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PubMed2000

The future of male infertility management and assisted reproduction technology.

Intracytoplasmic sperm injection (ICSI) is undoubtedly a powerful, and sometimes the only effective, form of infertility treatment. Nonetheless, it is a non-specific treatment that, combined with increasingly heroic techniques to recover male germinal cells, has led to perceptions of men as just providers of gametes in the infertility equation. In response to this nihilist attitude, where women are investigated extensively and scant attention is paid to men, there is a re-emerging awareness of andrology--particularly in countries with limited healthcare resources. Structured management strategies, using diagnostic information to recognize causative factors amenable to simpler, even systemic, therapies with reasonable chances of pregnancy rather than resorting prematurely to assisted reproduction technology, represent rational, cost-effective approaches to infertility management. Furthermore, genetic testing (particularly cystic fibrosis gene defects and Y-chromosome microdeletions) is essential for couples to make fully informed decisions on their options. Recognition that free radical-induced damage to the sperm genome (e.g. from smoking or in-vitro sperm manipulation) underlies deleterious paternal effects on preimplantation development promotes further synergy between andrology and embryology. Although societies strike different balances between considerations of affordability and cost-effectiveness of assisted reproduction technology, ICSI represents a last resort, to be used when less-invasive, lower-cost treatments have been deemed inappropriate or have failed. Consequently, rather than assisted reproduction technology eliminating the need for andrology, the future will see increasingly tighter integration of multidisciplinary infertility care, embracing careful diagnosis and patient education before obtaining truly informed consent and embarking upon cost-effective treatment.

Delivery of Health Care↗
PubMed1999

Role of reproductive technologies and genetic resource banks in animal conservation.

In combination with modem reproductive technologies, there is potential to use frozen and stored germplasm (genetic resource banks) to support conservation measures for the maintenance of genetic diversity in threatened species. However, turning this idea into reality is a complex process, requiring interdisciplinary collaboration and clearly defined goals. As the number of species deserving the attention of conservation scientists is overwhelmingly large, yet detailed knowledge of reproductive physiology is restricted to relatively few of them, choosing which species to conserve is one of the most difficult issues to be tackled. Besides the direct application of technologically advanced reproductive procedures, modern approaches to non-invasive endocrine monitoring play an important role in optimizing the success of natural breeding programmes. Through the analysis of urine and faecal samples, this type of technology provides invaluable management information about the reproductive status of diverse species. For example, it is possible to diagnose pregnancy and monitor oestrous cycles in elephants and rhinos without causing stress through restraint for sample collection. In this review, we identify the potential contribution of reproductive biology and genetic resource banks to animal conservation, but also highlight the complexity of issues determining the extent to which this potential can be achieved.

Animals↗
PubMed2005

[Surgical management of male infertility beyond assisted reproductive technology].

OBJECTIVE: To investigate the role of urological surgery for male infertility which is beyond the help of assisted reproductive technology (ART). METHODS: We retrospectively reviewed the records of 7 male infertility patients who, having failed to respond to ART, underwent urological surgery from 1999 to 2003. Of the 7 cases, 4 were varicocele, 2 were post-bilateral vasectomy and 1 was bilateral chronic epididymitis. For the 7 patients, 6 times we performed in vitro fertilization-embryo transfer (IVF-ET) and 5 times we attempted intracytoplasmic sperm injection (ICSI) , but all failed. After that, we resorted to surgical approaches, ligation of internal spermatic veins in 4 cases, bilateral vasovasostomy in 2, and unilateral epididymovasostomy in 1. RESULTS: After surgical intervention, 2 cases fathered children, 1 achieved pregnancy and 3 cases improved in the quality and quantity of seminal fluid; only 1 failed to respond to the therapy. CONCLUSION: In the treatment of male infertility, priority should be given to surgical intervention and, in case of failure, assisted reproductive technology could be considered.

Adult↗
PubMed2006

Assisted reproductive technologies (ART) in Canada: 2002 results from the Canadian ART Register.

