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PubMed1993

Significance of assisted reproductive technology for other areas of medicine.

Assisted reproductive technology has achieved its place in the management of women with infertility. It is now being used to refocus gynaecological attention on patients with other enigmatic benign gynaecological conditions, such as endometriosis, and their medical treatments. Now that reasonable success rates can be achieved without risking unacceptable multiple pregnancy rates, many other medical disciplines are becoming involved. Specialists in these other disciplines need to modify their treatments accordingly to allow for future parenthood if this is appropriate. These specialists need also to be aware of past ethical dilemmas that infertility units have had to confront during the first ten years of this new technology.

Endocrinology↗
PubMed1990

Efficacy of assisted reproductive technology during diagnostic and operative infertility laparoscopy.

Women being evaluated for infertility were offered assisted reproductive technology at the time of diagnostic laparoscopy. Oocyte retrieval was performed after ovulation induction in 33 women, of whom 19 had concurrent operative laparoscopy. Gamete intrafallopian transfer (GIFT) or in vitro fertilization (IVF) and embryo transfer were performed subsequently depending on laparoscopic assessment of pelvic architecture, oocyte maturity, and semen parameters. The clinical pregnancy rate was 24% per cycle and 28% per gamete or embryo transfer (four pregnancies after GIFT and four after IVF/embryo transfer). The clinical pregnancy rate per transfer did not differ significantly between the 19 women who had therapeutic operations in conjunction with laparoscopy (lysis of adhesions and/or fulguration of endometriosis) and the 13 who did not (25 versus 30%; P greater than .05). Assisted reproductive technology can be performed successfully during diagnostic infertility laparoscopy. Operative endoscopic manipulation did not adversely influence pregnancy outcome.

Adult↗
PubMed2006

The need for interaction between assisted reproduction technology and genetics: recommendations of the European Societies of Human Genetics and Human Reproduction and Embryology.

Infertility and reproductive genetic risk are both increasing in our societies because of lifestyle changes and possibly environmental factors. Owing to the magnitude of the problem, they have implications not only at the individual and family levels but also at the community level. This leads to an increasing demand for access to assisted reproduction technology (ART) and genetic services, especially when the cause of infertility may be genetic in origin. The increasing application of genetics in reproductive medicine and vice versa requires closer collaboration between the two disciplines. ART and genetics are rapidly evolving fields where new technologies are currently introduced without sufficient knowledge of their potential long-term effects. As for any medical procedures, there are possible unexpected effects which need to be envisaged to make sure that the balance between benefits and risks is clearly on the benefit side. The development of ART and genetics as scientific activities is creating an opportunity to understand the early stages of human development, which is leading to new and challenging findings/knowledge. However, there are opinions against investigating the early stages of development in humans who deserve respect and attention. For all these reasons, these two societies, European Society of Human Genetics (ESHG) and European Society of Human Reproduction and Embryology (ESHRE), have joined efforts to explore the issues at stake and to set up recommendations to maximize the benefit for the couples in need and for the community.

Journal Article↗
PubMed1996

Outcome of assisted reproduction technology in infertile couples of consanguineous marriage.

PURPOSE: The outcome of pregnancies resulting from assisted reproduction technology does not seem to differ from the outcome of those arising from spontaneous natural conception. METHODS: There is increased risk of chromosomal abnormality in spontaneous natural pregnancies resulting from consanguineous marriage, with consequent higher rates of miscarriage, stillbirth, and congenital abnormalities. RESULTS: This study has shown a trend of an increased miscarriage rate (but not statistically significant) in pregnancies achieved in infertile couples of consanguineous marriages by assisted reproductive technology. CONCLUSIONS: Selecting embryos for transfer on the basis of their morphology does not appear to reduce the risk of chromosomal abnormality in these couples.

Abortion, Spontaneous↗
PubMed1998

Failure to collect oocytes in assisted reproductive technology: a retrospective.

