Religion, infertility and assisted reproductive technology

This chapter describes religion in general before discussing the centrality of its concern for family formation. In light of this, the impact of infertility on religious people is considered. Recognizing religion's cautiously positive attitude towards assisted reproductive technology (ART) as a potential ally in the project of family formation and the relief of infertility, two areas that have caused concern for the religions are discussed: perceived threats to marriage and the sanctity of the human embryo. Throughout the chapter, illustrations are drawn from particular religions, including Christianity, Judaism, Islam, Hinduism and Buddhism. There are striking similarities in their concerns and in the range of their responses to ART. Ways in which medical personnel should take into account the religious dimensions of the experience of infertility in their care for patients are suggested.     

Right to assisted reproductive technology: Overcoming infertility in low-resource countries

This article examines the high prevalence of primary and secondary infertility in low-resource countries. Provision of assisted reproductive technology (ART) to overcome both female and male infertility is in line with the reproductive rights agenda developed at the International Conference on Population and Development (ICPD) in Cairo 15 years ago. In addition to the right to control fertility, reproductive rights must encompass the right to facilitate fertility when fertility is threatened. Facilitation of fertility may require resort to ART, among both men and women. Egypt is highlighted as a positive example of progress in this regard.     

Second-look operative laparoscopy 1 year following reproductive surgery

To evaluate the efficacy of a second-look operative laparoscopy following a reproductive surgery, a randomized study was conducted on women who failed to conceive 1 year following terminal salpingostomy or following salpingo-ovariolysis by laparotomy. There is no significant difference in the cumulative probability of pregnancy at 12, 24, and 36 months follow-up between women who underwent second-look operative laparoscopy 1 year after salpingo-ovariolysis (27%, 67%, and 67%) and women who were continued to be observed expectantly (27%, 45%, and 52%, respectively). The cumulative probability of conception at 12, 24, and 36 months follow-up in women who underwent second-look laparoscopy 1 year after salpingostomy was 6%, 18%, and 18% and in women who were observed expectantly was 5%, 21%, and 27%, respectively (P = no significant). The incidence of ectopic pregnancy which was high (about one-half of patients who conceived) was also not affected by this procedure. This study suggests that second-look operative laparoscopy 1 year after terminal salpingostomy or salpingo-ovariolysis does not increase the pregnancy rate or decrease the incidence of ectopic pregnancy. Women who fail to conceive 1 year after a reproductive surgery still maintain some of their reproductive potential, but the risk of having an ectopic pregnancy is high.     

159对接受助孕治疗不孕症夫妇支原体和衣原体感染情况分析

目的探讨接受助孕治疗的不孕症夫妇支原体和衣原体携带情况及其与体外受精／卵细胞质内单精子注射结局的关系。方法选择2009年3月至2011年9月北京大学第一医院生殖与遗传医疗中心无下生殖道感染症状且接受助孕治疗的159对不孕症夫妇,在取卵日或人工授精日分别取宫颈分泌物和精液,采用聚合酶链反应（PCR）法进行支原体和衣原体的检测。结果女性患者支原体阳性29例（18．200,29／159）,其中解脲支原体（ureaplasma urealyticum,UU）和人型支原体（mycoplasma hominis,Mh）分别为26例（16．4％,26／159）和3例（1．9％,3／159）,未检出衣原体。男性患者支原体阳性4例（2．5％,4／159）,均为UU;衣原体阳性3例（1．9％,3／159）。输卵管性不孕症患者支原体阳性10例（16．9％,10／59）,非输卵管性不孕症患者支原体阳性19例（19．0％,19／100）,两者比较,差异无统计学意义（P〉0．05）。女性支原体阴性组和阳性组的获卵数[（11．8±6．0）个,（14．6±6．2）个]、优质胚胎率（37．6％,43．2％）和临床妊娠率（48．2％,30．0％）比较,差异无统计学意义（P〉0．05）。结论进入助孕治疗周期的不孕症夫妇仍有一定的生殖道支原体和衣原体携带率,支原体携带与临床妊娠结局无明显关系。     

