Assisted reproduction and the male

Male reproductive problems are the commonest single cause of infertility and respond poorly to conventional treatment. Because of this, and because of the importance of co-existing female pathology, the techniques of assisted reproduction have acquired an important place in the management of male infertility. For many couples with a male factor, conventional in vitro fertilisation and embryo transfer will be appropriate. However, for those who fail with IVF, or whose semen is too poor (perhaps below 0.5 × 10⁶ progressive spermatozoa/ejaculate), the techniques of micro-assisted fertilisation show much promise. These include partial zona dissection (PZD), sub-zonal sperm insertion (SUZI) and intracytoplasmic sperm injection (ICSI) the latter showing much promise, with pregnancy rates in excess of 30% per cycle being reported. However, the diagnosis of ‘male-factor’ infertility remains problematic, as does the intelligent selection of couples for treatment by these techniques.     

Assisted reproduction for postmenopausal women

Abstract

With increasing longevity, an ageing population and advances in assisted reproductive technologies (ART), a greater number of women are deciding to have a child and become a mother in their later years. With this social and demographic change, an important social and ethical debate has emerged over whether single and/or married postmenopausal women should have access to ARTs. The aim of this paper is to address this question and review critically the arguments that have been advanced to support or oppose the use of ART by older women.

The arguments presented consider the consequences for the individual, the family and wider society. They cover the potential physical and emotional harm to the older woman, the possible impact on the welfare and wellbeing of the future child, and the impact on the norms, values, customs and traditions of society. After reviewing the evidence, and weighing the opposing arguments, this paper concludes that there is no moral justification for a restriction on the use of ART by postmenopausal women. Allowing access to ART for postmenopausal women is an extension of reproductive autonomy and procreative rights in an age where the promotion of agency, autonomy, individual choice and human rights is paramount.     

Assisted reproduction may change birth intentions

OBJECTIVE: To determine whether the development and expansion of assisted reproductive technology (ART) between 1982 and 1995 raised the birth intentions of subfecund people relative to fecund people. DESIGN: Comparison of birth intention rates among fecund and subfecund women in the 1982, 1988, and 1995 rounds of the National Survey of Family Growth, standardized by age, parity, and education. SETTING: No clinical setting. PARTICIPANT(S): Nationally representative samples of married women who were 20 to 44 years old. INTERVENTION(S): None. RESULT(S): Between 1982 and 1995, birth intentions rose at least 2.5 times faster among subfecund women than among fecund women. This rise was not due to increasing average age at maternity over the period. CONCLUSION(S): The development of ART and expansion of services may well have increased birth intentions among subfecund women between 1982 and 1995.     

Assisted reproduction in hepatitis carrier couples

Chronic Hepatitis B virus (HBV) infection is endemic worldwide, and the prevalence is especially high in the Asia-Pacific regions. Despite its high prevalence, the literature regarding the impact of HBV infection on subfertility and fertility treatment remains limited and conflicting. Latest studies do not suggest any detrimental effect of HBV infection on the outcome of IVF/ICSI treatment in women having chronic HBV infection. There is evidence that HBV exists in ovarian tissue including oocyte and follicular fluid, and therefore has the potential risk of transmission to the embryo, which can explain the finding of vertical transmission despite immunoprophylaxis. Most recently, we have observed the evidence of HBV viral replication in female HBV carriers undergoing IVF/ICSI treatment. This raises the question of whether antiviral medication should be administered during ovarian stimulation in IVF/ICSI treatment cycles for women with chronic HBV infection to help reduce the chance of vertical transmission.     

Assisted reproduction technology and defects of genomic imprinting

It is estimated that approximately 1% of the newborn population of the British Isles are conceived following assisted reproduction technologies such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). While the long term outcome of IVF children is mostly reassuring, some concerns remain. Specifically, recent studies have suggested a possible association between assisted conception and clinical conditions of genetic origin known as genomic imprinting defects. This has arisen from several different studies observing an excess of assisted conceptions among the rare clinical disorders of Beckwith-Wiedemann syndrome (BWS) and Angelman syndrome (AS). The numbers of such patients described in the studies to date are small but indicate a clear need for large-scale investigations to clarify the link between genomic imprinting defects and assisted conception as well as to establish the exact biological basis of any such link. In view of the strong public interest in this area of medicine, it behoves all professionals working in reproductive medicine and associated areas to be aware of these emerging data and be in a position to discuss them in as informed and responsible a manner with patients, as current data limitations permit.     

