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Stability of in vitro fertilization-embryo transfer success rates from the 1989, 1990, and 1991 Clinic-Specific Outcome Assessments.

OBJECTIVE: To determine if the differences in IVF-ET success rates among clinics are due to chance alone. DESIGN: Retrospective analysis of data reported by individual clinics. SETTING: One hundred seventy-five clinics in 1989, 192 clinics in 1990, and 208 clinics in 1991 that reported IVF-ET success rates to the Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine (formerly The American Fertility Society). PATIENTS: Women < 40 years of age with no male factor. INTERVENTION: In vitro fertilization-ET. MAIN OUTCOME MEASURE: Delivery rate per retrieval and delivery rate per transfer. RESULTS: The hypothesis that the differences among IVF-ET success rates for clinics is due to chance alone can be rejected. Seven clinics were found to have pregnancy rates significantly higher than average and six clinics were found to have pregnancy rates significantly lower than average. Significant correlations were found between different years in the success rates for individual clinics but not for success as a function of the number of patients treated. CONCLUSIONS: Success rates for a few clinics are significantly different from the average success rate, but success rates must be used with caution in selecting a clinic.

Adult↗

Reproductive liberty, disease and disability.

There are many arguments from many sides, which purport to give reasons for limiting access to reproductive technologies and to gene-based reproductive procedures. There is one reason to reject them all, and that is that they do not point to dangers or harms of sufficient seriousness, probability or proximity to justify the limitation on human freedom that they require. This paper shows why this is so and argues that reproductive liberty must also include the liberty to select against disability both for moral and for libertarian reasons.

Persons with Disabilities↗

Human reproductive cloning and related techniques: an overview of the legal environment and practitioner attitudes.

PURPOSE: This study provides an overview of the legal environment and assisted reproductive technology (ART) practitioner attitudes toward human reproductive cloning. METHODS: A review of the law and a survey of ART practitioners and a comparison group of attorneys were undertaken. RESULTS: Human reproductive cloning has been prohibited in many countries, and may soon be prohibited in others. However, many ART practitioners support its use for limited indications. CONCLUSIONS: ART practitioners were surveyed concerning their views on human reproductive cloning and related techniques. A few had considered using or had used embryo splitting or germ cell nuclear transfer. Although they expressed some concerns about the present risk of reproductive cloning, most indicated that it did not violate their religious beliefs. More than three-quarters of ART practitioners responding indicated that they would be willing to provide human reproductive cloning in indicated cases if it were legally permissible to do so. A significant percentage of the group also indicated that they currently have the ability to provide this service.

Attitude of Health Personnel↗

Research in nondomestic species: experiences in reproductive physiology research for conservation of endangered felids.

Tremendous strides have been made in recent years to broaden our understanding of reproductive processes in nondomestic felid species and further our capacity to use this basic knowledge to control and manipulate reproduction of endangered cats. Much of that progress has culminated from detailed scientific studies conducted in nontraditional laboratory settings, frequently at collaborating zoological parks but also under more primitive conditions, including in the field. A mobile laboratory approach is described, which incorporates a diverse array of disciplines and research techniques. This approach has been extremely useful, especially for conducting gamete characterization and function studies as well as reproductive surveys, and for facilitating the development of assisted reproductive technology. With continuing advances in assisted reproduction in rare felids, more procedures are being conducted primarily as service-related activities, targeted to increase effectiveness of species propagation and population management. It can be a challenge for both investigators and institutional animal care and use committees (IACUCs) to differentiate these service-based procedures from traditional research studies (that require IACUC oversight). For research with rare cat species, multi-institutional collaboration frequently is necessary to gain access to scientifically meaningful numbers of study subjects. Similarly, for service-based efforts, the ability to perform reproductive procedures across institutions under nonstandard laboratory conditions is critical to applying reproductive sciences for managing and preserving threatened cat populations. Reproductive sciences can most effectively assist population management programs (e.g., Species Survival Plans) in addressing conservation priorities if these research and service-related procedures can be conducted "on the road" at distant national and international locales. This mobile laboratory approach has applications beyond endangered species research, notably for other scientific fields (e.g., studies of hereditary disease in domestic cat models) in which bringing the laboratory to the subject is of value.

Animals↗

[The incidence of sperm antibodies in patients included in a program of assisted reproduction].

