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PubMed2005

[Advances in researches on inhibin B and male reproduction].

Inhibin B, a dimeric glycoprotein, is directly secreted by the testis and responses to a diversity of exogenic hormones. Serum inhibin B levels will be influenced by different factors, such as age, testis volume, the time of puberty, the time of sample collection, varied groups of people and so on. Inhibin B is directly relevant to spermatogenesis of the testis and can be viewed as a valuable marker to assess male fertility. The determination of serum inhibin B has an applicable value in diagnosing the etiology of male infertility, assessing the damage to spermatogenesis in men after radiotherapy or chemiotherapy, and evaluating therapeutic effect on cryptorchidism and varicocele. Moreover, as far as assisted reproductive technology is concerned, the investigation of serum inhibin B has a predictive value in testicular sperm extraction.

Fertility↗
PubMed2002

Knowledge and attitudes about the differences between emergency contraception and medical abortion among middle-class women and men of reproductive age in Mexico City.

Two reproductive technologies--emergency contraception and medical abortion--have the potential to reduce unintended pregnancy significantly in Latin America. Lack of knowledge and negative attitudes about the methods may limit their impact, however. Results from focus group discussions with middle-class men and women of reproductive age residing in Mexico City indicate that knowledge about emergency contraception and medical abortion is low. After being informed about both methods, participants supported emergency contraception but tied their support for medical abortion to its legal status. Participants remained concerned about the methods' efficacy, mechanism of action, and potential to encourage sexual risk-taking. While almost all desired greater dissemination of information about and access to both methods in Mexico, participants cited religious and cultural concerns, as well as barriers in communication with providers and within families, as significant challenges. Participants hoped, however, that both emergency contraception and medical abortion might play important roles in preventing unwanted pregnancy and abortion-related morbidity and mortality in Mexico in the future.

Abortifacient Agents↗
PubMed2000

[Relationship between human immunodeficiency virus and sperm--implications in medically assisted procreation].

The number of HIV-sero-discordant couples (man HIV+, woman HIV-) asking for assisted reproductive technologies (ART) has been increasing more and more since the efficiency of antiretroviral therapy was clinically proven. Long-term survey and amelioration of life quality in treated HIV-seropositive patients have induced in these couples a strong wish to conceive but they expected the most reduced risk of viral contamination. Epidemiologic data concerning HIV transmission during episodic unprotected sexual acts showed an elevated annual seroconversion rate which justifies that since 1992, European biologists specialized in human reproduction have proposed to carry out ART using intrauterine insemination (IUI) with prepared sperm in the population of couples where the man is HIV-seropositive. In spite of adapted technologies of sperm preparation, presence of HIV nucleic acids was demonstrated in purified spermatozoon (SPZ) fractions, resulting from residual free virus or virus linked to SPZ or residual infected cells, not completely eliminated. However, approximatively 2000 IUI were carried out with an HIV-controlled sperm treatment and no female and newborn seroconversions were reported. Even if the total lack of risk is impossible to obtain, a strict method of infected sperm preparation associated with sensitive virological techniques should permit us to obtain a minimal risk of contamination of women after IUI. In vitro fertilization (IVF) with or without microinjection allowed us to obtain the same results but they should be confirmed by further studies to be more relevant. These European workings, associated to a clear legal regulation in France, permit us to considerate that carrying out ART in HIV-sero-discordant couples in which the man is HIV-seropositive is allowable regarding both the viral problem and eventual sterility.

Adult↗
PubMedDate not supplied

The effective cumulative pregnancy rate of different modes of treatment of male infertility.