Results of treating endometriosis with infertility using operative laparoscopy]

In the work, the efficiency of treating endometriosis by hormonal as well as combined methods, and employing the operative laparoscopy was evaluated. The study involved 89 infertile women with endometriosis being of various grade of advancement. Sixty women underwent combined treatment according to Samm, the remaining 29 were given hormonal therapy with Danazol and Orgametril preparations. After combined treatment full recovery was obtained in 26.7% of cases, improvement in 40%, but after the use of preparations Orgametril, Organon or Danazol, Winthrop, complete cure was reached in 12.8% of cases, improvement in 31%. Only 8 women became pregnant after combined therapy. Complete recovery concerned mainly less advanced endometriosis, particularly following the combined treatment according to Semm. Early laparoscopic diagnosis increases the chance of curing endometriosis and fertility associated with it.     

Hysterosalpingography, pre- and postoperative laparoscopy in operative treatment of infertility

The benefit of routine hysterosalpingography (HSG) and pre- and postoperative laparoscopy in diagnosing and treating anatomical infertility was investigated in 115 women. The findings at HSG and laparoscopy were compared with the diagnoses obtained by laparotomy. Laparoscopy was significantly better than HSG in detecting adhesions. Both procedures were of equal value in assessing tubal pathology. Although HSG revealed additional findings in 5 per cent of cases, none of these needed operative correction. Postoperative laparoscopy, which was performed in 70 patients, did not affect the incidence of either intra- or extra-uterine pregnancy. It is concluded that all patients should be offered diagnostic laparoscopy. HSG and second-look laparoscopy should not be used routinely.     

Male factor infertility and assisted reproductive technologies.

Male infertility has many facets that need to be evaluated in an initial screening. Once these are known, recommendations become clearer for aggressively pursuing assisted reproductive techniques. Progress has been made in defining more clearly the severe male factor: concentration less than 5 x 10(6) sperm/mL, motility less than 10%, morphology less than 4% normal forms (by strict criteria), and recovered swim-up sperm less than 1.5 x 10(6). Sperm preparation techniques may be improved by use of Percoll separation medium, and morphology may be used in prediction of cleavage rate in in vitro fertilization. Hopefully, these techniques will lead to more specific guidelines for successful use of assisted reproductive technology in male factor patients.     

Efficacy of assisted reproductive technology after ovarian tissue transplantation in a cohort of 11 patients with or without associated infertility factors

PurposeIVF treatment in women with grafted frozen-thawed ovarian tissue is associated with poor reproductive outcomes. The aim of this study was to evaluate the efficacy of ovarian tissue transplantation (OTT) followed by assisted reproductive technology (ART) in women with or without associated infertility factors.MethodsThis is a prospective cohort study with retrospective data collection including eleven women, four of whom having an infertility factor (IF), who had undergone OTT in one university center between 2005 and 2017, followed by ART in six in vitro fertilization (IVF) centers.ResultsIn total, 25 of the 85 cycles initiated (29%) were canceled, resulting in 60 oocyte retrievals. Ninety-five oocytes were retrieved: 36 were abnormal or immature, 29/39 fertilized (74%) after ICSI and 13/20 (65%) after IVF. Thirty-five embryos were transferred in seven patients (5/7 patients without IF and 2/4 patients with IF). After ART, one patient with IF experienced two pregnancies, one resulting in a live birth. For all patients, pregnancy rates and live birth rates were 7.4% and 3.7% per embryo transfer, respectively. Nine pregnancies and four live births occurred after spontaneous conception in five patients without IF, none in the infertility group.ConclusionThis study confirms that IVF treatment in women with grafted frozen-thawed ovarian tissue is associated with poor outcomes. However, the chances of natural conception are high in women without IF. Patients with IF, without the possibility of spontaneous pregnancy, should be informed of poor reproductive outcomes after OTT followed by ART.Trial registration number{"type":"clinical-trial","attrs":{"text":"NCT02184806","term_id":"NCT02184806"}}NCT02184806Supplementary InformationThe online version contains supplementary material available at 10.1007/s10815-020-02033-9.     

