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PubMed2006

Assessment of attitudes towards assisted reproduction: a survey among medical students and parous women.

BACKGROUND: The present paper explores attitudes towards different aspects of assisted reproductive technologies among parous women and future doctors (third- and fourth-year medical students). METHODS: We anonymously surveyed 200 parous women who had at least three infants and had given birth at Kuopio University Hospital, and 200 medical students of Kuopio University. RESULTS: The overall response rate was 45%. Most of the medical students were childless (95.7%), unmarried (63.8%), and younger (24 vs. 35 years) compared with the parous women (p < 0.001). Medical students were liberal in questions of who has the right to get infertility treatment: 49% of them would allow the possibility to lesbian couples, 43% to homosexual couples and over 50% to single women. Over 40% of medical students would allow the use of a surrogate mother for lesbian and homosexual couples; the number was under 20% in the group of parous women. Their setting of priorities within the field of reproductive health also showed differences in prostate cancer screening, doctor's appointments for contraception, abortion and menopausal hormone replacement therapy. CONCLUSIONS: Medical students take a rather liberal stance on reproductive issues. On the other hand, baseline attitudes among medical students reveal some degree of subjectivism when it comes to allocation of scarce healthcare resources within the field of reproductive health. Medical education faces a challenge in ensuring that future physicians are able to set priorities and balance resources between preventive medicine and management of specific medical conditions, and to base their attitudes on evidence.

Adult↗
PubMed2000

Public perception on infertility and its treatment: an international survey. The Bertarelli Foundation Scientific Board.

The first large survey on the public perception of infertility and its treatment was conducted in six European countries, the USA and Australia. A representative sample of 8194 adults was polled, using standard validated methodology. The results obtained highlighted the following major aspects: (i) infertility is perceived as a disease by less than half of the people surveyed (38%), in contrast to the accepted medical opinion; (ii) awareness about the definition and incidence of infertility is relatively low, despite the fact that half of the people polled claimed to know someone affected by infertility; (iii) close to 90% of the adults surveyed knew about in-vitro fertilization (IVF), but less than one-quarter of them knew about the chances of success of this assisted reproductive technology; and (iv) when confronted with the knowledge that the cost of three IVF cycles is roughly equivalent to the cost of a hip replacement (a commonly reimbursed procedure), a large majority (70%) of the individuals interviewed agreed that IVF should be reimbursable.

Adult↗
PubMed2001

Preimplantation genetic diagnosis and embryo research--human developmental biology in clinical practice.

Research on human preimplantation embryos in vitro is controversial. Yet it has been the cornerstone for the development important clinical assisted conception techniques. Preimplantation genetic diagnosis which has developed out of this assisted reproductive technology for the first time provides a realistic alternative to prenatal diagnosis and abortion for couples who are at substantial risk of conceiving a pregnancy affected by a known genetic disorder. It also provides the first real hope of therapy for couples who have suffered repeated miscarriages due to chromosome translocations. However, the ability to test very early embryos in vitro presents new and unusual ethical challenges for clinicians and developmental biologists.

Achondroplasia↗
PubMed1998

Adjusting to life when assisted conception fails.

According to our basic (psychosomatic) tenet, every somatic problem has its emotional side; therefore, medical treatment and counselling are not separate but are interlinked and equally important. First interviews and interviews after failed assisted reproductive technology (ART) are held together in four person settings; the couple with two counsellors. The sessions last for approximately 1 h. The aim is to help patients escape the agonizing and distressing state in which they are kept by their foci (psychogenic aspects causing distress). Stress and iatrogenic factors are discussed and when patients are able to re-experience their suffering, many possible psychological effects on infertility and/or treatment failure are explored. If the patients consciously perceive these mechanisms of action, they will turn to their basic emotional needs and perspectives; approximately 30% of them will conceive later while approximately 20% opt for adoption. However, half of the patients take no positive action, neither giving up nor continuing with activities for a child. Nor do they seek counselling. The analysis of many of their reports argues in favour of an adaptive model for coping with reproductive failure.

Adaptation, Psychological↗
PubMed2006

Pregnancy loss and assisted reproduction: preliminary results after the law 40/2004 in Italy.