The clinical efficacy of conventional and advanced methods of treatment was assessed in 814 couples with infertility due to a male factor. The monthly and effective cumulative rate of ongoing or term pregnancies was calculated during 4712 couple-months. Treatment of varicocele by transcatheter embolization, resulting in 3.9% pregnancies per cycle and an effective cumulative pregnancy rate of 41% after 1 year, is more effective than counselling and timed intercourse (9% pregnancies after 12 months). Intrauterine insemination (IUI) of washed spermatozoa produced 17% pregnancies in the initial 4 months, but the success rate of the subsequent cycles (1.7% per cycle) was not different from that of the controls. In vitro fertilization (IVF) resulted in 16% pregnancies per attempt, but the effective cumulative pregnancy rate was only 31% in 12 months due to the long interval between treatment attempts and the high drop-out rate. With subzonal microinjection of sperm, the fertilization rate was higher (71%) than with regular IVF (29%) but both the pregnancy rate per attempt (9%) and the effective cumulative pregnancy rate (17% after 12 months) were low. The 10th percentile of sperm characteristics (cut-off values) of successful cases showed intrauterine insemination to be advantageous in cases with a lower percentage of spermatozoa with progressive motility (9%) than in the controls (15%). The cut-off value of sperm morphology in IVF (4%) is lower than that of IUI (8%) and of the controls (9%), but higher than that of subzonal insemination (1%). Treatment strategy must be defined selecting or combining conventional and assisted reproductive technology for each individual couple with male factor infertility.

Female↗
PubMed2005

Preimplantation genetic diagnosis: the earliest form of prenatal diagnosis.

Preimplantation genetic diagnosis (PGD) can provide genetic information on embryos obtained through in vitro fertilization (IVF), allowing implantation of embryos identified as unaffected with a given genetic or chromosomal disorder. With the availability of increasingly sophisticated genetic testing, its use has advanced from the selection of female embryos for the prevention of X-linked genetic diseases to testing for single gene disorders via PCR. Recently, PGD has also been used in the setting of assisted reproductive technology to select for chromosomally normal embryos in an effort to increase the rates of implantation and successful pregnancy. As the number of patients undergoing IVF increases, the indications for its use broadens, and more mutations underlying genetic disorders are identified, PGD is becoming more widespread. As this evolution continues, recognition of the limitations of PGD, as well as ethical concerns regarding use and misuse of this technology, need to be considered by patients, clinicians, and policy makers.

Cytogenetic Analysis↗
PubMed2003

The case for regulating collaborative reproduction: a children's rights perspective.

There is little regulation of collaborative reproduction--the use of the eggs, sperm, or embryos of a third party to create a child biologically unrelated to at least one intending parent. This Article argues that the dearth of regulation should be assessed from a children's rights perspective and accordingly adjusted. After examining the effects of the experimental reproductive technologies, it concludes that traditional family law preferences and policies are undercut by the deliberate creation of collaboratively reproduced children. The lack of regulation might stem from constitutional protection afforded parents in the right of privacy and substantive due process cases. The author, however, contends that collaborative reproduction implicates the rights of children and requires a separate balancing of rights not contemplated in other cases. Collaborative reproduction also requires regulation because of its spill over effects on the acceptability of cloning. The Article concludes by offering several possible regulatory responses to the problems posed by collaborative reproduction.

Child↗
PubMed2006

Assessing the reproductive performance of men co-infected with HIV-1 and hepatitis C undergoing assisted reproduction.

OBJECTIVE: To assess the reproductive performance of men co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV-1) undergoing assisted reproduction. DESIGN: A retrospective analysis. SETTING: University-based assisted reproductive technology (ART) center. PATIENTS: We reviewed 217 consecutive ART cycles performed on 106 HIV-1 serodiscordant couples between August 1997 and March 2004, in which 28 men (26%) were seropositive for HCV and HIV-1 (group 1). MAIN OUTCOME MEASURES: Patient demographics and laboratory testing were compared to reproductive outcomes of men undergoing similar treatment but infected only with HIV-1 (group 2). RESULTS: Co-infected men and their partners were of similar age as men infected only with HIV-1. Comparing group 1 to group 2, like values were noted for HIV-1 viral loads [1,993 +/- 1,140 copies/ml (mean +/- SE) vs. 1,659 +/- 487 copies/ml]; CD4 counts (520 +/- 98 vs. 604 +/- 38 mm(-3)); and semen parameters. IVF performance and outcomes were similar, with fertilization rate (0.68 +/- 0.03 vs. 0.71 +/- 0.02); number of normally cleaving embryos (6.0 +/- 0.5 vs. 5.3 +/- 0.3); embryo implantation rate (0.27 +/- 0.04 vs. 0.2 +/- 0.02); and clinical pregnancy rate (40 vs. 29%). Although the male mortality rate was low in both groups, morbidity among co-infected men was significantly higher. Seven of 28 men (25%) had detectable HCV viral loads, and 14 (50%) had elevated liver function tests. CONCLUSION: Men co-infected with HCV and HIV-1 do reasonably well undergoing ART to prevent transmission of viruses to their partners and children.