Assisted reproduction in women with uterine anomalies

A retrospective analysis was performed to evaluate the reproductive performance of 17 women with uterine anomalies who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and embryo transfer (ET). Eight women had a unicornuate uterus, and two a didelphic uterus. Seven women with a subseptate uterus underwent metroplasty before assisted reproduction. Ten (58.8%) out of 17 women achieved 11 (18.0%) pregnancies out of 61 embryo transfers in 55 stimulated cycles. The implantation rate per embryo was 8/83 (9.6%) for women with a unicornuate uterus, one of 17 (5. 9%) for those with didelphic uterus and four of 48 (8.3%) for those with subseptate uterus. Pregnancy rates per embryo transfer were 19. 4, 11.1 and 19.0%, respectively. Three out of 11 pregnancies were ectopic, three were miscarriages and five were full-term deliveries, two sets of twins. Delivery rate per embryo transfer was 5.0% in patients with unicornuate or didephic uterus and 14.3% in women who had a subseptate uterus operated prior to assisted reproduction. Women with uterine anomalies treated by IVF or ICSI had low implantation rates. Pregnancy in a subseptate uterus which has been previously operated had a trend to end more frequently in delivery than that in a unicornuate uterus or in a didelphic uterus.     

多囊卵巢综合征的助孕策略

传统的多囊卵巢综合征 (polycysticovariansympton ,PCOS)的临床表现为闭经、多毛、肥胖、游离睾酮及黄体生成素 (LH) /卵泡刺激素 (FSH)增高 ,且常因排卵障碍而导致不孕 ,影响PCOS患者的生活质量。一、PCOS的发病机理目前 ,PCOS的发病机理尚不清楚 ,有关研究资料多来源于动物实验。多数研究认为 ,PCOS是代谢与内分泌紊乱的疾病 ,涉及内分泌、代谢、遗传、免疫等诸多因素。目前 ,关注的焦点是胰岛素抵抗和高胰岛素血症与发病有密切关系 ,其中高胰岛素血症与高雄激素存在微妙的关系 ,高雄激素是PCOS最具有特征的表现[1,2 ] 。从…     

Assisted reproduction in patients with early-stage ovarian malignancies

OBJECTIVE: To determine the outcome of women with early-stage ovarian malignancies who subsequently underwent assisted reproductive technologies (ART). DESIGN: Retrospective study. SETTING: Academic assisted reproductive technology program. PATIENT(S): Four infertile women who were previously diagnosed with early-stage ovarian malignancies. INTERVENTION(S): Controlled ovulation hyperstimulation, IVF, and/or gamete intrafallopian transfer treatments using clomiphene citrate and/or gonadotropins. MAIN OUTCOME MEASURE(S): Development of tumor recurrence and disease-free interval. RESULT(S): All four women remain free of disease for up to 15 years after treatment. Three of the four women achieved pregnancy. CONCLUSION(S): In patients with early-stage ovarian malignancies, conservative therapy followed by ovarian stimulation for assisted reproduction is an acceptable strategy.     

Assisted reproduction developments in the Islamic world.

A November 2000 workshop organized by the International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo, considered use of assisted reproduction technologies (ART) in the Islamic world. The workshop reinforced a 1997 recommendation that a Standing Committee for Shari'a Medical Ethics be constituted to monitor and assess developments in ART practice. Among issues the workshop addressed were equitable access to services for infertile couples of modest means, and regulation of standards of equipment and personnel that ART centers should satisfy to gain approval to offer services. Acceptable uses of preimplantation genetic diagnosis were proposed, and follicular maturation research in animals, including in vitro maturation and in vitro growth of oocytes, was encouraged, leading to human applications. Embryo implantation following a husband's death, induced postmenopausal pregnancy, uterine transplantation and gene therapy were addressed and human reproductive cloning condemned, but cloning human embryos for stem cell research was considered acceptable.