While there is much information and discussion on pregnancy failure after assisted reproductive technologies, less emphasis is placed on the failure to collect oocytes after apparently successful ovarian stimulation. This retrospective survey reviewed 4973 treatment cycles in order to obtain information about the likelihood of this event. Overall 42 women (43 treatment cycles) failed to have oocytes collected [0.86% of treatments started and 0.92% of women given human chorionic gonadotrophin (HCG)]. However, in only six cases was this failure unexpected (0.1%) with no obvious potential clinical reason (i.e. all six cases had: HCG administered; more than two follicles >15 mm in diameter; oestradiol values >2000 pmol/l; <38 years old; normal body mass index). Indifference concerning uncommon events is fraught with peril, as although rare, the particular outcome may be devastating to the individual, both economically and psychologically. Eighteen of the 42 women did not return for on-going treatment suggesting increased contact by clinic staff may be required when oocyte retrieval is not achieved. These data suggest that the failure to collect oocytes after apparently successful ovarian stimulation is rare and random. The information has proved useful in allaying the fears of couples contemplating assisted reproductive technologies.

Adult↗
PubMed1995

Instructing the animal physiology graduate student in human assisted reproductive technology.

Animal physiology graduate students provide an excellent personnel resource for laboratories performing human assisted reproductive technology (ART) procedures. However, the basic training of these students falls short of what is required for this highly specialized field. We designed a course to enhance their education in this area via classroom and hands-on laboratory instruction in a hospital and university setting. Topics covered in the course included in vitro maturation, in vitro fertilization, embryo culture, embryo transfer, quality control, quality assurance, micromanipulation, and cryopreservation. These techniques were applied to a group project to evaluate the influence of spermatozoal quality and quantity on early embryonic development in cattle and humans. Student grades were based on 1) oral and written examinations; 2) demonstrated competency in laboratory techniques; 3) presentation of class project data at a state academy of science meeting; and 4) initiative, determination, and interest in the coursework. Three aspects of the course stood out as very positive. First, the team approach to accomplishing a class project was new to some of the graduate students. Second, a bond was formed between hospital- and university-based faculty that did and will continue to foster unique teaching and research opportunities between the two groups. Third, the opportunity for students to present research data in a formal setting was very rewarding. This course made the students keenly aware of the many aspects of ART and provided them with specialized skills that should make them more marketable in the field of reproductive technology.

Animal Husbandry↗
PubMed2001

Recombinant human chorionic gonadotropin (rhCG) in assisted reproductive technology: results of a clinical trial comparing two doses of rhCG (Ovidrel) to urinary hCG (Profasi) for induction of final follicular maturation in in vitro fertilization-embryo transfer.

OBJECTIVE: To compare the efficacy and safety of 250 microg and 500 microg of recombinant hCG with 10,000 U USP of urinary hCG in assisted reproduction technology. DESIGN: Open, comparative, randomized, prospective clinical study. SETTING: Twenty tertiary care U.S. infertility centers. PATIENT(S): Two hundred ninety-seven ovulatory infertile women undergoing a single cycle of assisted reproduction technology. INTERVENTION(S): Patients were randomized 1:1:1 to 250 microg of recombinant hCG SC, 500 microg of recombinant hCG SC, or 10,000 U USP urinary hCG IM after completing gonadotropin stimulation. MAIN OUTCOME MEASURE(S): Number of oocytes retrieved per patient receiving hCG. Also, measures of oocyte maturity, embryo development, and luteal function, as well as pregnancy and pregnancy outcome. Adverse safety events, laboratory changes, local tolerance, and immunogenicity were also assessed. RESULT(S): Mean numbers of oocytes retrieved per treatment group were equivalent, 13.6, 14.6, and 13.7 with 250 microg of recombinant hCG, 500 microg of recombinant hCG, and urinary hCG, respectively. The numbers of 2PN fertilized oocytes on day 1 after oocyte retrieval, and 2PN or cleaved embryos on the day of embryo transfer, were significantly higher with 500 microg of recombinant hCG than with the lower dose. However, the incidence of adverse events also tended to be higher with this dose. CONCLUSION(S): Recombinant hCG is effective and well tolerated in the induction of final follicular maturation and luteinization in women undergoing assisted reproduction technology. Recombinant hCG (250 microg) SC is equivalent to 10,000 U USP of urinary hCG in this indication.

