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PubMed2004

[Transition to parenthood in twin gestations after assisted reproduction].

We reviewed the literature regarding twin parenthood after the use of assisted reproductive technologies. The transition to parenthood is followed by changes in personal, marital, familial, social, and professional lifestyle. Couples may experience acute stress, which may lead to temporary or chronic psychological distress. Twin pregnancies may be considered "premium pregnancies" and as such, may add to the sense of stress in parenthood since parenting twins is both a demanding and challenging task. In particular, couples that endured treatments for long-standing infertility may face difficulties in the first months of parenthood. In light of the findings, these parents should be considered at risk because they may have reduced parental competence, which in turn may impede their children's psychological development and well-being. Psychological support for these couples should be offered during infertility treatment, pregnancy, and during the first months of infancy.

Female↗
PubMed2005

Genetics then and now: breeding the best and biotechnology.

In the past, domesticated animals were genetically improved by identifying meritorious individuals, mating animals displaying desired traits, continued breeding of related animals to perpetuate their superior traits and crossbreeding when inbreeding depression became evident. Today, assisted reproduction and biotechnology allow breeders to design and direct the reproductive course, disseminate desired traits and hasten genetic improvement. Generation interval can be greatly reduced by combining artificial insemination, which is the oldest and most widely used assisted reproductive technology, with the more recent techniques, such as oestrus synchronization, superovulation, ovum pick up from immature females even out of breeding season, and in vitro embryo production and transfer. Furthermore, the sex and genetic make-up of the offspring can be selected by using sex-sorted sperm for insemination, marker-assisted selection, functional deletion or addition of specific genes to the offspring's genome, or somatic cell nuclear transfer for cloning. However, the poor success rates with some of these procedures have delayed their large-scale application which, in turn, has hindered the proper evaluation of their genetic impact. The potential genetic consequences of some of these approaches merit the same degree of diligent evaluation that is currently extended to the procedures used for overcoming their 'technical' inefficiencies.

Animals↗
PubMed1996

[Prognostic value of high FSH concentrations].

Ovarian age is a major determinant of success in assisted reproductive technologies. The number and quality of oocytes retrieved directly depend upon the ovarian reserve. The evaluation of FSH concentration during the first days of the menstrual cycle provides a simple and accurate means of assessing ovarian reserve. Plasma FSH value is correlated with cancellation rate, peak estradiol, number of oocytes retrieved and of the resulting embryos, pregnancy rate, outcome of cryopreservation. However, a poor response to the stimulation treatment is unpredictable in a subgroup of women whose FSH concentration remain within the normal range. Ovarian aging begins several years before any clinical or endocrinological modification. Recurrent FSH determinations may help in predicting a poor response, as a large intercycle FSH variability is correlated with ovarian failure. The value of ovarian reserve tests is presently not fully established.

Age Factors↗
PubMed2006

ART: iatrogenic multiple pregnancy?

Assisted reproductive technologies (ART) are now widely accepted as effective treatment for most causes of infertility. With improving success rates, attention has turned to the problem of multiple pregnancies, which are associated with a poor perinatal outcome, maternal complications and significant financial consequences. The challenge is to reduce multigestational pregnancies while maintaining good treatment outcomes. Methods to prevent multiple pregnancy include restrictive use of ART in couples with a good chance of spontaneous pregnancy, cautious use of gonadotrophins, and increased use of natural-cycle intra-uterine insemination and elective single embryo transfer in in-vitro fertilization and intracytoplasmic sperm injection. The aim of this article is to review the contribution of fertility treatment to multiple pregnancies and strategies for reducing multiples in ART.

Embryo Transfer↗
PubMed2004

Ovarian aging and infertility.

