased risk of CP in assisted reproductive technology gestations is to be expected because of the higher proportion of preterm births. The increase in risk of CP associated with monochorionic placentation will not be observed except for the minority of assisted reproductive technology gestations that undergo monozygotic splitting.

Birth Weight↗
PubMed2003

Transfer of nonselected transferable day 3 embryos in low embryo producers.

OBJECTIVE: To examine the implantation potential of embryos from assisted reproductive technology cycles with low embryo production and to assess the effects of clinical variables and embryo scores (ES) on pregnancy outcome. DESIGN: Prospective clinical study. SETTING: Assisted reproductive technology unit in a tertiary medical center. PATIENT(S): From July 1998 to December 2001, 280 cycles in 229 infertile couples produced a limited number of one, two, or three embryos 3 days after oocyte retrieval and underwent fresh embryo transfer (ET). INTERVENTION(S): Embryos with two or more blastomeres were scored and transferred. MAIN OUTCOME MEASURE(S): ES and implantation rate per ET. RESULT(S): Of 863 fresh ET cycles during the study period, 32.4% (280) were low embryo producers. Among them, there were no significant differences in average ES of individual embryos in single, dual, or triple ET or in embryos obtained from patients with low or high E2 responses, or young or old age. Embryos derived from conventional IVF had a better ES than those derived from intracytoplasmic sperm injection. The clinical pregnancy rate was strongly correlated with the cumulative ES. Implantation rates were similar among and between groups, with an average rate of 15.9%. CONCLUSION(S): Embryos of low embryo producers had an inherently low implantation potential that appeared to be unrelated to the number of embryos transferred, female age, ovarian E2 genesis, or fertilization method. The cumulative ES can serve as a predictor of pregnancy.

Adult↗
PubMed2002

Vitrification can be more favorable than slow cooling.

OBJECTIVE: Cryopreservation of embryos and oocytes has become an essential service for infertility treatment. The clinical application of this technology should ensure optimal survival of the embryos and oocytes that are stored and subsequently thawed for transfer. The aim of this review is to compare the widely employed slow cooling procedures with vitrification to evaluate and recommend the more effective and safer procedure. DESIGN: The review is mainly based on a comparison of the principles, procedures, and results reported in the literature. A historical description of vitrification and personal experiences with this technology are also included. SETTING: University-based hospitals and private clinics that treat infertility and have published information on cryopreservation. PATIENT(S): Women being treated for infertility and reproductive technology clinics. INTERVENTION(S): The application of slow cooling involving a range of cooling rates is compared with vitrification using rapid and ultrarapid cooling in simple containers. The purpose of both techniques is the induction of a glasslike state in cells to protect them from damage by ice crystals. The early development of vitrification involved the use of long pre-equilibration procedures. Improved methods resulted from the use of mixtures of penetrating and nonpenetrating solutes that are not toxic and a range of cooling rates. MAIN OUTCOME MEASURE(S): Reported number of pregnancies established after transfer of embryos that were cryopreserved by vitrification, or transfer of embryos derived from vitrified oocytes. RESULT(S): Both slow cooling and vitrification procedures have resulted in the successful cryopreservation of human embryos and oocytes. Both procedures have resulted in healthy births, although the slow cooling of oocytes gives very low success rates. Vitrification is a promising novel technique in assisted reproductive technology, but comparative success rates are yet to be established. CONCLUSION(S): Vitrification is a simple procedure that requires less time and is likely to become safer and more cost effective than slow cooling.

Animals↗
PubMed1991

Reproductive considerations during abdominal surgical procedures in young women.

The state of the art in reproductive technology is changing so rapidly that the future is hard to predict. In this regard, surgeons performing abdominal procedures in young women must be aware of the adverse reproductive effects of common surgical procedures. They should adopt changes in technique and practices to reduce adhesion formation. They should also be aware of the contemporary approach to the management of the various forms of tubal pregnancy and ovarian tumors of low malignant potential or of germ cell origin. The availability and success of changes in reproductive technology should lead to a reappraisal of the indications for hysterectomy, especially in young women. If there are indications for surgical excision of the ovaries and oviducts, the decision to remove the uterus should be made separately. The indication for hysterectomy needs to be very carefully considered, and the patient's input is critical.

Abdomen↗
PubMed1999

Social and ethical aspects of in vitro fertilization.

In vitro fertilization (IVF) stands out as one of the contemporary period's most extraordinary technologies, and its social and ethical consequences among the most far reaching. Despite its uncertain effectiveness and medical consequences, IVF has contributed significantly to the medicalization of infertility and the increasingly imperative character of reproductive technology. New developments in IVF, particularly oocyte donation, have created new definitions of treatable infertility and new social needs for IVF; when the technology does not result in pregnancy or healthy babies, these developments have created profound new disappointments. IVF and the commodification of the extracorporeal embryo have also confused the social meaning and legal definition of parenthood. Ultimately the relationship between prospective parents, infertility specialists, and the embryos that they create is a highly ambiguous one. This ambiguity is likely to be a long-term characteristic of efforts to develop, use, and assess assisted reproductive technologies.

Commodification↗
PubMed2005

Effects of competition among fertility centers on pregnancy and high-order multiple gestation rates.