The new Italian law on assisted reproduction technology rules that no more than three oocytes can be fertilized at one time, and that all embryos obtained must be transferred to the maternal uterus simultaneously. The aim of the present study was to investigate the influence of the new law on spontaneous embryonic/fetal losses through comparison of data collected over an identical period of time: the first year of application of the new law compared with the same time period 1 year before (March 10, 2004 to March 9, 2005 versus March 10, 2003 to March 9, 2004). A total of 271 clinical pregnancies were analysed. In the post-law period, a significantly lower percentage of total spontaneous embryonic losses compared with the pre-law period, and a higher percentage of surviving embryos in singletons and twins was observed. In conclusion, the impact of the limitations imposed by the new legislation regulating assisted reproduction in Italy seems to exert positive effects on spontaneous embryonic loss both in singletons and multiple pregnancies. These findings are in contrast to international predictions on this issue and, in general, are counter-intuitive. This suggests that further investigations on a larger cohort of women are required to confirm these preliminary results.

Abortion, Spontaneous↗
PubMed2002

The science of ART.

The methods of gamete manipulation used in assisted reproductive technology (ART) are rapidly proliferating and in some instances outpacing the underlying science. In this review, we discuss two major advances in the ART laboratory-intracytoplasmic sperm injection and extended embryo culture before embryo transfer. We outline the rationale for these approaches, discuss results of experiments obtained from animal model systems and human preimplantation embryos that provide the scientific basis for these procedures, and point out potential concerns that have arisen from these studies.

Animals↗
PubMed1992

The recognition of proprietary rights in human tissue in common law jurisdictions.

Human tissue is used in an increasing number of medical and scientific contexts. Despite this, the law has traditionally regarded such tissue as having no status in law. This paper provides an overview of the issue of property rights in human corpses, cadaveric specimens, donated living tissue, and human tissue used in biotechnology and human reproductive technology. It discusses Australian common law and legislation, and reviews developments in England and the United States from an Australian perspective. The paper argues that limited proprietary rights, consistent with Australian legislation, ought to be recognized both in living and in dead human tissue, in order to achieve worthwhile objectives.

Australia↗
PubMed1994

Cloning: revisiting an old debate.

The debate about cloning that took place 25 years ago, although directed toward a different sort of cloning, elucidates fundamental issues currently at stake in reproductive technologies and research. Paul Ramsey and Joseph Fletcher were participants in this early debate. The differences between Ramsey and Fletcher about the meaning and sufficiency of freedom, the understanding and weighing of good and evil, the connection between embodiment and personhood, the relationship of humans with nature, and the meaning of parenthood suggest both a broader agenda for the debate about cloning and a cautious move forward in the development of embryo-splitting.

Christianity↗
PubMed2001

[GnRH antagonist (Orgalutran) for prevention of premature LH surges during controlled ovarian hyperstimulation].

The author present a different stimulation regiment in assisted reproductive technologies (ARTs). Gonadotropin-releasing hormone antagonist (GnRH-antagonist) introduces a new treatment option for patients undergoing ovarian stimulation for IVF or ICSI. This protocol is safe (with reduction of OHSS risk), short and simple. No significant differences in fertilization rates and embryo quality were found between agonist and antagonist treatment. The clinical outcome was good and the ongoing pregnancy rate was within the range of pregnancy rates of a long protocol GnRH-agonist.

Amino Acid Sequence↗
PubMed2004

Preimplantation genetic diagnosis and the welfare of the child.

Preimplantation genetic diagnosis is a form of very early prenatal diagnosis. The technique combines assisted reproductive technology with molecular genetics and cytogenetics to allow the identification of abnormalities in embryos prior to implantation. Since its introduction in 1990 this approach has been applied to an increasing number of single gene disorders, chromosomal rearrangements, and more recent indications such as aneuploidy screening and HLA matching. Since its inception the technology has attracted much attention: geneticists have expressed concerns about the robustness and validity of diagnosis based on single cell analysis, perinatologists were anxious about the effect of embryo biopsy on normal fetal development; and philosophers and ethicists have argued the cases for and against embryo selection. This article attempts to highlight the difficult choices and ethical challenges confronting patients and clinicians in an effort to balance the recognition of parental autonomy with the obligation of clinics to consider the welfare of any child born as a result of this treatment.

Child↗
PubMed1997

Management of involuntary childlessness.