Adult↗
PubMed1993

Current reproductive technology: considerations for the oncologist.

Advances in reproductive technology now afford options for certain cancer patients that the oncologist must consider when planning treatment. For men undergoing treatment likely to destroy testicular function, the development of sperm banks to store cryopreserved sperm offers the hope of future fatherhood. Cryopreserved sperm can be held indefinitely, with pregnancies via artificial insemination reported up to 15 years after freezing. For female cancer patients who will lose ovarian function but likely retain a viable womb, in vitro fertilization techniques hold the promise of pregnancy with the use of donated ova. In some cases, it may even be possible to extract the woman's own eggs before surgery and fertilize them with her husband's sperm. The resulting embryos, like sperm, can be frozen for indefinite future use. In the future, with new technological advances, extraction of ova for freezing at the time of ovarian extirpation may be a possibility.

Cryopreservation↗
PubMed2004

Development of culture media for human assisted reproductive technology.

Contemporary culture systems in human assisted reproductive technologies meet the metabolic needs of preimplantation embryos by addressing energetic and amino acid requirements in a stage-specific manner. This approach significantly enhances viability compared with the historical use of simple salt solutions or complex somatic cell media.

Culture Media↗
PubMed2005

Defining the typical work environment for assisted reproductive technology laboratories in the United States.

OBJECTIVE: To determine time and staffing requirements as they relate to laboratory personnel in the field of assisted reproductive technology (ART). DESIGN: Descriptive study. SETTING: Assisted reproductive technology clinics in the United States. PERSONNEL: All personnel working in ART laboratories, which included laboratory directors and technicians (those laboratory personnel trained in specific areas of embryology, andrology, and endocrinology). INTERVENTION(S): None. MAIN OUTCOME MEASURES(S): Frequencies were determined for time and staffing requirements as they pertained to individuals and procedures (e.g., oocyte retrieval, embryo transfer, semen analysis, hormone assay, etc.) performed in embryology, andrology, and endocrine laboratories. RESULT(S): Two different surveys of ART clinics in the United States were combined in this report. The average technician worked 40 hours a week, whereas the average laboratory director worked 49 hours per week. The average embryologist performed 181 procedures (not cases) per year. The average andrologist performed 648 procedures (not cases) per year, while the average endocrinologist completed 2,673 procedures (not cases) per year. CONCLUSION(S): This is the first report to describe time and staffing requirements as they relate to the laboratory personnel in an ART facility.

Attitude of Health Personnel↗
PubMed1998

Profiling assisted reproductive technology: outcomes and quality of infertility management.

OBJECTIVE: To critically appraise the content of the American Society for Reproductive Medicine (ASRM)/Society for Reproductive Technology (SART) Registry. DESIGN: English-language literature review. PATIENT(S): Women undergoing treatment with assisted reproductive technology (ART). INTERVENTION(S): Current ART treatments, including IVF, GIFT, zygote intrafollopian transfer (ZIFT), oocyte micromanipulation, and cryopreserved embryo transfers. MAIN OUTCOME MEASURE(S): Compliance with clinical practice guidelines, and casemix-adjusted rates of live delivery, clinical pregnancy, ectopic pregnancy, miscarriage, birth defects, implantation, fertilization, and retrieval. RESULT(S): Outcomes should be adjusted for variation in patient characteristics known to affect prognosis, including maternal age, the duration of infertility, the presumed cause(s) of infertility, the patient's prior history of treatment for infertility, and diethylstilbestrol exposure. Outcome rates should be reported using the patient as the denominator, as well as cycle, retrieval, and transfer. The statistical significance of observed differences in events rates should be indicated. Because widely accepted clinical practice guidelines related to performance of ART procedures are not available, compliance with practice guidelines cannot currently be assessed. CONCLUSION(S): Reports based on ASRM/SART Registry data can be enhanced by refined casemix adjustment, assessing outcome rates per patient, as well as per component of ART procedure, and by providing an indication of the statistical significance of observed differences in event rates. In addition, a critical appraisal of available evidence related to particular aspects of infertility management would help clarify the areas in which there is an evidentiary basis for formulation of practice guidelines, as well as topics requiring additional clinical research.