Adult↗
PubMed2002

Leptin and ovarian folliculogenesis: implications for ovulation induction and ART outcomes.

Leptin participates in regulation of ovarian folliculogenesis indirectly via control of luteinizing hormone and follicle-stimulating hormone secretion. More recent evidence suggests that leptin also has direct regulatory actions on the developing follicle. The presence of leptin receptors on follicular cells, including oocytes, and early preimplantation embryos suggests that leptin may play a direct physiologic role in follicular maturation, oocyte development, and early cleavage. Because circulating leptin levels are directly related to body adiposity, elevated leptin concentrations associated with obesity may partly explain the negative impact of obesity on fertility. The influence of leptin on follicular development and oocyte maturation has important implications for ovulation induction and assisted reproductive technologies. Moreover, polycystic ovarian syndrome may be associated with altered leptin phsyiology.

Female↗
PubMed2006

An update on antenatal screening for Down's syndrome and specific implications for assisted reproduction pregnancies.

Since the introduction of antenatal serum screening for Down's syndrome (DS) more than two decades ago, several screening approaches have been utilized in routine clinical practice. The current DS screening strategies involve mid-trimester serum biochemistry tests, first trimester tests combining sonographic markers and serum biochemistry and integration of first and second trimester markers. In this review, we evaluate the performance of DS screening strategies according to the Serum, Urine and Ultrasound Screening Study (SURUSS), the First and Second Trimester Evaluation of Risks (FASTER) Trial and the Serum Biochemistry and Fetal Nuchal Translucency Screening (BUN) Study. We also evaluate the performance of first trimester screening in studies and meta-analyses by other groups. Specific issues related to assisted reproduction technology (ART) pregnancies are also addressed in this review.

Biomarkers↗
PubMed2002

Psychoanalysis and infertility. Myths and realities.

Psychoanalysis, long interested in infertility, and a valuable treatment for men and women suffering with this affliction, has also helped to create and support a myth of psychogenic infertility. Multiple causes of infertility exist across the physiological-psychological spectrum. There is no simple psychodynamic causality. Advances in assisted reproductive technologies provide treatments that create emotional stress and outpace psychological preparedness of patients and analysts. This paper is based on the experience of a unique study group in Boston. An analytic case illustrates some of the ways analysis can be a treatment of choice for people using assisted reproduction. In fact, analysis offers a unique opportunity to elaborate fully the complex realities and dilemmas faced by people and their therapists throughout the infertility experience. More generally, this study of the concept of psychogenic infertility explores a valuable role for psychoanalysis in the treatment of medical conditions.

Female↗
PubMed2004

Ethical differences between socialized and HMO systems.

A visiting scholar from the School of Philosophy of Leeds University, England, was invited to participate in a seminar at the Section of Bioethics of Drexel University School of Medicine, which discussed (a) ethical differences between socialized and HMO systems, (b) physician-assisted suicide, (c) reproductive technology, (d) triage and rationing, and (e) organ donation and sale.

Ethics, Medical↗
PubMed2006

Sperm DNA damage: clinical significance in the era of assisted reproduction.

Evidence suggests that damage to human sperm DNA might adversely affect reproductive outcomes and that the spermatozoa of infertile men possess substantially more sperm DNA damage than do the spermatozoa of fertile men. This is particularly relevant in an era where advanced forms of assisted reproductive technologies are commonly used (technologies that often bypass the barriers to natural selection), because there is some uncertainty regarding the safety of using DNA-damaged spermatozoa. In this review, we outline our current understanding of how sperm DNA is organized, what causes sperm DNA damage, what impact this damage may have on reproductive capacity and whether tests of sperm DNA damage are clinically useful.

DNA↗
PubMed2006

Treatment of infertility in women with pituitary tumors.

