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PubMed2002

The nanny state or responsible government?

The use of statutory regulation of medical treatments is always contentious. This is particularly so in the case of assisted reproductive technologies (ART), and the treatments offered through IVF and related procedures. These technologies challenge traditional understandings of the family and motherhood, but also raise questions about the status of the human embryo and how it should be treated. This article argues that governments do have a role to play in the regulation of ART, in addition to the professional guidelines governing such treatments. It looks at three different types of statutory regulation in the Australian context.

Australia↗

PubMed2002

The control of follicular wave development for self-appointed embryo transfer programs in cattle.

Our expanding knowledge of the control of follicular wave dynamics during the bovine estrous cycle has resulted in renewed enthusiasm for the prospects of precisely controlling the follicular and luteal dynamics and finely controlling the time of ovulation. Follicular wave development can be controlled mechanically by ultrasound-guided follicle ablation or hormonally by treatments with GnRH or estradiol and progestogen/progesterone in combination. Treatment of cattle with GnRH in combination with prostaglandin F2 alpha (PGF) 7 d later and a second GnRH 48 h after PGF (known as Ovsynch) has resulted in acceptable pregnancy rates after fixed-time AI in lactating dairy cows and in recipients in which embryos were transferred without estrus detection. Alternatively, treatments with estradiol and progestogen/progesterone-releasing devices resulted in synchronous emergence of a new follicular wave and, when a second estradiol treatment was given 24 h after device removal, synchronous ovulation and high pregnancy rates to fixed-time AI. Self-appointed embryo transfer (without estrus detection) using estradiol and progesterone treatments have resulted in pregnancy rates comparable with those obtained with recipients transferred 7 d after estrus. Furthermore, estradiol and progesterone treatments combined with PGF and eCG (given 1 d after the expected time of wave emergence) have resulted in high rates of recipients selected for transfer (84.6%) and an overall pregnancy rate of 48.7% (recipients pregnant/recipients treated). Estradiol and progestogen/progesterone treatments have also been widely used for self-appointed superstimulation protocols with equivalent embryo production to that of donor cows superstimulated using the traditional approach beginning 8 to 12 d after estrus. In summary, exogenous control of luteal and follicular development facilitates the application of assisted reproductive technologies in cattle by offering the possibility of planning the superstimulation of donors and synchronization of recipients at a self-appointed time, without the necessity of estrus detection and without sacrificing results.

Animals↗

PubMed2003

[In vitro maturation, fertilization and embryo transfer of human immature oocyte].

OBJECTIVE: To try a new method for treating infertile women by in vitro maturation technique. METHODS: To set up in vitro maturation (IVM) program, including stimulating regimen, oocyte retrieval technique, and culture system of the immature oocytes with the medium consisted of essential supplements and human mature follicular fluid. IVM was performed in 30 infertile patients (35 cycles), (1) with polycystic ovary syndrome (POCS) (14/30), (2) ovary hyperstimulation syndrome (OHSS) in the previous stimulating cycles (6/30), and (3) retardation of the oocyte growth in conventional IVF cycles (10/30). RESULTS: Totally 203 oocytes were obtained, with a mean of 5.8 oocytes each cycle. First polar bodies were observed in 156 oocytes, maturation rate was 76.8%. There were 120 oocytes getting into pronucleus stage, normal fertilization rate was 76.9%. Embryo transfer was performed in 33 cycles. Eight pregnancies were established, pregnancy rate was 24%. Five patients have delivered 7 healthy babies. CONCLUSIONS: The result of our study indicated that IVM is one of the new assisted reproductive technologies for the infertile women with PCOS, poor response to stimulation and the history of OHSS. Human mature follicular fluid would be an ideal component in the maturation medium for oocyte maturation in vitro and provides a much simplified and practical method for clinical use.

Adult↗

PubMedDate not supplied

Ethics and the reproductive process.

Changes in reproductive technology and contraceptive availability have resulted in ethical reconsiderations in many countries. The United States has been no exception. A discussion of the applicable ethical principles for contraceptive research and family planning programs is presented. Each country must decide its own individual response to a given ethical problem. The paper does not propose solutions but is designed to raise the necessary questions.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Poland anomaly after in vitro fertilization.

