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PubMed1992

Variables which influence the selection of an egg donor.

We have analysed the different variables which affected the efficacy of egg donation in our assisted reproductive technology unit. Potential donors (n = 108) were divided into two groups. Group 1 comprised partial donor (PD) subjects who underwent assisted reproduction for the treatment of their infertility and who agreed altruistically to donate extra eggs not used during their own cycles (n = 31). Group 2 consisted of full donor (FD) subjects who donated all the eggs recovered during their ovarian stimulation cycle (n = 77) and included sister to sister donation, volunteers and patients undergoing diagnostic or sterilization laparoscopies. The entire donor population was divided into two sub-populations by age, those under 30 and 31-39 years old, and correlated with the pregnancy rate in their recipients. From this analysis, a higher pregnancy rate was observed when the oocytes were provided by the younger group of donors (54 versus 36%). We did not find a significant difference in the recipients' pregnancy rate, according to the previous reproductive performance of their donors. Even though FD and PD yield similar pregnancy rates during the fresh cycles, the availability of cryopreserved embryos in the former group enhances the cumulative pregnancy rate.

Adult↗
PubMed2001

Infertility in men with cystic fibrosis.

The majority of men with cystic fibrosis (CF) have associated congenital bilateral absence of the vas deferens (CBVAD). This congenital defect results in the absence of the anatomic ducts through which spermatozoa pass from the testes to the urethra. No spermatozoa are found in the semen, a condition referred to as obstructive azoospermia. This abnormality of the genital-urinary system is associated with the same genetic mutation in the cystic fibrosis transmembrane conductance regulator gene (CFTR ), which leads to the classic presentation of a patient with CF. However, patients may have CBVAD and CFTR mutations without symptoms of CF. Screening for the common mutations may miss a milder rare gene alteration: a DNA variant in the 5T allele. With the advent of assisted reproductive technologies, fertility is now possible for these men. The National Institutes of Health recommend genetic counseling for any couple attempting assisted reproductive techniques when the man has CF or presents with obstructive azoospermia and is positive for a CF mutation.

Alleles↗
PubMed2005

Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy.

OBJECTIVE: To prospectively analyse the outcomes of microsurgical vasoepididymostomy using the intussusception technique, as vasoepididymostomy is considered the most challenging reconstructive microsurgery in urology. PATIENTS AND METHODS: From 1998 to 2003, of 324 men with obstructive azoospermia who had undergone microsurgical reconstruction of the reproductive tracts, 68 (21%) had intussusception vasoepididymostomy bilaterally or unilaterally in a functionally solitary testis. The outcomes of these patients were analysed prospectively. RESULTS: The mean age was 39.8 years for the men and 31.8 years for their partners. The causes of obstruction were after vasectomy in 31%, infection in 22%, iatrogenic in 19%, trauma in 1.5%, and idiopathic in 27%. The median duration of obstruction was 18.8 years; 37% of patients had had previous failed attempts at reconstruction. The mean (range) follow-up was 15.2 (1-36) months. The overall patency (>10 000 sperm/mL) rate was 84% (53/63). Patency was achieved in 60% (38/63) of men at 1 month after surgery. The mean best sperm count was 12.8 (0.01-80) x 10(6)/mL, with a 21 (0-30)% motility. Among patients with a follow-up of > 1 year, the natural paternity rate was 40%. The median time to achieve a natural pregnancy was 14.3 (3-30) months. Pregnancy was achieved with in vitro fertilization or intracytoplasmic sperm injection in 31% of cases, all using fresh ejaculated sperm. CONCLUSIONS: A favourable patency and pregnancy rate can be achieved using microsurgical intussusception vasoepididymostomy. Even when assisted-reproductive technology is needed, fresh ejaculated sperm can be used without requiring a subsequent sperm retrieval procedure. Thus, microsurgical reconstruction of the reproductive tract should be primary therapeutic method in cases of azoospermia from epididymal obstruction.

Adult↗
PubMed2000

Reproductive ethics and the family.

The phrase 'reproductive ethics', as used by bioethicists, typically refers to concerns over morally appropriate employment of assisted reproductive technologies and, perhaps somewhat less commonly, to issues arising from technologies that block conception or end pregnancies. I here recommend to the attention of the field a more commodious use of 'reproductive ethics', one that takes seriously how humans are brought into the world as moral and social beings, and not simply as biological individuals. As a focus for this expanded agenda, I examine prevalent disagreements over the patterns and sources of the responsibilities and prerogatives that help define family structures, both as these are reflected in assisted reproductive practices involving the purchase of gametes, and in U.S. legal controversies about whether parents, or family courts, should determine who has the right to a relationship with children.