The aim of the present investigation was to establish the sperm antibody incidence among patients included in a program for assisted reproduction by the means of the classical and new methods for sperm antibody detection; to analyze the correlation between the results demonstrated by the different techniques; to evaluate the obtained data in the context of the application of new assisted reproduction technologies (ART). In the Laboratory of Reproductive Immunology, Department of Biology, Medical University of Sofia, 73 sera from patients (35 couples and 3 men) with primary and secondary infertility, aged 23-46 years, grouped according to the diagnosis and included in the program for assisted reproduction "Technobioassistance" were tested. Our results demonstrated the highest incidence of sperm antibodies amongst patients with primary unexplained infertility. The percentage of positive reacting couples for at least one of the applied tests was 31%. The highest relative share of those reacting positively, was observed with ELISA and the tray agglutination test (TAT) of Friberg. For ELISA 31.48% of the sera reacted positively, while clinically relevant liters of sperm antibodies were found with TAT in 21.92% of the tested sera. We also found that 17.46% and 13.7% of the tested sera were positive, respectively in the sperm immobilization test (SIT) of Isojima and the gelatin agglutination test (GAT) of Kibrick. The high degree of correlation (P < 0.0001) between the tests of Kibrick and Friberg showed the appropriateness of their application for patients in an ART program. At the other hand, the lack of correlation between the other applied tests (the Isojima test and ELISA) confirmed the assumption that immunity against spermatozoa should be sought with at least two diagnostic tools. Five of the tested families with clinically relevant TAT titers were included in our ART program for "in vitro" fertilization and embryo transfer, after preliminary absorption of the seminal fluid with autologous semen, or underwent the ICSI technique. For these patients, one ICSI pregnancy finished with the successful birth of a healthy child and one "in vitro" pregnancy is developing at the moment.

Adult↗

Reassessing Semen Analysis: Clinical Insights Beyond Sperm Count and Motility.

BACKGROUND: Semen analysis (SA), recognized by the World Health Organization (WHO) as the cornerstone of male infertility evaluation, remains indispensable in reproductive medicine. However, advances in assisted reproductive technology (ART) and artificial intelligence (AI) have highlighted the limitations of relying solely on conventional semen parameters. OBJECTIVE: To critically review the evolving clinical role of SA by integrating conventional assessment with emerging functional, molecular, and computational approaches that improve diagnostic accuracy and individualized patient care. METHODS: A narrative review of contemporary evidence was conducted, focusing on conventional semen parameters, biofunctional sperm testing, omics technologies, AI-assisted analysis, and broader clinical applications of SA. RESULTS: Conventional parameters, including sperm concentration, motility, and morphology, remain essential but inadequately reflect fertilizing capacity. Adjunctive assessments, including oxidative stress biomarkers and sperm DNA fragmentation, provide valuable insights into sperm function and reproductive potential. Omics technologies, including genomics, transcriptomics, proteomics, and metabolomics, deepen mechanistic understanding, while AI enhances diagnostic precision, reproducibility, and standardization. Beyond infertility evaluation, SA also supports male contraceptive assessment, natural conception, ART, and patient counseling. CONCLUSIONS: Integrating conventional SA with functional, molecular, and AI-driven diagnostics provides a comprehensive framework for evaluating male fertility, advancing precision reproductive medicine and personalized clinical management.

cryopreservation↗

A womb of his own.

Although some feminists formerly saw utopian possibilities in reproductive technology, many now fear that the new technologies are turning women's bodies into test tubes. They feel that these technologies are designed less to help infertile women than to appease men's envy of women's reproductive power. The consequences of the new technologies for the psychology of women and children and the future creation of culture are open questions. Should the technologies succeed in taking reproduction out of the body altogether, it remains to be seen whether women will gain in freedom, or whether this will simply fulfill the age-old misogynistic fantasy of depriving women of their central place in procreation.

Fathers↗

Freezing immature oocytes.

The establishment of a long-term preservation system for mammalian oocytes is important for the development of both biological and medical sciences. A number of efforts have been made to develop this system. In human reproductive medicine, the development of an oocyte cryopreservation system can improve the efficacy of the current assisted reproductive technology (ART) for infertile patients with severe reproductive disorders. In this article, the technical development of cryopreservation programs for human oocytes and its biological background were reviewed. Clinical outcome after the use of this technology was further introduced.

Cell Culture Techniques↗

Ethics in a bicultural context -- a report from New Zealand.

The distinctiveness of Bioethics in New Zealand stems in part from a renewal of emphasis on Maori rights, based on the Treaty of Waitangi, the foundation document of the New Zealand state. Increasingly, committees dealing with health research ethics and with the ethics of assisted reproductive technology have to incorporate Maori values and perspectives.

Advisory Committees↗

Early ovarian ageing: a hypothesis. Detection and clinical relevance.

An important scientific breakthrough of the 20th century, IVF helped open new horizons in medicine, such as pre-implantation genetic diagnosis and embryonic stem-cell therapy. A further contribution of assisted reproduction technology has been the better understanding of reproductive ageing. Data from IVF cycles suggest that there is a fixed time-interval between accelerated decline of fertility and the menopause. This leads to the hypothesis that a significant proportion of asymptomatic women in the early thirties may be at risk of early onset of subfertility. IVF provides a model for the development of ovarian reserve tests, some of which appear promising as potential screening tools for early ovarian ageing in the general population.