Ovarian aging is expressed with altered menstrual cyclicity, endocrine and biochemical profiles and impaired fertility. Shortening of the menstrual cycle may be the first signal of diminished ovarian reserve. Hormonal interplay in the aging ovary is manifested as a monotropic FSH rise, decreased inhibin B concentrations and fluctuating estradiol concentrations. Due to social changes, childbearing has been delayed, thus the group of women in their late thirties seeking infertility treatment has been increasing. Intrauterine insemination (IUI) usually precedes more sophisticated assisted reproductive technology (ART) treatments such as in vitro fertilization-embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI). We present the outcomes of ART treatments achieved in our institution in women over 38 compared to younger women. The pregnancy rate after IUI was 3.7% in women over 38 years, and 28.6% in women less than 38 years; after IVF-ET the cumulative pregnancy rate was 16% (the miscarriage rate 21%) in women over 38, and 28% (13%) in women less than 38 years; the cumulative pregnancy rate after ICSI was 9% (the miscarriage rate 26%) in women over 38, and 27% (the miscarriage rate 14%) in women younger than 38 years. Women in advanced age should therefore be properly counselled and informed about poor success rates, and about the high cost of infertility treatment.

Adult↗
PubMed1999

Fibrin glue improves pregnancy rates in women of advanced reproductive age and in patients in whom in vitro fertilization attempts repeatedly fail.

OBJECTIVE: To evaluate the possible contribution of fibrin sealant to the ET stage of IVF. DESIGN: Case-control study. SETTING: An assisted reproductive technology unit that performed 2,535 treatment cycles from 1996-1997. PATIENT(S): All consecutively seen patients who underwent ET from January 1996 to September 1997. INTERVENTION(S): All women who underwent ET with the aid of fibrin sealant during the study period were compared with those who underwent standard ET (controls). Thereafter, a case-control study was conducted on the first consecutively seen 174 women who underwent ET with fibrin sealant and a control group that was matched for age and number of previous unsuccessful cycles. MAIN OUTCOME MEASURE(S): Patient age, number of previous unsuccessful IVF attempts, number of embryos transferred, and pregnancy rates. RESULT(S): During the study period, ET was performed with fibrin sealant in 265 women and by the standard procedure in 1,402 women. Women in the fibrin sealant group were significantly older. The pregnancy rate was not significantly different between the groups in the whole-cohort study (20.4% versus 23.1%), but it was significantly higher in the fibrin sealant group in the case-control study (25.3% versus 14.9%). This also was true when the older women (>35 years) and the women with > or =4 previous failed IVF attempts were analyzed separately (23.2% versus 9.8% and 26.1% versus 13.4%, respectively). CONCLUSION(S): The use of fibrin sealant in ET appears to be beneficial in women of advanced reproductive age and in patients in whom IVF attempts repeatedly fail.

Adult↗
PubMed2005

Assisted reproduction: the epigenetic perspective.

Developmental pathways in humans and other organisms are buffered against changes in genotype and environment. Therefore, it should not come as a surprise that most of the children conceived by assisted reproduction technology (ART) are healthy, although ART bypasses a lot of biological filters and subjects the gametes and the early embryo to environmental stress. If, however, the buffer breaks down, the development of certain tissues or organs may follow abnormal trajectories. We argue that both normal and abnormal development in children conceived by ART can be explained by epigenetic mechanisms, which control the establishment and maintenance of gene expression patterns in the placenta and fetus. Imprinted genes are of special importance in this respect. There is increasing evidence that genetic factors in infertile couples as well as environmental factors (hormones and culture media) can have adverse effects on epigenetic processes controlling implantation, placentation, organ formation and fetal growth. In addition, loss of epigenetic control may expose hidden genetic variation.

Birth Weight↗
PubMed1993

IVF and related technology. The present and the future.