Due to the pituitary's critical position, a pituitary tumor may disrupt gonadal function, either by its expanding size or the inappropriate secretion of hormones. Menstrual cycles may be disrupted even without frank hypogonadism, particularly in the case of hormone-secreting adenomas. Despite optimal medical and surgical management of pituitary tumors, ovulation-induction therapy with gonadotropins is often required to restore fertility in these women. This article will provide an overview of the therapeutic options available for women with infertility resulting from pituitary tumors. Treatment strategies including dopamine agonists, gonadotropins and the role of assisted reproductive technologies will be discussed. Unique pregnancy considerations in the female patient with hypopituitarism will also be addressed.

Dopamine Agonists↗
PubMed2005

Efficacy of Ovsynch program on reproductive performance in dairy cattle: a meta-analysis.

The efficacy of the Ovsynch program in improving conception and pregnancy rates was compared with untreated controls and other synchrony programs in lactating dairy cows. This meta-analysis examined 71 treatment and control comparisons extracted from 53 research papers. Programs evaluated included Ovsynch, natural breeding, single, double, or triple prostaglandin injections, Select Synch, Heat Synch, and modified Ovsynch. Pregnancy rates for Ovsynch programs did not differ significantly from those with natural breeding programs [predicted Bayesian relative risk (RR) = 1.04, 95% Bayesian credible interval = 0.36 to 3.23]. Results of Ovsynch vs. PGF(2alpha) programs showed that the risk of conception (predicted Bayesian RR = 0.89, 95% Bayesian credible interval = 0.31 to 2.64), and pregnancy rates predicted Bayesian RR = 1.11, 95% Bayesian credible interval = 0.61 to 2.13) did not differ significantly between the Ovsynch group and cows in the PGF(2alpha) group. Comparisons between Ovsynch and Select Synch demonstrated that the risk of conception (predicted Bayesian RR = 0.94, 95% Bayesian credible interval = 0.52 to 1.59), and pregnancy rates (predicted Bayesian RR = 1.08, 95% Bayesian credible interval = 0.38 to 3.09) did not differ significantly between the 2 groups. Examination of Ovsynch vs. modified Ovsynch programs showed that the risk of pregnancy in cows synchronized with modified Ovsynch was similar to those treated with Ovsynch (predicted Bayesian RR = 0.89, 95% Bayesian credible interval = 0.71 to 1.12).Meta-analyses identified that the conception and pregnancy rates obtained with the prostaglandin, Select Synch, and modified Ovsynch (including presynch and CoSynch) programs were comparable with the Ovsynch program. Modifications to the Ovsynch program such as presynchronization and timed artificial insemination at the time of second GnRH injection (CoSynch) may be an alternative for reproductive management of dairy herds where detection of estrus is less than optimal. The findings of this study demonstrate that the Ovsynch program could benefit dairy operations because it allows for timed artificial insemination of lactating cows without detection of estrus. There was, however, little or no significant improvement in pregnancy rates using Ovsynch over other programs and the costs of labor and hormone administration should be considered when selecting this form of reproductive technology for routine use.

Animals↗
PubMed2002

Obesity increases the risk of spontaneous abortion during infertility treatment.

OBJECTIVE: This study examines the relationship between body mass and the risk of spontaneous abortion in a large cohort of patients who received infertility treatment. RESEARCH METHODS AND PROCEDURES: This is a retrospective study using data on pregnancies (n = 2349) achieved after treatment in a tertiary medical center from 1987 to 1999. One pregnancy per subject was included, and the subjects were stratified into five body mass groups based on body mass index (BMI): underweight, <18.5 kg/m(2); normal, 18.5 to 24.9 kg/m(2); overweight, 25 to 29.9 kg/m(2); obese, 30 to 34.9 kg/m(2); and very obese, > or =35 kg/m(2). Logistical regression analysis was used. RESULTS: The overall incidence of spontaneous abortion was 20% (476 of 2349). The effect of BMI on the risk of spontaneous abortion was significant after adjusting for several independent risk factors. Compared with the reference group (BMI 18.5 to 24.9 kg/m(2)), underweight women had a similar risk of spontaneous abortion, whereas there was progressive increase of risk in overweight, obese, and very obese groups (p < 0.05, p < 0.01, and p < 0.001, respectively). DISCUSSION: Of all known risk factors for spontaneous abortion, the control of obesity has great significance because it is noninvasive, potentially modifiable, possibly amenable to low cost, and self-manageable by patients. This study established a positive relationship between BMI and the risk of spontaneous abortion in women who became pregnant after assisted reproductive technology treatment.