Adult↗

Multifetal pregnancies: evolution of methods of initiation and impact of REI certification for patients seeking reduction.

OBJECTIVE: Multifetal pregnancy as a result of ovulation induction (OI) and assisted reproductive technologies (ART) correlate with Board certification in reproductive endocrinology and infertility (REI). DESIGN: Retrospective chart analysis of 304 patients referred to Wayne State University (WSU) and Thomas Jefferson University (TJU) for multifetal pregnancy reduction (MFPR) from March 1986 to January 1995 compared to 275 patients referred from January 1 to December 31, 2000 at MCP Hahnemann University. MATERIAL AND METHODS: Chart review for fetal number, pregnancy generation (OI or ART) and physician REI Board certification from the American Board of Specialties Obstetrics and Gynecology. Information was available on 296 of 304 patients studied in the 1986-1995 WSU cohort and 275 patients studied from the MCP Hahnemann 2000 cohort. RESULTS: Analysis of 296 multifetal pregnancies at WSU and TJU for REI Board status showed non-REI Board-certified (NREI) physicians generated 174 pregnancies with quadruplets or more compared to 122 quadruplets or more by REI Board-certified physicians. Board certification did not impact quadruplet or more rates for OI or ART (p < 0.368). Of 275 patients with triplets or more at MCP Hahnemann, 156 (56.7%) were from ARTs versus 41.2% from 1986-1995 (chi(2) = 13.1, p < 0.001). Quintuplets or more decreased from 18.5 to 9.7% (chi(2) = 8.3, p = 0.004), and for REIs from 22.1 to 9.6% (chi(2) = 4.7, p < 0.01), while 14.4% of cases coming from non-REIs had quintuplets versus 9.6% from REIs (p = NS). CONCLUSIONS: Cases of MFPR from ARTs have risen, while percentage of cases with quintuplets have fallen in half. We found no difference in quintuplets between REIs and non-REIs overall, but REI quintuplets fell significantly, and NREI has not.

Adult↗

Relative concerns associated with genetics and surrogacy.

Assisted reproductive technologies, incorporating artificial insemination and in-vitro fertilization techniques, are widely practised across Europe. Concern about surrogacy prompted the UK Government to commission a review and consultation on surrogacy arrangements. The ensuing document was concerned primarily with the questions of payment to the surrogate, and the regulation of agencies involved in surrogacy arrangements. This author feels that more fundamental issues should first be debated by both health professionals and society. Genetic aspects of surrogacy merit special attention, particularly regarding the genetic contribution to parenthood and the ownership and use of genetic information. Health professionals need to be fully aware of the ethical implications of advances in genetics and technology when they are applied to assisted reproduction.

Female↗

Cryopreserved embryos in the United States and their availability for research.

OBJECTIVE: To determine the number of embryos stored at assisted reproductive technology (ART) clinics in the United States and their current disposition. DESIGN: A targeted survey instrument sent by the SART-RAND team to all medical practices providing in vitro fertilization services in the United States. RESULTS: The SART-RAND team surveyed all 430 ART practices in the United States. Of these practices, 340 returned surveys for analysis. The data from these surveys were merged with data taken from the 1999 SART dataset, which contains information about practice size and success rates. Responding clinics reported a total of 396,526 embryos in storage as of April 11, 2002. The vast majority of the embryos (88.2%) were targeted for patient use. Small numbers of embryos were available for research, donation, destruction, quality assurance, or other uses. CONCLUSIONS: Nearly 400,000 embryos are stored in the United States, the majority of which (88.2%) are targeted for patient use. Few are available for research (2.8%), limiting possible conversion into embryonic stem cell lines.

Cryopreservation↗

Prisoners of progress or hostages to fortune?

The new reproductive technologies, especially in vitro fertilization (IVF), have extended the possibilities of assisted reproduction to the benefit of the childless couples. At the same time these technologies and their added techniques, however, have fragmented reproduction and exposed the human egg to intervention yet unknown.... These possibilities have legal as well as ethical implications. The challenge is to obtain all the advantages of the reproduction revolution and avoid the disadvantages: to avoid becoming prisoners of progress, but to control the development and guide it in the directions we want. One of the problems is trying to foresee unwarranted consequences. Another is to agree upon which consequences are unwarranted and how they are best avoided or minimized. Although the questions that arise with respect to law, medicine and bioethics are similar all over the world, there are differences of a philosophical, economic, social, political, religious and even geographical nature which are not easily bridged. It is apparent, though, that core approaches are desirable. This article is an attempt to explore the ways in which these determinants have been manipulated in two European [Great Britain, Denmark] legal systems. We are interested in the ways in which those legal systems have been customized to provide temporary answers and marshalling points for regulating reproduction and we seek to make some observations on the ways in which laws, customs and values have been manipulated to produce pictures of the family and the way in which we want -- literally and figuratively -- to conceive of it in the 21st century.