OBJECTIVE: To present the success rates of assisted reproductive technology (ART) cycles performed in 2002 in Canada. This is the second annual report of Canadian ART outcomes. DESIGN: Prospective cohort study. SETTING: Twenty-one of 22 ART centers in Canada. PATIENT(S): Couples undergoing ART treatment in Canada during 2002. INTERVENTION(S): Assisted reproductive technology treatments, including IVF, intracytoplasmic sperm injection (ICSI), frozen embryo transfer (FET), and oocyte donation. MAIN OUTCOME MEASURE(S): Clinical pregnancy, live birth, and multiple birth rates. RESULT(S): A total of 9,188 ART cycles was reported to the Canadian ART Register. There were 6,547 IVF/ICSI cycles using the woman's own oocytes. Per cycle started, the clinical pregnancy rate was 29.9% (36.0% per ET procedure) and the live birth rate was 23.8%; the multiple birth rate per delivery was 34.8%. Of cycles with oocytes retrieved, IVF was performed in 46% and ICSI in 54%; the outcomes were similar with the two procedures. There were 325 IVF/ICSI cycles using donor oocytes. The clinical pregnancy rate was 34.8% and the live birth rate was 24.6%; the multiple birth rate was 34.6%. There were 2,083 FET cycles using the woman's own oocytes. The clinical pregnancy rate was 20.9% and the live birth rate was 16.3%; the multiple birth rate was 25.2%. CONCLUSION(S): For 2002, the Canadian ART Register achieved 95% voluntary participation from Canadian ART centers. Clinical pregnancy and live birth rates comparable to those of other countries were achieved. Success rates were higher in 2002 than in the previous year.

Adult↗
PubMed2002

Problems with the regulation of assisted reproductive technology: a clinician's perspective.

The use of the Infertility Treatment Act 1995 (Vic) as a model for regulating reproductive technologies throughout Australia poses many problems. This article argues that the legislation in Victoria is overly restrictive. In particular, banning embryo research is hypocritical. Embryo research was required to develop the clinical procedures and should be used to test innovations. Other problems are restricted access; privacy infringement; an intrusive regulatory body; conflicts with other laws; and confusion because of poor drafting or lack of foresight. Uniform statutes are unnecessary. The interests of individuals and the community are better served by regulation through the Reproductive Technology Accreditation Committee.

Australia↗
PubMed2003

A nightmare for King Solomon: the new reproductive technologies.

King Solomon had only two claimants for the baby whose fate he was to decide. With the new reproductive technologies, several people may assert claims to a child whose existence would have been impossible until only recently, and a mass of legal and ethical problems have been created that could barely have been envisioned even half a century ago. It can, for example, no longer be assumed that the woman who carries and gives birth to a baby is that child's biological mother. The legal claims threaten to turn a child into a piece of property rather than a human being with rights and needs. Existing statutes and competing religious or other perspectives, moreover, are not necessarily compatible with these new scientific realities, enlarging the spectrum of problems. This article reviews recent developments in reproductive technologies and some legal, ethical, and psychological issues that may be relevant in these circumstances.

Child↗
PubMed2000

Ovarian function before and after salpingectomy in artificial reproductive technology patients.

To determine the effect of the removal of the tube on ovarian function we studied 52 artificial reproduction technology cycles in 26 women before and after undergoing laparoscopic salpingectomy for ectopic pregnancy. Ovarian response was measured by the duration and quantity of human menopausal gonadotrophins used in the cycle, the pre-ovulatory concentrations of oestradiol, the number of oocytes retrieved, and the quality of the embryos. All parameters were compared between cycles carried out before and after salpingectomy as well as between affected and unaffected sides. Our findings show no significant difference in any of the parameters studied. We conclude that laparoscopic salpingectomy does not abate ovarian response in artificial reproduction technology cycles that follow the procedure.

Adult↗
PubMed1998

Treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology.

PURPOSE: We determined a rational strategy for treatment of patients with retrograde ejaculation in the era of modern assisted reproduction technology. MATERIALS AND METHODS: In 7 consecutive patients medical treatment or retrieval of spermatozoa from the bladder was performed at a male infertility clinic. RESULTS: Antegrade ejaculation was restored in 3 patients, and spermatozoa were retrieved from the bladder and used for assisted reproduction in 3. Spermatozoa with good oolemma penetrating ability were collected by seminal vesicle massage. CONCLUSIONS: Modern assisted reproduction technology is a powerful treatment option for retrograde ejaculation when combined with a technique to retrieve spermatozoa of good quality from the bladder.

Adult↗
PubMed2002

Influence of acupuncture on idiopathic male infertility in assisted reproductive technology.

