Correct coding for laboratory procedures during assisted reproductive technology cycles

While the currently approved codes have been in use for several years, many professionals in the field of ART are unfamiliar with them. The Society is now leading an effort to add additional codes for new procedures related to ART.     

Epigenetics in assisted reproductive technology

It has been reported that the rates of epigenetic disorders such as Angelman syndrome (AS) and Beckwith–Wiedemann syndrome (BWS) are high in offspring conceived by assisted reproductive technology (ART). Angelman Syndrome is characterized by intellectual disability and BWS is known as large offspring syndrome (LOS). Weight abnormalities have also been reported in cloned animals. Possible factors underlying these findings include inherent gamete characteristics, influence of in vitro culture and peculiarity of ART methods. It is important to conclusively determine whether such epigenetic abnormalities are present in children conceived by ART, so as to consider the health of next generations.     

Ultrasound in assisted reproductive technology

Transvaginal ultrasound-guided oocyte retrieval is the gold standard for in vitro fertilization (IVF) treatment. Despite its relative safety, oocyte retrieval is associated with risk to the adjacent pelvic organs, bleeding, and pelvic infection. The embryo transfer (ET) procedure is considered a crucial step in an IVF cycle. The success of the ET is dependent upon multiple factors including embryo quality, proper endometrial receptivity, and the technique by which the embryos are transferred. Optimizing the technique of ET would therefore provide the best chance for pregnancy. No standard evidence-based protocol exists, but ET with ultrasound guidance has been shown to significantly increase the chance of embryo implantation, an ongoing pregnancy, and a live birth and to improve the ease of transfer. Identifying appropriate ultrasound-guided simulation training techniques in ET would ensure adequate fellowship training without affecting the outcome of assisted reproductive technology cycles.     

抑制素与人类辅助生殖技术

关于抑制素的研究已经有70余年的历史,随着研究的进一步深入,抑制素在人类辅助生殖技术中的作用越来越受到重视了。然而要达到利用抑制素或基于其结构的复合物制备药物来调节生育力,仍然任重而道远。本文就抑制素的研究基础、生理作用及在人类辅助生殖技术中的应用作一综述。     

Obesity and assisted reproductive technology outcomes

Obesity is a rising health problem in Western societies. It has been related to increased morbidity and mortality rates due to several pathologies. In the field of gynaecology and reproduction, obesity is associated with menstrual disorders, hirsutism, infertility, miscarriage and obstetric complications. It is known to impair human reproduction through different mechanisms such as insulin resistance, hyperandrogenism and elevated leptin levels. Weight management and dietary intervention can reverse this situation and improve reproductive function. Obesity can also impair the outcome of assisted reproductive technologies. The lower probability of a healthy live birth described in obese women seems to be the result of a combination of lower implantation and pregnancy rates, higher preclinical and clinical miscarriage rates and increased complications during pregnancy for both mother and fetus. Studies performed in infertile women undergoing assisted reproduction technologies indicate that the ovary plays a leading, but not exclusive, role in the fertility prognosis of these patients. The endocrine and metabolic environment may affect oocyte quality and, therefore, embryo development, implantation and pregnancy outcome. The endometrium seems to play a subtle role in the more negative reproductive outcome of obese women, according to recent studies based on the ovum donation model.     

Outcomes from assisted reproductive technology

The use of assisted reproductive technology (ART) for treating the infertile couple is increasing in the United States. The purpose of this paper is to review the short-term outcomes after ART. Pregnancy rates after ART have shown nearly continuous improvement in the years since its inception. A number of factors affect the pregnancy rate, with the most important being a woman's age. Certain clinical diagnoses are associated with a poorer outcome from ART, including the presence of hydrosalpinges, uterine leiomyomata that distort the endometrial cavity, and decreased ovarian reserve. Multiple gestations are the major complication after ART. New laboratory techniques, including extended embryo culture, may allow the transfer of fewer embryos to maintain pregnancy rates while reducing the risk of multiple gestations. Although much of the morbidity in children born after ART is the result of multiples, recent analysis suggests that even singletons are at higher risk for perinatal morbidity, including preterm delivery and small for gestational age infants. In vitro fertilization may be associated with a slight increased risk for birth defects. The major short-term complication of ART in women is the development of ovarian hyperstimulation syndrome. This syndrome is difficult to predict, but new treatments are being developed that may limit its frequency. Because of its high pregnancy rate, couples are moving to ART more quickly in the management of their infertility. All outcomes of ART, including pregnancy rates and adverse complications, need to be compared with standard non-ART therapy when deciding the appropriate course of treatment for a given couple.     

Transparency of results in assisted reproductive technology

Clear results in ART need to take into account the technical performances of the centre but also patients selection, cycles cancelling and embryo transfer policies. The risk of a partial transparency is an inappropriate selection of patients. From classical criterias like pregnancies per oocytes retrievals or embryo transfers we are heading towards more global indicators like live births of singletons by initiated cycles rate.