Civil Rights↗
PubMed1996

[The achievements of medical embryology and the successes in treating infertility].

In connection with the decade of the first test-tube children appearance in Russia a contribution of medical embryology to the working out of auxiliary reproduction method is discussed. The significance of close interaction and mutual understanding between embryologists and representatives of other professions (gynaecologists, endocrinologists and geneticists) in successful solving of the problem is emphasized Main stages of the modern reproductive technology forming were followed up so as the role of medical embryology in sterility treatment. Certain ethic and lawful problems concerning reproduction including the limits of research on human embryos were discussed.

Embryology↗
PubMed2026

De-extinction technology and its application to conservation.

De-extinction, once the realm of science fiction, has evolved into a tangible scientific endeavor thanks to breakthroughs in genome sequencing, engineering, advanced assisted reproductive technologies, and stem cell biology. Alongside this work are innovations in reintroduction science and artificial intelligence, which are refining strategies for species translocations, rewilding, and long-term ecosystem monitoring of de-extinct species and populations. While the primary motivation for de-extinction is restoring lost ecological functions to eroded ecosystems, each of these technologies can also be applied to conservation biology for de-endangerment, offering new solutions for biodiversity preservation. This review synthesizes the technological advancements emerging from de-extinction science and explores their broad applications in conservation, demonstrating how de-extinction is both about resurrecting lost species and about expanding the conservation toolkit to sustain and rebuild biodiversity in the face of accelerating environmental change.

Conservation of Natural Resources↗
PubMed2006

Making technology familiar: orthodox Jews and infertility support, advice, and inspiration.

This paper examines how orthodox Jews use traditional strategies and new media simultaneously to cope with infertility in the age of new reproductive technologies. Not only have they used the Internet to establish support, information, and educational networks, but also they have created frameworks for unique professional collaborations among rabbis, doctors, and clinic personnel in order to ensure that their fertility treatments are conducted with strict attention to Jewish legal concerns, particularly with regard to incest, adultery, and traditional practices regarding bodily emissions. Throughout these processes, they have innovated a hybrid language for describing and explaining infertility treatments that blends Hebrew prayers, Yiddish aphorisms, English slang, Gematria (numerology), and biomedical terminology. By using idiomatic language and folk practice, orthodox Jews construct a unique terrain that shapes and makes familiar their experience and understanding of fertility treatment. Biomedicine in this context is understood as a set of tools and strategies that can be readily appropriated and harnessed to a particular set of individual and collective goals.

Female↗
PubMed2006

Ageing and ART: a waste of time and money?

In many societies, more and more young women are delaying childbearing until the fourth decade of life. It is well known that fertility is remarkably reduced with increasing age of women in both natural conceptions and assisted reproductive technology (ART). In this chapter, the effect of ageing on the pregnancy rate in ART, and the options available to improve the reproductive outcomes in women of advanced age will be presented after understanding the mechanism of reproductive ageing and the effects of ageing on the reproductive outcomes in normal women. It is important to identify the predictive factors associated with a better treatment outcome.

Adult↗
PubMed2004

The contribution of farm animals to human health.

Farm animals and their products have a longstanding and successful history of providing significant contributions to human nutrition, clothing, facilitation of labour, research, development and medicine and have thus been essential in improving life expectancy and human health. With the advent of transgenic technologies the potential of farm animals for improving human health is growing and many areas remain to be explored. Recent breakthroughs in reproductive technologies, such as somatic cloning and in vitro embryo production, and their merger with molecular genetic tools, will further advance progress in this field. Here, we have summarized the contribution of farm animals to human health, covering the production of antimicrobial peptides, dietary supplements or functional foods, animals used as disease models and the contribution of animals to solving urgent environmental problems and challenges in medicine such as the shortage of human cells, tissues and organs and therapeutic proteins. Some of these areas have already reached the level of preclinical testing or commercial application, others will be further advanced only when the genomes of the animals concerned have been sequenced and annotated. Provided the necessary precautions are being taken, the transmission of pathogens from animals to humans can be avoided to provide adequate security. Overall, the promising perspectives of farm animals and their products warrant further research and development in this field.

Animal Structures↗
PubMed2003

Providing assisted reproductive care to male haemophiliacs infected with human immunodeficiency virus: preliminary experience.