OBJECTIVE: To describe the current status of in-vitro fertilisation (IVF) and related technologies, including: the indications for the procedures and the problems associated with the use of stimulated cycles; the use of frozen embryos and donor eggs; and the newer procedures of gamete micromanipulation for male infertility, immature egg collection as a possible alternative to the stimulated cycle, and preimplantation genetic diagnosis. DATA SOURCES AND STUDY SELECTION: The clinical experience and research at Monash IVF and the Centre for Early Human Development, Monash University, were reviewed in association with key original or review articles in the world literature. DATA SYNTHESIS: Cumulative pregnancy rates for IVF and the gamete intrafallopian transfer (GIFT) procedure at Monash IVF demonstrate that 29% of IVF patients and 55% of GIFT patients will have a live baby, the average number of treatments pursued being 3.4. Analogues of gonadotrophin releasing hormone (GnRH) have improved pregnancy rates, reduced blood sampling, and prevented natural ovulation. Disadvantages of stimulated cycles include a higher risk of multiple pregnancy, a higher risk of hyperstimulation, and behavioural changes due to the effects of drugs. Natural cycles or immature egg collection at incidental laparoscopy may become alternatives to the use of the stimulated cycle. In Australia the GIFT procedure is more successful than IVF and is nearly always used if the fallopian tubes are normal. Multiple pregnancies may be reduced, particularly triplets, by reducing the number of eggs or embryos transferred to two when egg or embryo quality is high. Embryo freezing has made a small but important contribution to overall pregnancy rates by enabling patients to use excess eggs and embryos. The social and legal concerns resulting from the use of frozen embryos have required new ethical and legal considerations. Donor eggs have made a small contribution to achieving pregnancy in women with absent or inappropriate eggs and increased the chance of conception in women over the age of 40. Micromanipulation of sperm and eggs has enabled fertilisation and conception when sperm are defective in quantity or quality. Sampling of cells in early embryos enables genetic diagnosis and may be used in selecting chromosomally normal embryos in IVF procedures or in couples at risk of recessive genetic disease. CONCLUSION: Assisted reproductive technology has developed over a decade to become useful for couples with infertility which cannot be cured by simpler treatments. The birth rates are comparable to natural conception and the incidence of congenital malformation is not increased. The costs and complexity of treatment have been reduced to in turn reduce the stress and social inconvenience of therapy. Problems related to the high risk of multiple pregnancy and the use of the stimulated cycle are being reduced and new techniques for severe male infertility and the detection of genetic abnormalities in the embryo are being introduced.

Female↗
PubMed2002

Fatherless families: how important is genetic relatedness?

How should families be constructed? Does it matter if we choose to ignore 'blood ties' and raise children without their genetic parents? The debate over a recent court ruling allowing single and lesbian women access to assisted reproductive technologies (ART's) illustrates two possible answers to this question. Many of those opposed to the ruling argue that the traditional biological family is the natural family unit and the ideal family form, which should be preserved. Amongst those in favour it is argued that families are not defined by nature but culturally constructed, that the traditional biological family is just one possible family form and that the way families are arranged is a matter of personal preference. This paper argues that questions about the importance of preserving the biological family rest largely on the value we attribute to genetic relatedness and not on whether the family is a natural or cultural construct. I argue against the claim that genetic relatedness and biological families are so important to children's welfare that lesbian and single women should be denied access to ART's.

Australia↗
PubMed1991

Multifetal reduction of triplets and pregnancy outcome.

Multifetal pregnancy reduction has been suggested as a strategy to improve pregnancy outcome in grand multiple gestations of three or more fetuses. We prospectively investigated multifetal pregnancy reduction in 13 women with triplet pregnancies in the first trimester following ovulation induction, in vitro fertilization, or gamete intrafallopian transfer procedures. Eleven women whose triplet pregnancies followed similar reproductive technologies and who declined or were not offered the procedure were managed expectantly. Mean (+/- standard deviation) infant birth weight was 2227 +/- 478 g in the multifetal reduction group and 2239 +/- 399 g in the group managed expectantly. Gestational age was 35.5 +/- 2.3 weeks in the study group and 35.7 +/- 2.5 weeks in the triplets managed expectantly. Newborn hospital days as well as newborn and maternal complications were not statistically different between the management groups. Maternal interventions included tocolytic medication, home uterine activity monitoring, and extended hospitalization, and were more common in the triplets managed expectantly than in the study group of triplets reduced to twins. Multifetal pregnancy reduction for triplet pregnancies does not necessarily improve pregnancy outcome, though it may be offered on the basis of parental choice.