Any definition of involuntary childlessness has to consider the difference between sterility and subfertility. As the latter affects about 20-30% of all couples at least once in their lives, general practitioners (GPs) may be the first to be confronted with this problem. This review presents the most relevant diagnostic and therapeutic options in cases of female or male infertility, and discusses the new assisted reproductive technologies (such as insemination, in vitro fertilization, gamete transfer and intracytoplasmatic sperm injection) so that GPs may adequately inform their patients about these procedures and their risks and outcomes. Although controversial, involuntary childlessness and its clinical treatment seem to have a strong psychological impact on a couple's social, emotional and sexual life. Being available for discussion with childless couples and offering ongoing support may be the most important role for the GP in this context.

Family Practice↗
PubMed2003

Sperm banking and rate of assisted reproduction treatment: insights from a 15-year cryopreservation program for male cancer patients.

BACKGROUND: Semen cryostorage remains the only proven method to preserve fertility in men with cancer. However, the necessity and the justification of banking spermatozoa have been questioned because it has been reported that only a small percentage of patients are referred for assisted reproductive technologies using frozen semen. METHODS: A 15-year cryopreservation program involving 776 men with malignant diseases who were referred to the study institution for semen cryopreservation before proceeding with chemotherapy and/or radiotherapy was reviewed. Data regarding cancer diagnosis, age, semen quality, and use of frozen semen were analyzed. RESULTS: Sperm banking was not performed for 90 of the 776 subjects (11.6%) because of azoospermia. Sperm quality was reduced in men with testicular carcinoma. To date, 36 of the 686 patients who had banked spermatozoa (5.2%) have attended the clinic for assisted conception treatments using frozen spermatozoa. Cumulative rates related to the use of frozen semen at 4, 8, and 12 years were 4.5%, 8.7%, and 11.8%, respectively. Relevant factors demonstrated to be significantly associated with a lower probability of using frozen material were a younger age at the time of cryostorage and a diagnosis of testicular carcinoma. CONCLUSIONS: The rate of referral for assisted reproductive techniques in patients who have banked their semen is low but tends to rapidly increase extending the length of follow-up. The cumulative percentage of use is at least above 10% but a longer follow-up is required to draw definitive conclusions. A diagnosis of testicular carcinoma is associated with a lower rate of use when compared with other cancers. Cancer 2003;97:1624-9.

Adult↗
PubMed1999

Survey of genetic screening for oocyte donors.

OBJECTIVE: To describe current screening practices of oocyte donation programs in the Society for Assisted Reproductive Technologies (SART). DESIGN: Descriptive data from a mailed questionnaire. SETTING: Academic medical center. PARTICIPANT(S): In vitro fertilization programs in SART. INTERVENTION(S): Survey mailed to IVF programs in the SART registry. MAIN OUTCOME MEASURE(S): Current practices, opinions, and genetic criteria for oocyte donor selection. RESULT(S): Results from 159 of 229 (69%) eligible oocyte donation programs are described. Most centers (70%) completed fewer than 25 cycles and used both anonymous and directed donors. There was considerable variability in limits on numbers of cycles or births allowed per donor, with many centers having no limits. As well, the use of well-established screening tests for genetic disorders, such as sickle cell anemia and cystic fibrosis, varied considerably. Consultation with a geneticist was possible at most (89%) centers and specifically mentioned by some centers as a means to help make decisions. CONCLUSION(S): Most programs follow recommendations made by the American Society of Reproductive Medicine (ASRM) for screening of gamete donors, but a significant percentage does not use well-established testing. The widespread availability of genetic consultation should promote responsible screening practices.

Female↗
PubMed2004

Use of sugars in cryopreserving human oocytes.

In the last 20 years, a worldwide effort to cryopreserve oocytes has resulted in 40 infants and approximately 50 ongoing pregnancies being reported. While the ability to freeze human embryos has become a standard of practice in assisted reproductive technologies, obtaining reliable techniques for oocyte cryopreservation has been more difficult. The unique properties of the mature oocyte, such as the meiotic stage with sensitive spindle structure as well as the large cell volume, are responsible for the limited success obtained to date. There have been two approaches to cryopreserving the oocyte: (i) slow freeze-rapid thaw, and (ii) vitrification protocols with rapid cooling-rapid warming. Both methods have incorporated sugars (sucrose) as a beneficial non-permeating extracellular cryoprotectant. Studies of organisms that survive extreme conditions of freezing/dehydration have demonstrated the ability to accumulate intracellular sugars to afford protection and survival. A novel technique using microinjection of sugars into the oocyte for cryopreservation has been developed as an alternative approach to external addition of sugars. Freezing the human oocyte has been a challenging goal; however, developing research and efforts will, in the near future, provide women with an important option for their reproductive health.