Advisory Committees↗

Fertilization in vitro increases non-disjunction during early cleavage divisions in a mouse model system.

BACKGROUND: We have been studying an unusual mouse-the BALB/cWt (Wt) male-in which the Y chromosome is susceptible to high rates of mitotic non-disjunction, particularly at the first two cleavage divisions. As these are the same divisions that human embryos generated through assisted reproductive technology must complete in an artificial setting, analysis of the Wt Y chromosome allows us to examine the effect of fertilization and culture in vitro on mammalian chromosome segregation. METHODS: We performed standard mouse IVF, cultured embryos in 5% CO2 in air or in a lowered oxygen atmosphere, and used fluorescence in-situ hybridization to examine the sex chromosome constitutions of 2-, 4-, 8- and 16-cell stage Wt Y-bearing embryos. RESULTS: We observed a significant increase in mosaic sex chromosome aneuploidy at each embryonic stage in embryos cultured in 5% CO2 in air, but under lowered oxygen conditions mosaicism returned to control (in-vivo) levels. CONCLUSIONS: Our results demonstrate that slight alterations in in-vitro conditions may have a considerable impact on the genetic quality of assisted reproductive technology-derived embryos and suggest that the genetic quality of embryos should be a fundamental concern in the development of new culture systems for clinical use.

Aneuploidy↗

A case for permitting altruistic surrogacy.

Canada's Royal Commission on New Reproductive Technologies rejects all forms of surrogacy arrangement under the rubric of objecting to commercial surrogacy. Noncommercial surrogacy arrangements, however, can be defended against the commission's objections. They can be viewed as cases of giving a benefit or service to another in a way that expresses benevolence, and establishes a relationship between surrogates and prospective 'social' parents that allows mutual understanding and reciprocal personal interaction between them.

Advisory Committees↗

The ICMART glossary on ART terminology.

The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent, international non-profit organization that has taken a leading role in the development, collection and dissemination of worldwide data on ART. Information on availability, efficacy and safety is provided to health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set of agreed definitions as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.

Journal Article↗

JSAR Innovative Technology Award. Development of ovulation synchronization and fixed time artificial insemination in dairy cows.

Recently, reproductive management has become more difficult as a result of increased herd size. Problems with missing estrous signs and decrease in conception rate by artificial insemination (AI) performed at wrong timing have caused low AI conception rates. In 1995, ovulation synchronization and fixed-time AI (Ovsynch/TAI) was developed in the USA as a new reproductive technology, which was accepted as an useful reproductive management tool in many countries. However, no information on the use of Ovsynch/TAI was available in Japan. It was, therefore, warranted to show the ovulation rate and conception rate after Ovsynch/TAI using gonadotropin releasing hormone analogue (GnRH-A, fertirelin acetate) and prostaglandin F2alpha (PGF2alpha)-THAM, both were commercially available in this country. The conception rate after Ovsynch/TAI has been known to vary among different herds and individuals. Investigation and analysis of factors affecting the conception rate was also warranted to improve the conception rate. A series of experiments were carried out to establish Ovsynch/TAI using domestically produced GnRH-A and PGF2alpha and to study factors affecting conception rate after Ovsynch protocol. Ovsynch using 100 microg GnRH-A and 25 mg PGF2alpha were observed using ultrasonography. As a result, a high synchronization rate of ovulation at 16 to 20 h after the second GnRH injection was confirmed. The conception rate after Ovsynch/TAI was compared in 87 cows with the conception rate after AI at estrus induced by PGF2alpha (139 cows). Conception rate after Ovsynch/TAI was higher than the figure after AI at induced estrus (59.1% vs 20.9%, P<0.05). The dose of GnRH-A was also studied and a practical dose of GnRH-A was found to be 50 microg per cow. To clarify some factors affecting the conception rate after Ovsynch/TAI, 1,558 cows were investigated for the state of their ovaries, days after calving, parity, season, ovarian cyclicity postpartum and nutritional state at the day of Ovsynch. The overall conception rate after Ovsynch/TAI was 51.5%. Fifty-six cows (3.6%) showed estrus at 6 to 7 d after the first injection of GnRH-A. The conception rate after Ovsynch/TAI was low in cows that were 40 to 60 d postpartum, those in their 5th lactation or more, those bred in July to August, and those recovering ovarian cyclicity later than 56 d postpartum. The conception rate after Ovsynch/TAI was high in cows in which body condition score (BCS) was 3.75 at dry period and 3.0 at the day of Ovsynch. In conclusion, Ovsynch/TAI is an effective tool for the reproductive management of dairy cows. A steady and sufficient conception rate after Ovsynch/TAI could be expected by taking the factors affecting the conception rate into the consideration.

Animals↗