Abortion, Induced↗
PubMed1994

Minimally invasive surgery in assisted conception.

Minimally invasive surgery enables the avoidance of, preparation for, participation in, and treatment of complications following assisted reproductive technology (ART). The major recent changes are, the development of surgical techniques to diagnose and treat intrafallopian tubal abnormalities; the use of operative endoscopy to avoid radical surgery in the treatment of severe endometriosis and large myomas; the use of endoscopy in the selection of patients for ART; the extension of gamete intrafallopian transfer (GIFT) procedures to include operative laparoscopy for endometriosis and adhesions; the ability to collect unripe oocytes from small follicles, thereby reducing the need for stimulated ovarian cycles in patients with polycystic ovaries; the ability to produce normal pregnancies from the intra-oocyte injection of a single sperm, which facilitates the treatment of severe male infertility; and the development of a promising technique to transfer an embryo to the uterus through the myometrium, thereby avoiding the cervical canal.

Embryo Transfer↗
PubMed2004

The place of the crossover design in infertility trials: a maximum likelihood approach.

BACKGROUND: For some years, there has been a debate as to the place of the crossover trial in assisted reproduction technology (ART). We aimed to investigate whether crossover and parallel designs result in different estimates of treatment effects. METHODS: We carried out computer simulation of cohorts of patients undergoing either intra-uterine insemination (IUI) or IVF under both parallel and crossover designs, under scenarios involving censoring and carryover effects. Results of the simulation were analysed using a maximum likelihood approach. RESULTS: No relevant difference was found between the designs. The crossover design resulted in slightly more pregnancies than the parallel design. Carryover effects may slightly distort the estimates of treatment effects. Crossover and parallel designs will produce essentially the same statistical estimates of treatment effect and percentage of pregnancies. The crossover design is an acceptable design in infertility research provided the data are analysed correctly.

Clinical Trials as Topic↗
PubMed2000

[Present state and future in reproductive medicine].

It has been almost 21 years since the first birth of IVF baby and rapid advances in assisted reproductive technology (ART) have taken place. Today, several new technology have been developed such as microfertilization and cryopreservation of embryos and ART has become an important and popular tools for treatment of infertility patients with several causes. However, the take home baby rates have still been low around 15%. To improve the results in ART programs, the improvement of embryo viability and the solution of problems of implantation have been required. Recently, sequential culture media for production of high quality blastocysts have been developed and results have been as good as with co-culture. These culture media are now commercially available. Several authors reported that higher clinical pregnancy rate was achieved and high-order multiple pregnancy can be eliminated with blastocyst transfer. It has been expected that blastocyst transfer would become the means to solve the major problem that ART has faced such as the low take home baby rates and high-order multiple pregnancy.

Female↗
PubMed2002

Lack of standardization in performance of the semen analysis among laboratories in the United States.

OBJECTIVE: To determine the level of standardization in performance of the semen analysis among clinical laboratories in the United States. DESIGN: A survey was mailed to laboratories requesting information about the laboratory and performance of the semen analysis. Responses were received from 536 laboratories. SETTING: Clinical laboratories enrolled in the American Association of Bioanalysts Andrology Proficiency Testing Program. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Agreement among laboratories. RESULT(S): Sixty-one percent of respondent laboratories were part of an assisted reproductive technology program. The laboratories perform less than 50 (53%), less than 10 (25%), or less than 5 (16%) andrology laboratory procedures per month. The laboratories routinely report sperm count (94% of laboratories), motility (95%), morphology (85%) and forward progression (69%), and semen volume (96%) as part of the semen analysis. Only 64% of laboratories routinely report abstinence, and 60% of laboratories indicate the criteria used for sperm morphology on the report form. The most common lower limits of normality for sperm count and motility were >20 x 10(6)/mL (77% of laboratories) and >50% (59% of laboratories), respectively. Few laboratories performed quality control for sperm counts (29%), motility (41%), and morphology (41%). CONCLUSION(S): These data indicate a significant lack of standardization in the performance and reporting of semen analyses among laboratories in the United States.