The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05). Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology.

Acupuncture Therapy↗
PubMed1987

Ethics of reproductive technology: AFS recommendations, dissent.

The Ethics Committee of the American Fertility Society recently released its report, "Ethical Considerations of the New Reproductive Technologies." The report examines general ethical, legal, and biological aspects of and makes ethical recommendations on procreative technologies, from standard in vitro fertilization, through all its possible variations and accompaniments, including donor gametes and preembryos, surrogate mothers, and cryopreservation. The judgment of ethical acceptability of third-party involvement in reproductive technology is the report's weakest aspect. The potential impact of such participation was not sufficiently weighed because of primacy given to a single value: the provision of a baby to an individual couple, or even an individual, who could not otherwise have one. A dissent to the report is based on two analyses: Third-party involvement itself violates the marriage covenant, independent of any potential damaging effects or benefits, and relaxation of marital exclusivity could harm the marriage (and marriage in general) and the prospective child. The committee also failed to resolve the problem of preembryo status. Instead, it recommended that local programs offering reproductive assistance draw up their own policies.

Advisory Committees↗
PubMed2006

Nuchal translucency in pregnancies conceived after assisted reproduction technology.

PURPOSE OF REVIEW: Nuchal translucency is one of the important markers in the first trimester during antenatal screening for fetal Down's syndrome. With the observation of alterations in biochemical markers in pregnancies conceived after assisted reproduction, this review presents current information related to the thickness of nuchal translucency in these pregnancies. RECENT FINDINGS: Early small studies did not demonstrate any discrepancy in the thickness of nuchal translucency in fetuses from assisted reproduction and from spontaneous pregnancies, but there has been recent evidence to suggest an increased level of nuchal translucency in singletons from various modes of assisted-reproduction technology. Nuchal translucency in twins following assisted reproduction did not, however, show a similar increase. Although the effect of chorionicity was not specifically addressed, nuchal translucency thickness in twins born after assisted reproduction was reported to be comparable to that in spontaneous singletons. It is possible that singletons and twins after assisted reproduction exhibit different antenatal behavior and pregnancy courses. SUMMARY: Similar to other biochemical markers of fetal Down's syndrome, nuchal translucency is increased in singletons after assisted-reproduction technology. Further studies on twin pregnancies, in particular dichorionic twins, are necessary before conclusive evidence can be drawn for multiple pregnancies.

Down Syndrome↗
PubMed1995

Assisted reproductive technology: a dilemma for the nursing profession.

Assisted Reproductive Technology, despite poor outcomes in the treatment of infertility, is poised to take on a new supplementary role to genetic engineering. As an extreme example of medical/reductionist philosophy it is diametrically opposed to the emerging commitment to holism within the nursing profession. Nurses in Australia have been noticeably absent from the debate, research and decision making that has occurred about this technology, yet the implications for professional practice are far-reaching.

Australia↗
PubMed1992

The nursing role in assisted reproductive technologies.

The role of the nurse in assisted reproductive technologies (ART) has evolved as the needs of couples and infertility programs have changed. This multidimensional nursing role encompasses skill as a manager, educator, counselor, researcher, and professional. Such skills are combined with a specialized knowledge base of reproductive endocrinology and infertility. This chapter describes the various facets of the role, including the interdependence of other team members.

Adult↗
PubMed1995

Families created by the new reproductive technologies: quality of parenting and social and emotional development of the children.

The creation of families by means of the new reproductive technologies has raised important questions about the psychological consequences for children, particularly where gamete donation has been used in the child's conception. Findings are presented of a study of family relationships and the social and emotional development of children in families created as a result of the 2 most widely used reproductive technologies, in vitro fertilization (IVF) and donor insemination (DI), in comparison with control groups of families with a naturally conceived child and 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, marital satisfaction, and emotional state. Data on children's psychiatric state were also obtained by standardized interview with the mother, and by questionnaires completed by the mothers and the children's teachers. The children were administered the Separation Anxiety Test, the Family Relations Test, and the Pictorial Scale of Perceived Competence and Social Acceptance. 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. No group differences were found for any of the measures of children's emotions, behavior, or relationships with parents. The findings are discussed in terms of their implications for understanding the role of genetic ties in family functioning and child development.