OBJECTIVES: To describe an extremely rare anomaly in an infant born after IVF-ET, and to assess its possible relationship to the artificial reproductive technology. DESIGN: Case report. SETTING: Infertility and IVF Unit, in a tertiary academic medical center. PATIENT: A 31-year-old healthy patient with a 9-year history of secondary, unexplained infertility. INTERVENTION: Standard IVF-ET treatment cycle, using GnRH-a (short protocol) and hMG for controlled ovarian hyperstimulation. RESULTS: Poland anomaly (asymmetric thorax with absence of the right pectoralis major muscle, low set rudimentary right nipple, and very mild hypoplasia of the right upper limb) is described for the first time in an infant who is one of a trizygotic triplet after IVF treatment. CONCLUSIONS: In view of the currently held hypothesis concerning the pathogenesis of Poland anomaly, the possibility of a teratogen or an event related to the reproductive procedure as the cause of this anomaly seems unlikely.

Adult↗

PubMed2002

Safeguarding ART.

Assisted reproductive technologies (ART) are exceptional among clinical therapies, as unlike most medical procedures, ART have generational consequences. Further, human embryo research in the US has been sponsored solely by the private sector and, until recent biotechnology forays into human embryonic stem cell (hESC) and cloning research, exclusively by infertility clinics. Additionally, the relatively brief clinical history of ART has made it difficult for practitioners and researchers to agree on criteria for its safety and success. Against this backdrop, market pressure on biotechnology companies to create hESC lines and on clinical practices to occupy the innovative forefront has resulted in arguably risky experiments with human embryo cloning, as well as in unintentional germ-line genetic modifications during ART and perhaps during gene therapy. Reproduction, once governed largely by passions and instinct, now seems to need further governance. Some argue that it could now be time for the biomedical community, especially in the US, to take further steps to safeguard ART.

Aging↗

PubMedDate not supplied

Informed consent issues in assisted reproduction.

Given the enormous ethicolegal controversies surrounding the use of assisted reproductive technologies (ART) in the United States, the most important role for nurses may be helping couples and third party participants obtain fully informed consent. The high compensation fees for egg donors may place them at special risk of exploitation. New government and professional guidelines, broader representation on ethics committees, and expanded counseling about risks and benefits can help reduce the potential for litigation and enhance patient autonomy.

Consumer Advocacy↗

PubMed2005

Ovarian reserve.

The tendency to delay childbirth has increased the importance of ovarian reserve as a determinant of infertility treatment outcome. In the context of assisted reproduction technology, effective strategies to overcome the impact of ovarian aging and diminished ovarian reserve on pregnancy chances remain elusive. Markers of ovarian reserve are increasingly used to aid management and counseling of these patients. Proper interpretation of currently applied hormonal markers, ultrasound parameters, and hormone challenge tests requires an understanding of what constitutes and determines ovarian reserve. This article addresses these aspects and highlights recent developments in the field.

Aging↗

PubMed2000

[Peculiarities of multiple pregnancy: epidemiology].

The epidemiology of multiple pregnancy is complex and depends on various factors including age, race, genetic and environmental factors, season of conception and, more recently, iatrogenic factors. In recent years, twinning rate increased dramatically especially in countries where ovulation induction and assisted reproductive technologies are widely used. Multiple pregnancies are most frequent in Nigeria where majority of them are dizygotic. The lowest frequency of twinning is observed in Japan where almost 70% of multiples are monozygotic. This paper discusses genetic, environmental and sociocultural factors which are related to the "epidemic" of multiples.

Age Distribution↗

PubMed2005

Expression of imprinted genes is aberrant in deceased newborn cloned calves and relatively normal in surviving adult clones.

Cattle are the species used most frequently for the development of assisted reproductive technologies, such as nuclear transfer. Cattle cloning can be performed by a large number of laboratories around the world, and the efficiency of nuclear transfer in cattle is the highest among all species in which successful cloning has been achieved. However, an understanding of the expression of imprinted genes in this important species is lacking. In the present study, real time reverse transcription polymerase chain reaction (RT-PCR) was utilized to quantify the expression of the bovine Igf2, Igf2r, and H19 genes in eight major organs (brain, bladder, heart, kidney, liver, lung, spleen, and thymus) of somatic cell cloned calves that died shortly after birth, in three tissues (skin, muscle, and liver) of healthy clones that survived to adulthood, and in corresponding tissues of control animals from natural reproduction. We found that, deceased bovine cloned calves exhibited abnormal expression of all three genes studied in various organs. Large variations in the expression levels of imprinted genes were also seen among these clones, which were produced from the same genetic donor. In surviving adult clones, however, the expression of these imprinted genes was largely normal, except for the expression of the Igf2 gene in muscle, which was highly variable. Our data showed disruptions of expression of imprinted genes in bovine clones, which is possibly due to incomplete reprogramming of donor cell nuclei during nuclear transfer, and these abnormalities may be associated with the high neonatal mortality in cloned animals; clones that survived to adulthood, however, are not only physically healthy but also relatively normal at the molecular level of those three imprinted genes.