Outlined is our experience with couples in whom the male was both human immunodeficiency virus (HIV) seropositive and a haemophiliac who underwent assisted reproductive technologies (ART) in order to attain family goals while minimizing the risk of HIV transmission. We report their demographics, attitudes towards assisted reproduction, and ART performance and outcomes. The study included HIV serodiscordant couples (n = 11) who underwent ART at a university-based infertility practice from August 1997 to May 2002. Prior to treatment, couples prospectively completed a survey regarding their demographics and attitudes towards assisted reproduction. All couples underwent ART and pregnancy outcomes were analysed. The majority of the patients were fully employed, college-educated, in good health, married and motivated to have a child while minimizing the risk of HIV transmission. Eleven couples underwent 25 cycles of ART [19 in vitro fertilization (IVF) cycles; five frozen embryo transfer cycles; and one oocyte donation cycle] resulting in nine successful pregnancies. The ongoing/delivered pregnancy rate per initiated IVF cycle was 42.1% per embryo transfer. Eight of 11 (72.7%) couples achieved a successful pregnancy. More than half (six of 11; 54.5%) the couples conceived during their initial attempt. Four of nine (44.4%) pregnancies were multiple gestations, including three sets of triplets. All female recipients tested seronegative for HIV at 3 and 6 months post-embryo transfer. All delivered babies (n = 8) tested seronegative for HIV at birth and 3 months postpartum. Four pregnancies are currently ongoing. ART should be considered for HIV serodiscordant couples with haemophilia who desire to have children in order to minimize the risk of viral infection.

Adult↗
PubMed1989

Reproductive behaviour in poultry: implications for artificial insemination technology.

1. Reproductive ability requires both endocrine and behavioural components. 2. Most reproductive behaviour is dependent upon the presence of sufficient circulating concentrations of the gonadal steroids, which in turn are synthesised and secreted in individuals who are in good reproductive condition. Mating behaviour patterns are thus not only essential for reproduction, but can provide excellent indices of the reproductive ability of an individual. 3. A number of factors can suppress or enhance reproductive behaviour in poultry, including management practices, flock social interactions, environmental variables, stressors, and disease. 4. Aspects of the regulation of reproductive behaviour and the endocrine control of reproductive processes in the male and in the female are reviewed in this paper. 5. An understanding of the impact of social and environmental stressors on reproductive physiology and behaviour is extremely important, both in order to improve breeding efficiency in natural mating systems and to facilitate the most effective application of artificial insemination technology.

Animals↗
PubMed2006

Turn, turn, turn.

Twenty years have passed since the publication in these pages of the oft-quoted editorial "The leader of the band is tired." At that time, the passing was mourned of the era of laparotomy for reconstructive pelvic surgery and the arrival of the laparoscope was heralded. Another transformation has occurred. Just as laparoscopy replaced laparotomy, all traditional treatments for infertility are being rendered obsolete by advanced reproductive technologies.

Female↗
PubMed2005

[FSH is a limiting factor].

FSH concentrations obtained early in the follicular phase is a good predictive factor of ovarian response for assisted reproductive treatment. Nevertheless, FSH levels should be correlated with estradiol levels, antral follicle count and patient age. A history of elevated basal FSH levels in patients under the age of 40 years predicts a lower oocyte yield in IVF cycles but does not translate to either lower pregnancy or implantation rates. In women with uncertain ovarian function, antral follicle count and serum antimullerian hormone/mullerian-inhibiting substance appear to be more discriminatory markers of assisted reproductive technology outcome.

Age Factors↗
PubMed1996

Ultrasound-guided transvaginal procedures.

Transvaginal ultrasound revolutionized the practice of obstetrics and gynecology in the past decade. Its 'port of entry' was its application in the diagnostic, as well as the technical and therapeutic aspects, in the reproductive aspects of infertility. This review summarizes the advances made by the continual improvement of equipment, and the ingenious use of different punctures guided by transvaginal sonography in the important area of reproductive technologies.

Female↗
PubMed2003

Impact of reproductive history on in vitro fertilization and intracytoplasmic sperm injection outcome: evidence from the German IVF Registry.