OBJECTIVE: To measure the effect of competition among fertility centers on pregnancy and high-order multiple (HOM) gestation rates after IVF. DESIGN: Retrospective cohort study. SETTING: Four hundred eight fertility clinics registered with the Society for Assisted Reproductive Technology as providing IVF services in 2000. Competition was defined as number of clinics in a geographically defined area. Demand for services was based on the population of reproductive-aged women. PATIENT(S): Three hundred eighty-one fertility clinics reporting clinical outcomes. INTERVENTION(S): Pregnancy rates, HOM gestation rates, population of reproductive-aged women, and number of competing clinics were calculated for each clinic from Society for Assisted Reproductive Technology and census data. MAIN OUTCOME MEASURE(S): The clinic HOM gestation rate (percentage of pregnancies that were HOM) and age-adjusted pregnancy rate. RESULT(S): The number of clinics in an area of competition ranged from 1 to 22. The HOM gestation rate per clinic ranged from 0% to 50%. As demand increased, competition increased. As competition increased, the number of HOM pregnancies per clinic decreased. In areas of low competition (1 to 2 clinics) the clinic HOM gestation rate was 8.43%, in areas of intermediate competition (3-7 clinics) 8.39%, and in areas of high competition (8-22 clinics) 8.24%. In areas with intermediate demand, high levels of competition resulted in fewer HOM pregnancies than intermediate competition (relative risk 0.56, 95% confidence interval 0.36-0.89) or low levels of competition (RR 0.57, 95% confidence interval 0.35-0.94). Age-adjusted pregnancy rates did not differ by level of competition. CONCLUSION(S): According to these data, the risk of HOM gestation decreases with increasing competition among clinics; however, pregnancy rates are unaffected.

Adult↗
PubMed2004

Simultaneous bilateral tubal pregnancies and intrauterine pregnancy with five fetuses.

A 28-year-old woman with severe right lower abdominal pain and vaginal bleeding at 7 weeks' (+/- 2 days') gestation was seen in the emergency room of our institution. The pregnancy was the result of natural conception after ovarian stimulation with gonadotropins. Transvaginal sonography revealed five intrauterine gestational sacs containing five live embryos. A positive fetal heartbeat was detected in the fallopian tube on the right. Laparoscopic findings disclosed the enlarged uterus with the unruptured right ectopic pregnancy in the ampullary region and an extrauterine pregnancy in the left tube as well. A linear salpingotomy was performed on the right tubal pregnancy. We decided to perform salpingectomy on the left tube because it was impossible to preserve the tube, and exploration of it showed the existence of another gestational sac. It is necessary to decry inappropriate and injudicious use of assisted reproductive technologies, especially by individuals with little or no training in monitoring the agents and treatments prescribed. In 2003, still waiting for official legislation from the Italian Parliament on assisted reproductive technology, we have to face dramatic situations, such as this very unique case of heterotopic pregnancy.

Adult↗
PubMed2005

Epigenetic deregulation of genomic imprinting in human disorders and following assisted reproduction.

Imprinted genes play important roles in the regulation of growth and development, and several have been shown to influence behavior. Their allele-specific expression depends on inheritance from either the mother or the father, and is regulated by "imprinting control regions" (ICRs). ICRs are controlled by DNA methylation, which is present on one of the two parental alleles only. These allelic methylation marks are established in either the female or the male germline, following the erasure of preexisting DNA methylation in the primordial germ cells. After fertilization, the allelic DNA methylation at ICRs is maintained in all somatic cells of the developing embryo. This epigenetic "life cycle" of imprinting (germline erasure, germline establishment, and somatic maintenance) can be disrupted in several human diseases, including Beckwith-Wiedemann syndrome (BWS), Prader-Willi syndrome (PWS), Angelman syndrome and Hydatidiform mole. In the neurodevelopmental Rett syndrome, the way the ICR mediates imprinted expression is perturbed. Recent studies indicate that assisted reproduction technologies (ART) can sometimes affect the epigenetic cycle of imprinting as well, and that this gives rise to imprinting disease syndromes. This finding warrants careful monitoring of the epigenetic effects, and absolute risks, of currently used and novel reproduction technologies.

Alleles↗
PubMed2002

Using attitudinal indicators to explain the public's intention to have recourse to gamete donation and surrogacy.

BACKGROUND: Although the donation and receipt of gametes has become an integral part of infertility management, previous research in the field of social attitudes and intention to use medical technologies is limited. This study aimed to investigate attitudinal indicators and their potential relationship with the public's intention to have recourse to gamete donation and surrogacy. METHODS: A total of 365 individuals of reproductive age (49.3% men and 50.7% women) completed a questionnaire referring to their intention to receive or donate sperm/oocytes and their acceptance of becoming a commissioning couple or surrogate mother, and also to explore their attitudes towards gamete donation and surrogacy. Two attitudinal indicators emerged from the principal component analysis identifying (i). recipients' and donors' choice for anonymity, donors' renunciation of parental obligations and refusal of children's rights to know their biological parents and (ii). favourable attitudes towards legislative and financial measures to be adopted by the Government for the promotion of reproductive technologies. RESULTS: It was found that the indicator of 'Donors Anonymity and Refusal of Children's Rights' (DARCR) and the 'Legislative and Financial Support' (LFS) scale are positively associated with intention to have recourse to Gamete Donation and Surrogacy (GDS) (regression coefficients 0.31 and 1.08 respectively). Moreover, among the other variables used in the analysis only the 'church attendance' variable is negatively related with reported rates of intention to have recourse to GDS (P = 0.029), suggesting that the more religious respondents are less willing to use GDS. CONCLUSION: Social, legislative and financial implications provide a convenient rationale for adopting a favourable intention towards reproductive technologies. The findings of the present research should be given close consideration by policy makers and health education campaigns.

Adult↗
PubMed2000

[The influence of infertility treatment and assisted reproduction techniques on multiple pregnancy rates].

It has to be remembered that pregnancies resulting from assisted reproductive technologies are more complicated that spontaneous pregnancies. There are higher rates of spontaneous abortions, ectopic, and multiple pregnancies. This work summarizes the latest year's experiences from the best world's clinics with multifetal pregnancy incidence in assisted reproductive technologies programs.

Female↗