Animals↗

PubMed2001

First trimester screening for Down syndrome and assisted reproduction: no basis for concern.

In pregnancies obtained after assisted reproduction the false-positive rate of second trimester Down syndrome (DS) screening is increased by 1.5-3-fold. This may cause an increase in the number of amniocenteses and the fetal loss rate. The present study for the first time examined whether assisted reproductive technologies affect the results of first trimester screening. The markers PAPP-A, free beta-hCG and the nuchal translucency (NT) thickness were examined at 12-14 weeks' gestation. Screening markers in 47 in vitro fertilisation (IVF), 63 ovulation induction (OI) and 3026 spontaneously conceived singleton pregnancies were compared. The MoM (multiples of the median) value in the IVF pregnancies was 1.02 (95% CI: 0.85-1.22) for PAPP-A, 1.14 (95% CI: 0.95-1.37) for beta-hCG and 0.97 (95% CI: 0.89-1.05) for NT; the MoM value in the OI pregnancies was 0.89 (95% CI: 0.76-1.05) for PAPP-A, 1.08 (95% CI: 0.93-1.25) for beta-hCG and 1.02 (95% CI: 0.95-1.11) for NT. The first trimester marker values in assisted reproductive pregnancies and spontaneously conceived pregnancies were not significantly different. Estimated false-positive rates for a risk cut-off of 1:400 varied from 4.7% in IVF pregnancies to 5.1% in OI pregnancies. Therefore the false-positive rate in Down syndrome screening should be independent of the method of conception.

Adult↗

PubMed2004

[Assays for assessment of sperm DNA integrity: relationships with fertility and conceptus quality].

Several assays are available for testing nuclear quality of spermatozoa, many of them allowing to define a DNA fragmentation index (DFI). Numerous recent studies on this subject agree on several points: negative correlations are observed between DFI and sperm characteristics. Concerning the relationships between DFI and artificial reproductive technologies, there are some disagreements about correlations between DFI and fertilization rates; conversely, in case of high DFI, both blastocyst formation rate and pregnancy rate are significantly reduced. Several authors have defined a threshold value for DFI, corresponding to an absence of pregnancy, or a very low pregnancy rate, for samples above this value. Unfortunately, there are no data available concerning the relationships between sperm DNA quality and abnormalities at birth.

Blastocyst↗

PubMed1988

Therapeutic hysteroscopic procedures.

Hysteroscopy has evolved from a diagnostic procedure into a therapeutic method for a variety of conditions. Instruments specifically designed for hysteroscopic operative procedures have improved. The indications for therapeutic hysteroscopy are increasing and its proper applications can improve patient's gynecologic care. These facts should stimulate the gynecologist to become proficient with hysteroscopy for diagnosis and the treatment of many intrauterine abnormalities. In selected patients there are major advantages including the avoidance of a laparotomy with the potential sequelae that can follow operations requiring entrance into the peritoneal cavity. The operative techniques have been refined and, with experience, good postoperative results and low morbidity have become evident. The septate uterus can be treated by hysteroscopic metroplasty with improved reproductive outcome. Symptomatic submucous myomas in selected patients can be removed hysteroscopically. Lysis of intrauterine adhesions has become the standard method of therapy. Foreign bodies lost in the uterine cavity or embedded IUDs can be removed atraumatically under direct vision. As the approach to intrauterine problems is refined, other applications are being investigated such as tubal cannulation, endoscopic chorionic villus sampling, and application of hysteroscopy to new reproductive technologies such as the placement of gametes in the fallopian tubes. Because of the simplicity of approaching the uterotubal ostia transcervically, hysteroscopy remains in the front line of investigation as a possible approach for inducing tubal occlusion as a permanent or temporary method of contraception. Finally, laser energy is being used in patients with intractable uterine bleeding to photocoagulate the endometrium and to create amenorrhea by means of inducing severe intrauterine adhesions.

Chorionic Villi↗

PubMedDate not supplied

Walking the line between feminism and infertility: implications for nursing, medicine, and patient care.

Traditionally infertility has been viewed as a medical condition and has been managed within the medical model of diagnosis, treatment, and cure. The prevalence of infertility has been medically explained by women's sexual promiscuity, pursuit of professional career advancement, and psychological immaturity. Although authors have recently recognized an equitable proportion of infertility problems attributable to male factors, the vast majority of infertility testing and treatment procedures remain directed toward women. Reproductive technologies and their potential for perpetual treatment create a scenario of vulnerability for the infertile woman, which demands the attention of care providers who advocate feminist values of health. In this article, we present a historical overview of infertility and offer a feminist perspective for providing physical and emotional health care to infertile women. Strategies for integrating feminist perspectives of health into infertility programs are discussed.