OBJECTIVE: To evaluate the effect of reproductive history on the outcome of different procedures in assisted reproductive technologies (ART) comparing IVF, ICSI, and cryopreserved embryo transfer (CPE). DESIGN: Prospective registration of ART cycles and their outcomes. SETTING: One hundred three reproductive programs in Germany. PATIENT(S): Women undergoing 174,909 ART procedures from January 1998 through December 2000. INTERVENTION(S): Data analysis of reproductive history collected by the German IVF Registry; multiple logistic regression modeling of success rates. MAIN OUTCOME MEASURE(S): Effect of type of conception and outcome of previous pregnancies, duration of infertility, female's age, and type of ART on clinical pregnancy rate per retrieval. Odds ratios with 95% CIs are reported. RESULT(S): More than one previous pregnancy was negatively correlated with outcome of IVF, ICSI, or CPE. This association disappeared when female age was restricted to a maximum of 35 years. A previous pregnancy achieved by spontaneous conception had less impact on outcome of IVF, ICSI or CPE outcome than did a previous assisted conception. Previous live births and miscarriages demonstrated a statistically significant increase compared with ectopic pregnancies and induced abortions. CONCLUSION(S): Reproductive history must be considered when counseling subfertile couples. Female age, method of conception, and previous pregnancy outcome have a significant effect on IVF, ICSI, and CPE outcome.

Abortion, Spontaneous↗
PubMed2003

Twinning.

Twinning has fascinated human beings over the centuries. New technologies and large study groups have led to improved documentation of frequency and complications in twin pregnancies and long-term outcomes. Artificial reproductive technologies have led to a pronounced rise in numbers of dizygotic and monozygotic twins. Although spontaneous dizygotic twinning is clearly associated with increased concentration of follicle-stimulating hormone and ovulation of more than one egg, causes of monozygotic twinning remain illusive. Twin studies are used increasingly to study complex traits and disorders: however, caution is suggested, since twins might not be representative of a typical singleton pregnancy. Monozygotic twinning seems to represent an anomaly in itself, with an increased number of spontaneous abortions and structural congenital anomalies. Both monozygotic and dizygotic twins have growth rates that slow at 30 weeks in utero and might be programmed both developmentally and biochemically earlier in pregnancy to have different responses at birth and after birth compared with singletons.

Chorion↗
PubMed2001

Ectopic pregnancy from surgical emergency to medical management.

During the past 25 years, the incidence of ectopic pregnancy has progressively increased while the morbidity and mortality have substantially decreased, and the treatment has progressed from salpingectomy by laparotomy to conservative surgery by laparoscopy and more recently to medical therapy. This therapeutic transition from surgical emergency to medical management has been attributed to early diagnosis through the use of sensitive assays for hCG and the high definition of vaginal ultrasound. By using these sensitive diagnostic tools, we are now able to select those patients who are most likely to respond to medical management versus those who are at high risk of rupture and require surgery. Besides being less invasive and associated with significantly lower risks, medical therapy with methotrexate results in significant cost savings, which have been calculated to be approximately $3,000 per treated patient. Our goal is to identify those patients with ectopic pregnancy who are most likely to respond to methotrexate therapy and least likely to develop significant side effects. Recent studies have helped us define the predictors of success with methotrexate treatment in women with ectopic pregnancy. The reported success rates of treating ectopic pregnancy with methotrexate vary from 71% to 100%. The highest success rates have been reported from institutions that have detailed diagnostic and therapeutic protocols, readily available assays for serum hCG levels, high-resolution vaginal probe ultrasound, and support staff that can closely monitor clinical response. The importance of developing specific protocols to create a clinical environment that supports the effective use of medical therapy for ectopic pregnancy is confirmed by the associated cost savings, decreased morbidity, and patient preference. Modern diagnostic advances and minimally invasive treatments coupled with improved success rates for assisted reproductive technologies should reduce the morbidity and mortality associated with ectopic pregnancy and offer the affected couple a much more optimistic outlook for subsequent reproductive potential.

Emergency Medical Services↗
PubMed2000

[Recent trends in male reproductive disorders].

There is growing concern about the considerable decline in semen quality and the increase of male reproductive disorders such as testicular cancer, hypospadias and cryptorchidism over the past decades. Such trend has also been manifested itself in the form of increasing demand for assisted reproductive technology in recent year. Concerning the above Skakkebaek has been proposed a hypothesis that there may exist common etiological factors for these male reproductive disorders. He presented a new evidence that male reproductive disorders are symptoms of an underlying testicular dysgenesis syndrome at the workshop "Hormones and Endocrine Disruptors in Good and Water: Possible Impact on Human Health" held in Copenhagen, May 27-30, 2000. In this paper, we review several topics presented in this workshop.

Cryptorchidism↗