Infertility treatment in Klinefelter syndrome

Until few years ago, Klinefelter syndrome with a homogenous 47.XXY caryotype was considered a model of absolute male sterility. In this review, we will discuss the fertility issue following TEsticular Sperm Extraction-IntraCytoplasmic Sperm Injection (TESE-ICSI) and the potential advantage of searching for and cryopreserving spermatozoa in adolescent instead of adult patients.     

Infertility. Contemporary office-based evaluation and treatment

Infertility is a common condition that is highly treatable. Couples can help themselves by recognizing that they have a problem, and practitioners can help patients by recognizing who requires an infertility investigation and when they need it. Instituting a clear and comprehensive evaluation will enable patients who need treatment to achieve their goals.     

Infertility treatment: implications for perinatology.

From 1975 to 1989 multiple birth rate in The Netherlands increased with almost 40%. Only a quarter of the increase can be related to births after in vitro fertilization. Evidence is presented that ovulation induction as an independent therapy or in combination with other forms of assisted reproduction is highly responsible for the rising number of multiplets. As a consequence, a heavy burden is placed on the units for specialized neonatological care as well as on the obstetrical wards in the tertiary centres for neonatology. Doctors should become aware of the facts and should inform the public properly about the risks of multiple pregnancy. An international approach is needed to get insight in the problems and to develop effective policies for the future.     

Infertility treatment: the viability of the laparoscopic view

Assisted reproductive technology (ART) and laparoscopy are not mutually exclusive, but coexisting and potentially complimentary treatments. For disease conditions contributing to infertility in addition to other concomitant or potential morbidity, laparoscopy represents a more comprehensive approach.     

Infertility, infertility treatment, and fetal growth restriction

OBJECTIVE: To examine the association between infertility, with or without treatment, and fetal growth, as well as perinatal and infant mortality. METHODS: From the Danish National Birth Cohort (1997-2003), we identified 51,041 singletons born of fertile couples (time to pregnancy 12 months or less), 5,787 born of infertile couples conceiving naturally (time to pregnancy more than 12 months), and 4,317 born after treatment. We defined small for gestational age (SGA) as the lowest 5% of birth weight by sex and gestational age. RESULTS: Crude estimates suggested an increased risk of perinatal mortality and SGA among infertile couples (treated and untreated), but the odds ratios (ORs) of perinatal mortality among infertile couples were attenuated after adjustment for maternal age and body mass index (1.32, 95% confidence interval [CI] 0.95-1.84 among untreated and 1.26, 95% CI 0.86-1.85 among treated couples). The elevated risk of SGA among infertile couples persisted after adjustment for maternal age, parity, and smoking (OR 1.24, 95% CI 1.10-1.40 among untreated, and OR 1.40, 95% CI 1.23-1.60 among treated). The risk of SGA increased with time to pregnancy, and a longer time to pregnancy was associated with a small reduction in birth weight across the whole distribution. CONCLUSION: The increased risk of SGA observed among infertile couples with or without infertility treatment suggests that infertility may be a risk factor for intrauterine growth restriction. Treatment per se may have little effect on fetal growth. A small-to-moderate increased risk of perinatal mortality in infertile couples cannot be ruled out due to the small number of cases. LEVEL OF EVIDENCE: II.     

Infertility treatment and informed consent: current practices of reproductive endocrinologists

Objective: To determine current practice patterns of obtaining informed consent for infertility treatment by reproductive endocrinologists and to assess changes in response to reports of an association between ovulation induction and ovarian cancer.Methods: Board-certified reproductive endocrinologists (n = 575) were surveyed by mail regarding how they informed patients and obtained consent for infertility treatments and how their practices had been influenced by studies suggesting a link between ovulation induction and ovarian cancer. Data were analyzed using χ² and logistic regression analyses.Results: The return rate was 62.1% (357 of 575 surveys). Most respondents (92%) used discussions with physicians to inform their patients of risks and benefits of all infertility treatments. Additional means, such as audiovisual aids, were used significantly more often for assisted reproductive technologies (including intracytoplasmic sperm injection and use of donated eggs) than for less invasive therapies (31–43% versus 4–11%, P < .001). Most physicians (46–66%) used verbal consent alone for hysterosalpingogram, intrauterine insemination, and ovulation induction. Formal written consent was used significantly more often for the various assisted reproductive technologies than for hysterosalpingogram, intrauterine insemination, or ovulation induction (94–95% versus 26–44%). Although most physicians (70%) did not believe that ovulation induction increases the risk of ovarian cancer, 83% addressed this risk when obtaining consent and 47% reported changing their practices since an association was reported. Common changes included limiting length of treatment and addressing ovarian cancer risk.Conclusion: Current practice patterns of obtaining informed consent for various infertility treatments by board-certified reproductive endocrinologists show, as expected, that informed consent is more rigorous for assisted reproductive technologies. Although most surveyed did not believe that ovulation induction increases risk of ovarian cancer, the majority of physicians addressed that risk when obtaining consent and nearly half changed their practices on the basis of a possible association.     

On Infertility

Infertility is not one objective life event and is not necessarily the salient event in understanding infertile couples' behaviors. Common behaviors observed in infertile couples may have different meanings. The nursing care of infertile couples is enhanced and more faithful to individual experience when the complexity and variation of infertility is recognized.