Humans↗
PubMed2004

Female age in ART: when to stop?

With increasing age the probability of ongoing pregnancy established by the use of assisted reproduction technology (ART) decreases. As a result the question arises whether age limits for the application of ART should be established. From a literature review and ongoing research data it appears that the costs per child born greatly increase after the age of 40 for both intrauterine insemination with mild ovarian stimulation and in vitro fertilisation treatment, while in cases of 44 and over, prognosis is flat zero. The willingness to pay for extra costs will greatly determine whether and at what age strict limits should be applied. Fortunately, predictive factors for success, like the antral follicle count, may enable the identification of women over 40 and under 44 that still have favourable prospects, thereby decreasing the necessary costs per childbirth and allowing couples into ART programs that are often denied based solely on female age.

Adult↗
PubMedDate not supplied

Assisted reproduction practice in Europe: legal and ethical aspects.

This report describes the ethical and legal aspects of assisted reproductive technologies (ART) that have been instituted in European countries. The data were collected from questionnaires circulated to fertility centres in 39 countries in Europe. Ninety six ART centres were located in 30 of these countries. Nine countries do not offer ART services. According to the survey, there are approximately 516 centres in Europe, which represent approximately 60% of the world ART centres. The survey included information regarding regulation of ART services, access to these services, attitude toward genetic material donation, cryopreservation of pre-embryos, surrogacy, manipulation of gametes and pre-embryos, research on pre-embryos and multiple fetal pregnancy reduction. At present, the majority of countries in Europe do not have established legislation pertaining to the various aspects of ART practice. The study reviews the ethical and legal aspects of ART practice in Europe.

Cryopreservation↗
PubMed1996

Do young women in tropical regions constitute a recognized social category?

In most tropical regions there is little organized health care for young women, yet their household roles within contexts of worsening socio-economic situations create special health problems. In the area of sexual and reproductive health, the onset of reproductive roles does not entitle the young women to either maternal and child health services or family planning services unless they are married and have children under 5 years. Societal values and norms at macro and micro levels have prevented young women from benefiting from reproductive technology, although they are, at the same time, increasingly expected to spend a great deal of their youth in school and outside marriage. Young women thus live in paradoxical situations as indicated by the increasing levels of early teenage pregnancy, induced abortion and related complications, school drop-out and infection with sexually transmitted diseases including HIV/AIDS. Young women clearly constitute an unrecognized social category, and research focusing on them would be particularly rewarding because of the potential it offers for addressing the gender imbalances and their dynamics in health.

Adolescent↗
PubMed2005

Assisted reproductive therapies and imprinting disorders--a preliminary British survey.

BACKGROUND: Recent reports have suggested a higher risk of Beckwith-Wiedemann syndrome (BWS) and Angelman syndrome (AS) after assisted reproductive technologies (ARTs), but it is unclear whether this might also apply to other disorders of genomic imprinting. METHODS: We contacted families of children with BWS, AS, Prader-Willi syndrome (PWS) and transient neonatal diabetes mellitus (TNDM) to determine use of ART. RESULTS: A statistically significant increased frequency of ART in children with BWS was confirmed [2.9%, 95% confidence interval (CI) 1.4-6.3% vs 0.8% expected] but there was no significant association with PWS or TNDM. Consideration of the molecular subgroup of BWS and AS suggested the feasibility of association with ART. CONCLUSIONS: These differences may relate to variations in (i) the molecular mechanisms for disordered imprinting in the different disorders and (ii) the susceptibility of specific imprinting control regions to ART-associated methylation alterations (epimutations).

Angelman Syndrome↗