Cryopreservation↗
PubMed1993

Quality of parenting in families created by the new reproductive technologies: a brief report of preliminary findings.

The creation of families by means of the new reproductive technologies has raised important questions about the consequences for parent-child relationships, particularly where gamete donation has been used to conceive the child. Preliminary findings are presented of a study of the quality of parenting in families created as a result of the two most widely used reproductive technologies, in vitro fertilization and donor insemination, in comparison with a control group of families with a naturally conceived child and a control group of adoptive families. The quality of parenting was assessed using a standardized interview with the mother, and mothers and fathers completed questionnaire measures of stress associated with parenting. The results showed that the quality of parenting in families with a child conceived by assisted conception is superior to that shown by families with a naturally conceived child. The findings are discussed in terms of their implications for understanding the role of genetic ties in parent-child relationships.

Adoption↗
PubMed2005

Should older and postmenopausal women have access to assisted reproductive technology?

In vitro fertilisation and other assisted reproductive technologies (ART) now enable many women to have children, who would otherwise have remained childless. The most obvious application for these technologies is to help physically infertile, but otherwise healthy young women to have children. However, increasingly, other groups are seeking access to ART to conceive, raising ethical questions about who should be allowed to use these technologies to bear children. In particular, the question of access to ART by lesbian couples and single groups has roused considerable ethical, legal and public debate. This paper examines the perhaps less often considered issue of older and postmenopausal women, who are infertile due to age, using ART to conceive. A range of objections have been made to allowing these women access to ART, including concerns about their ability to care for the child, the risk of birth defects and the 'unnaturalness' of extending childbearing capacity beyond the menopause. This paper examines these objects and provides some responses.

Age Factors↗
PubMed1999

Some ethical and legal issues in assisted reproductive technology.

The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients' treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must (or choose to) publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities.

Embryo Disposition↗
PubMed2007

Uterine artery Doppler velocimetry at 11-14 weeks in singleton pregnancies conceived by assisted reproductive technology.

OBJECTIVE: Singleton pregnancies resulting from assisted reproductive technologies (ART) have an increased risk of preterm delivery, pre-eclampsia and intrauterine growth restriction. The aim of the present study was to determine whether first-trimester trophoblastic invasion, as assessed by uterine artery Doppler velocimetry, is different in singleton pregnancies resulting from ART compared to those conceived naturally. METHODS: Case-control study on 31 singleton ART pregnancies (26 in-vitro fertilization-embryo transfer, five intracytoplasmic sperm injection) and 62 matched pregnancies conceived spontaneously. Doppler velocimetry was performed at 11-14 weeks of gestation. RESULTS: The mean resistance index (coefficient of variation) was 0.70 (17%) and 0.70 (18%) in ART and controls, respectively (P = 0.92). The corresponding values for mean pulsatility index were 1.40 (44%) and 1.47 (44%) in ART and controls, respectively (P = 0.58). Pregnancies with no, unilateral or bilateral diastolic notches were 48%, 26%, 26% and 36%, 37%, 27%, in ART and controls, respectively (P = 0.43). CONCLUSION: There are no differences in uterine artery Doppler indices between pregnancies obtained by invasive ART and naturally conceived matched controls. This finding suggests that there is no major difference in trophoblastic invasion of the maternal spiral arteries between ART and spontaneous pregnancies.

Adult↗
PubMed2004

What is the most relevant standard of success in assisted reproduction?: challenges in measuring and reporting success rates for assisted reproductive technology treatments: what is optimal?