Abortion, Spontaneous↗
PubMed2001

Uterine transplantation, abdominal trachelectomy, and other reproductive options for cancer patients.

More and more women with cancer issues are now raising fertility concerns as survival improves and childbearing is delayed. Pregnancy is no longer contraindicated in cancer patients including breast and endometrial cancer survivors. In fact, survival in patients treated for breast cancer who subsequently become pregnant is actually higher than that in patients who do not become pregnant. "Therapeutic" abortions are no longer recommended. Assisted reproductive technology (ART) have been associated with ovarian neoplasms, but the association is probably not causal. Neither ART nor hormone replacement is contraindicated in cancer patients. Our institution is very supportive of patients and the difficult decisions cancer survivors face. Using a program of counseling and close collaboration between oncologists, perinatologists, and reproductive endocrinologists, informed patients are offered every possible option, including ART and uterine transplantation, to achieve their family planning objectives.

Breast Neoplasms↗
PubMed1999

Early pregnancy losses in in vitro fertilization and oocyte donation.

OBJECTIVE: To evaluate prospectively the incidence of early pregnancy losses (before menstruation occurs) in IVF and ovum donation cycles. DESIGN: Prospective case-control study. SETTING: Tertiary care, university-associated center. PATIENT(S): One hundred forty-five patients undergoing IVF and 92 undergoing oocyte donation were recruited. The control group for IVF consisted of 15 ovum donors who had no ET and were instructed to avoid intercourse. The control group for oocyte donation included 10 women undergoing a mock cycle of steroid replacement. INTERVENTION(S): Starting on day 6 after ET, the women were instructed to collect the first urine sample of the day every 2 days. Each patient collected six different specimens of urine (days 6, 8, 10, 12, 14, and 16 after ET for cases or the same days without ET for controls. MAIN OUTCOME MEASURE(S): beta-HCG was measured with a standardized microparticle enzyme immunoassay, and IVF reproductive outcome was assessed. RESULT(S): For IVF, positive implantation was registered in 88 of 145 cycles of embryo replacement (60.7%). Only 30 (20.7%) resulted in viable pregnancies, whereas the remaining 58 miscarried. Forty-two of these miscarriages (72.4%) were early pregnancy losses and 13 (22.4%) were classified as clinical abortions. In ovum donation, positive implantation was recorded in 64 of 92 cycles of ET (69.6%). A total of 30 (32.6%) ended in viable pregnancies, whereas the remaining 34 (37.0%) were miscarriages. Early pregnancy loss accounted for 70.6% of pregnancy losses, whereas biochemical pregnancies and clinical abortions accounted for 11.8% and 17.6%, respectively. CONCLUSION(S): Our results demonstrate that patients undergoing assisted reproductive technology have an increased rate of early pregnancy loss compared with fertile patients. In addition, these data indicate that implantation is more frequently impaired in IVF than in oocyte donation cycles, resulting in a high incidence of early pregnancy loss. This suggests that implantation may be subjected to abnormal conditions in assisted reproduction.

Case-Control Studies↗
PubMed2004

Endometriosis and inflammation in infertility.

A wealth of publications proposes that endometriosis and inflammation may have an unfavorable influence on fertility. A recent meta-analysis of assisted reproductive technologies demonstrated that, once confounding factors are controlled for, the pregnancy rate in women with endometriosis is approximately 50% of the rate of women with tubal factor infertility. Peritoneal fluid of women with endometriosis contains elevated amounts of macrophages and their secreted products, such as growth factors, cytokines, and angiogenic factors. Because reproductive organs are bathed in and thus will be influenced by peritoneal fluid, these proinflammatory mediators would affect various aspects of reproduction in women with endometriosis. Advanced stages of endometriosis may have easily understandable factors, such as distortion of the anatomy, causing infertility. On the other hand, in minimal or mild endometriosis mechanisms underlying reproductive failure are subtle and remain controversial. Recent reports suggest that inflammatory factors play a role in this endometriosis-associated reproductive failure. This review provides an overview of recent data on the effects of endometriosis-associated inflammation on fertility.

Endometriosis↗