Adoption↗
PubMed2006

APIKIDS: a cohort of children born after assisted reproductive technologies.

A cohort of children born after assisted reproductive technologies (ART) was set up in 2003 in Italy. It aims to follow up the children in order to study the short- and long-term effects of ART. Parents who agreed to participate were contacted for a telephone interview; questions included occupational and non-occupational exposure to carcinogens, reproductive history, history of index pregnancy (including drugs used during pregnancy), delivery and the child's health status. By August 2005, 40 out of the 50 centres contacted (80%) had agreed to participate in the study, and 17 had already sent their data. Information on a total of 2451 cycles ending with a pregnancy are currently available, from 2245 couples. We have contacted 351 of these couples (16%), 309 of whom (88% of the contacts) agreed to participate in the study and were interviewed, while 36 (11%) refused to be interviewed. The total number of children currently included in the database is 411. This study is the first attempt to create a database containing information on children born after ART in Italy. It will provide results on both short- and long-term outcomes in these children.

Carcinogens↗
PubMed1995

The achievement of pregnancies using assisted reproductive technologies for male factor infertility after retroperitoneal lymph node dissection for testicular carcinoma.

OBJECTIVE: To evaluate the success of electroejaculation with assisted reproductive technologies (ART) in anejaculate men after retroperitoneal lymph node dissection (RPLND) for testicular cancer. DESIGN: Retrospective clinical study. SETTING: Tertiary care, university-affiliated IVF program. PATIENTS: Anejaculate men after RPLND, spouses. INTERVENTIONS: Electroejaculation, microsurgical sperm aspiration, various assisted reproductive technologies. MAIN OUTCOME MEASURES: Sperm density and motility, fertilization rate, pregnancy rate (PR). RESULTS: Compared with patients not receiving chemotherapy, patients who received chemotherapy had diminished average sperm densities and motilities (63 x 10(6) and 20% versus 101 x 10(6) 32%, respectively); decreased fertilization rates per cycle for IVF and intracytoplasmic sperm injection (ICSI) (11% versus 26%, respectively); lower PRs per cycle of hMG-IUI and IVF (14% versus 60% and 8% versus 50%, respectively). No pregnancies were achieved with natural cycle-IUI, clomiphene citrate-IUI, or GIFT. Two couples progressed to intracytoplasmic sperm injection with one achieving the successful delivery of healthy twins. The overall PR per cycle was 22%. CONCLUSIONS: Patients receiving chemotherapy had decreased sperm densities, motilities, fertilization, and PRs for each modality used. Rectal probe electroejaculation with ART can help anejaculate men after RPLND achieve biologic paternity. An early move to the more aggressive therapies (hMG-IUI, IVF, ICSI) is supported.

Adult↗
PubMed2004

The concerns during assisted reproductive technologies (CART) scale and pregnancy outcomes.

OBJECTIVE: To determine whether concerns specific to IVF/GIFT (i.e., side effects, surgery, anesthesia, not enough information, pain, recovery, finances, missing work, and live birth delivery) that were measured by the previously validated Concerns During Assisted Reproductive Technologies (CART) instrument are negatively associated with reproductive endpoints. DESIGN: Prospective study. SETTING: Seven centers in Southern California between July 1993 and June 1998. PATIENT(S): One hundred fifty-one women completed two questionnaires at baseline and at the time of the procedure. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Number of oocytes aspirated and fertilized, number of embryos transferred, pregnancy rates, and live birth delivery rates. RESULT(S): At baseline, women who were concerned about the medical aspects (i.e., side effects, surgery, anesthesia, not enough information, pain, and recovery) of the procedure had 20% fewer oocytes retrieved and 19% fewer oocytes fertilized, while simultaneously adjusting for female age, race, education, smoking status, parity, type of assisted reproductive technologies (ART) procedure (IVF or GIFT), type of infertility, and number of previous attempts. Women who were very concerned about missing work had 30% fewer ooyctes fertilized. For women who were moderately concerned about missing work, the odds ratio was 2.83 for not achieving a pregnancy. Women who were extremely concerned about the finances associated with the procedure had a very high risk (odds ratio [OR] = 11.62) of not achieving a successful live birth delivery. CONCLUSION(S): The CART scale identified two areas of concerns for women undergoing IVF or GIFT: "missing work/finances" and "medical aspects of the procedure."

Absenteeism↗