Attitude to Health↗

PubMedDate not supplied

Current progress on assisted reproduction in dogs and cats: in vitro embryo production.

The objective of the development of assisted reproduction techniques in dogs and cats is their application to non-domestic canine and feline species, most of which are considered threatened or endangered. Among these techniques, an entirely in vitro system for embryo production is effectively an important tool for conservation of wildlife. In the last decade, progress has been made in embryo production in carnivores. It has been shown that canine oocytes can resume meiosis in vitro and that these oocytes can be fertilized and developed in vitro, although at a much lower rate than most other domestic animal oocytes. The reason lies in the dissimilarities of reproductive physiology of the dog compared to other species and the lack of precise information concerning the oviductal environment, in which oocyte maturation, fertilization and early embryonic development take place. Successful in vitro embryo production in the domestic cat has been attained with oocytes matured in vitro, and kittens were born after transfer of IVM/IVF derived embryos. On the basis of these results the in vitro fertilization of oocytes has also been applied in several non-domestic feline species. The effectiveness of such protocols in the preservation of genetic material of rare species can be improved by developing better techniques for long-term storage of gametes. In dogs and cats sperm cells have been successfully frozen and the cryopreservation of oocytes would greatly increase their availability for a range of reproductive technologies. Cryopreserved cat oocytes can be fertilized successfully and their development in vitro after fertilization is enhanced when mature oocytes are frozen. Thus refined techniques of oocyte maturation and fertilization in vitro coupled with oocyte cryopreservation could allow for an easy establishment of genetic combinations when male and female gametes in the desired combination are not simultaneously available, and the propagation of endangered carnivores would be facilitated.

Animals↗

PubMed2002

Reproductive medicine: the ethical issues in the twenty-first century.

Reproductive medicine has developed to such an extent that numerous moral questions arise about the boundaries of applications of new reproductive technology. It is possible to imagine a future in which 'designer babies' are created and in which cloning, sex selection and male pregnancy become the instruments of individual desire or social policy. In this article, the concept of 'natural' is explored but rejected as an insufficient moral criterion for deciding these complex questions. A case is made for the criterion of welfare of the child and for the concept of the child as gift rather than product.

Bioethics↗

PubMed2002

Twin heterotopic pregnancy after assisted reproduction. A case report.

BACKGROUND: Heterotopic pregnancy is a potentially catastrophic form of ectopic pregnancy and is increasing in incidence secondary to assisted reproductive technology. Early diagnosis and intervention are important in avoiding short- and long-term morbidity. CASE: A 36-year-old, nulliparous woman became pregnant by in vitro fertilization and embryo transfer. A total of three embryos were transferred. She presented to the emergency room approximately six weeks after transfer with the complaint of severe abdominal pain. Laboratory analysis revealed a decreasing hematocrit with stable vital signs despite continued abdominal pain. On transvaginal ultrasound, two fetal poles were present, with cardiac activity in two of the three gestational sacs. At surgery the patient was found to have a ruptured tubal pregnancy in addition to the intrauterine gestations. Pathologic analysis revealed a twin tubal pregnancy. CONCLUSION: Heterotopic pregnancy should be considered in the differential diagnosis of any patient who becomes pregnant by assisted reproduction techniques and presents with signs and symptoms of ectopic pregnancy.

Abdominal Pain↗

PubMed1993

Genetic material donation: sperm, oocyte, pre-embryo.

Genetic material donation has become an integral part of the management of infertility. Sperm, oocyte and pre-embryo donation are medical and technical successful procedures, undertaken to deliberately procure the creation of a child. By application of the modern assisted reproductive technologies (ART), it is the adult's interests which are upheld. This does not necessarily imply that those interests apply also to the resulting offspring. Therefore, practice of genetic material donation raises ethical, legal, religious and social issues, which are discussed. The practice of gametes and pre-embryo donation is opposed by the main religions. The medical problems are related mainly to selection of donors, evaluation of recipients and quality control of the genetic material. The relationship between the biological and social parents and safeguarding the interest of the offspring, may be resolved by legislation pertaining to the individual country. Sperm and pre-embryo banks should be subjected to licensing and should not be run by a commercial system. The donated genetic material should not be used to extend the natural reproductive life span. By practicing sperm, oocyte and pre-embryo donation the medical profession and society should consider not only the interests of the infertile couple but the interests of the offspring as well.

Economics, Medical↗