The diagnostic value of hysterosalpingography and laparoscopy in infertility investigation

Four hundred and twenty infertile patients had hysterosalpingography (HSG) and laparoscopy as a part of their infertility workup. A comparison of HSG and laparoscopy findings was carried out to study the diagnostic value of each of these two procedures. It was found that the accuracy in the diagnosis of tubal patency or tubal blockage was quite similar for both procedures. However, laparoscopy revealed peritubal adhesions in 29.8% of patients, whereas HSG made an accurate diagnosis in only 8.8%. It is concluded that HSG is as accurate as laparoscopy in the diagnosis of tubal patency or blockage, and should remain an integral part of female infertility investigation. Laparoscopy excels HSG in the diagnosis of pelvic pathology and thus should always be performed whenever a pelvic factor is suspected in female infertility.     

Impact of thyroid cancer treatment on assisted reproductive technology outcomes in women with infertility

Journal of Assisted Reproduction and Genetics - We investigated the effect of different surgical procedures and radioactive iodine treatment (RAIT) on in vitro fertilization/intracytoplasmic sperm...     

Major complications of operative and diagnostic laparoscopy for gynecologic disease

STUDY OBJECTIVE: To compare complication rates of diagnostic and operative laparoscopy. Design. Retrospective study (Canadian Task Force classification II-2). SETTING: One medical center and three teaching hospitals. PATIENTS: Six thousand four hundred fifty-one women with various indications for laparoscopic diagnosis and/or laparoscopic surgery from January 1994 through June 1999. INTERVENTION: Diagnostic and operative laparoscopies. MEASUREMENTS AND MAIN RESULTS: Forty-two major complications occurred that directly resulted in one death. One patient had stomach injury, 3 had major vessel injuries, 5 had ureter injuries, 10 had intestinal injuries, and 23 had bladder injuries. The overall complication rate for all laparoscopies was 0.65% (42/6451); however, it rose to 0.80% (39/4865) for operative laparoscopy compared with 0.19% for diagnostic laparoscopy (3/1586; p <0.001, Fisher's exact test). CONCLUSION: Laparoscopic surgery is appropriate for managing various gynecologic diseases and has an acceptable complication rate. However, operative laparoscopy should be performed carefully because its rate of complications is significantly higher than that of diagnostic laparoscopy, especially for laparoscopic-assisted vaginal hysterectomy. (J Am Assoc Gynecol Laparosc 8(1):68-73, 2001)     

Unrecognized bladder perforation during operative laparoscopy

During operative laparoscopy in a 42-year-old woman, 12-mm trocar lacerations occurred through anterior and posterior walls of the bladder but were not recognized. This case demonstrates important issues related to predicting, avoiding, detecting, and treating bladder trauma associated with laparoscopic surgery. It also indicates that some classic warning signs of accidental cystotomy may be absent or delayed in appearance.     

Gender, infertility, motherhood, and assisted reproductive technology (ART) in Turkey

In Turkey, as in many other countries, infertility is generally regarded as a negative phenomenon in a woman's life and is associated with a lot of stigma by society. In other words, female infertility and having a baby using Assisted Reproductive Technologies (ART) have to be taken into consideration with respect to gender motherhood, social factors, religion and law. Yet if a woman chooses to use ART she has to deal with the consequences of her decision, such as being ostracized by society. Other types of procedures in this area, such as sperm and ova donation or surrogate motherhood, are not permitted in law. However; both before and after the development of this techonology, society has been finding its own solutions which are rarely questioned and are still performed This article will discuss what these practices are and try to reach some pragmatic conclusions concerning female infertility, the concept of motherhood and some traditional practices in Turkey.