For assisted reproductive technology (ART) treatments, measures of success that move beyond traditional measures of pregnancy and live birth and narrow the numerator to infant outcomes with an optimal short- and long-term prognosis are needed. Hence, presentation of singleton live birth delivery rates is warranted. Twins have greatly increased risks for morbidity and mortality in comparison with singletons. Success rates based on singleton live births will more completely inform patients evaluating which ART treatment options will maximize their chance for a healthy infant. Additionally, providers who limit embryos transferred can feel they are on an even playing field in reporting their success rates. Measures of success that narrow the numerator further to exclude preterm or low birth weight singleton births might also be informative. However, the utility of such measures is less clear because the aetiologies of preterm birth and low birth weight among singletons are probably multifactorial. While it may be desirable to consider adverse outcomes such as congenital anomalies in defining treatment success, it is unfeasible to collect complete and accurate data on anomalies in current ART registries. As ART use increases, continual re-examination and critique of the manner in which success is defined and presented to the public is critical.

Birth Rate↗
PubMed2006

The application of reproductive technologies to natural populations of red deer.

Over the past decade, there has been increasing interest in the application of reproductive technology to the conservation and management of natural populations of deer. The application of assisted reproduction technologies within natural population of deer is in its infancy. However, its future potential is enormous, particularly in relation to genetic management or conservation. This paper reviews the present state of such technologies for a wild subspecies of red deer, the Iberian red deer (Cervus elaphus hispanicus), by discussing the major components of oestrous synchronization, semen collection/cryopreservation and insemination techniques. In addition, findings made during the course of studies on natural populations have enormous potential for the understanding of novel reproductive mechanism that may not be uncovered by livestock or human studies. A summary of these results are also reviewed here.

Animals↗
PubMed1994

The value of routine screening of female serum for antisperm antibodies in assisted reproductive technology cycles.

OBJECTIVE: To determine the effect of antisperm antibodies in the female serum on fertilization and pregnancy rates (PRs) in assisted reproductive technology (ART) cycles. DESIGN: Retrospective case control study. SETTING: Assisted reproductive technology program at North Shore University Hospital. PATIENTS, PARTICIPANTS: All patients undergoing an ART cycle in 1990 whose husbands did not have significant antisperm antibodies in the semen. Thirty-four female patients had significant antisperm antibodies level in the serum (antisperm antibodies-significant); 62 patients with no antibodies or nonsignificant levels constituted the control group (antisperm antibodies-negative). Incubation media were prepared with maternal serum in 37 of the antisperm antibodies-negative and in 10 of the antisperm antibodies-positive patients, whereas donor's serum (DS) was used for 25 and 24 patients, respectively. MAIN OUTCOME MEASURES: Fertilization rate and clinical PR, defined as an intrauterine sac by transvaginal ultrasonography, were recorded for each group. RESULTS: Analysis of variance showed a significant interaction between antisperm antibodies grouping and the type of media used, with fertilization rate in antisperm antibodies-significant patients significantly higher with maternal serum than with DS, whereas fertilization rate in antisperm antibodies-negative was quantitatively, though not statistically lower with maternal serum than with DS. When maternal serum was used, fertilization was higher in antisperm antibodies-significant than antisperm antibodies-negative. Of 29 clinical pregnancies, 11 were in antisperm antibodies-significant and 18 in antisperm antibodies-negative. In 10 of the pregnancies, maternal serum was used, whereas in 19 pregnancies DS was used. No variable was significantly predictive of pregnancy in the logistic regression analysis. CONCLUSIONS: [1] Female patients with significant levels of antisperm antibodies in the serum had similar fertilization rates as patients with nonsignificant levels if DS was used. [2] The use of maternal serum in antisperm antibodies-significant patients did not result in inferior fertilization rates or the occurrence of pregnancy. [3] These findings suggest that a female antisperm antibodies may not hinder fertilization in vitro. [4] This study questions the value of routine screening of female serum for antisperm antibodies in ART.

Adult↗