Cell Survival↗
PubMed2003

Educating for social responsibility: changing the syllabus of developmental biology.

Developmental biology is deeply embedded in the social issues of our times. Such topics as cloning, stems cells, reproductive technologies, sex selection, environmental hormone mimics and gene therapy all converge on developmental biology. It is therefore critical that developmental biologists learn about the possible social consequences of their work and of the possible molding of their discipline by social forces. We present two models for integrating social issues into the developmental biology curriculum. One model seeks to place discussions of social issues into the laboratory portion of the curriculum; the other model seeks to restructure the course, such that developmental biology and its social contexts are synthesized directly.

Curriculum↗
PubMed2005

Expectation of pregnancy outcome among mature women.

OBJECTIVE: Increasing numbers of mature women are achieving pregnancy largely through assisted reproductive technology (ART). Our objective was to investigate women over 45 years of age to determine the impact of pregnancy complications on newborn outcome. STUDY DESIGN: A study of women older than 45 years at their estimated date of confinement (EDC) was compared with a control group under 36 years at their EDC, matched by parity and plurality. All study patients and controls received uniform obstetric management through a single maternal fetal practice. The primary outcome was gestational age at birth stratified by plurality; secondary outcomes included birth weight, NICU days, composite neonatal morbidity, and a variety of obstetric complications. Wilcoxon signed rank and McNemar's tests were used as appropriate; logistic regression was used to calculate odds ratios (ORs) and CIs. Statistical significance was assumed for P < .05. RESULTS: Fifty study and control patients were identified over a 5-year period. Study patients were older than controls, but the difference in "gamete" age was not significant. There was significantly more assisted reproduction (donor egg) and preeclampsia among study patients. Importantly, gestational age at birth and birth weights stratified by plurality were not different (86% power to detect 2-week gestational age difference, alpha 0.05). Hospital days, NICU days, and composite neonatal morbidity were not different between study patients and controls. CONCLUSION: When controlled for parity and plurality, mature women over 45 years conceiving largely through ART with donor eggs can expect newborn outcomes similar to younger women cared for in the same setting of a high-risk maternal-fetal practice.

Adult↗
PubMed2005

Obesity does not impact implantation rates or pregnancy outcome in women attempting conception through oocyte donation.

OBJECTIVE: To independently evaluate the effect of body mass index (BMI) on implantation, pregnancy, and incidence of spontaneous miscarriage using the donor oocyte recipient model. DESIGN: Institutional Review Board-approved retrospective data analyses of donor oocyte cycles from 1999 to 2004. SETTING: Private assisted reproductive technology (ART) center. PATIENT(S): Five hundred thirty-six first cycle recipients of donor oocytes. INTERVENTION(S): Data were collected from the first cycle of each donor oocyte recipient included in the study. The body mass index (BMI) of each recipient was calculated using the formula weight (in kilograms)/height (in meters squared). Patients were divided into four groups based on BMI: underweight, normal, overweight, and obese. Pregnancy outcomes in each group were compared. MAIN OUTCOME MEASURE(S): Body mass index, implantation rate, pregnancy rate (PR), miscarriage rate. RESULT(S): There were no statistically significant differences in the implantation rates, ongoing PRs, or spontaneous abortion rates among patients in the four BMI groups. When further divided into those patients receiving blastocyst vs. day 3 transfers, there was still no effect of BMI on implantation rate, PR, or loss rate among the blastocyst or day 3 donor oocyte recipients. CONCLUSION(S): Body mass index has no adverse impact on implantation or reproductive outcome in donor oocyte recipients. Therefore, obesity does not appear to exert a negative effect on endometrial receptivity.

Adult↗
PubMed2005

A pen injection device for self-administration of recombinant follicle-stimulating hormone for fertility treatments.

A pen injection device modeled on the insulin pen used by diabetic patients has been introduced to deliver recombinant follicle-stimulating hormone to women undergoing controlled ovarian stimulation for in vitro fertilization or other forms of assisted reproductive technology. The pen device makes it easier and less painful for women to self-administer daily injections. The high precision and accuracy of the device enables physicians to fine-tune dosage. The woman simply inserts the multidose cartridge into the Puregon (Follistim) Pen, attaches a BD Micro-Fine Pen Needle, selects the prescribed dose on the dial at the base of the pen, inserts the needle subcutaneously and pushes the injection button to administer the injection. A fresh needle is used for each injection.

Equipment Design↗