Free Access Articles
A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF
Polycystic ovary syndrome (PCOS) is one of the most common and complex hormonal disorders seen in women and is considered to be a significant public health issue (Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group, 2004). PCOS has a negative effect on women's health across the lifespan, leading to, for example, anxiety, depression, insulin resistance, abdominal obesity, hypertension and dyslipidaemia (Teede et al., 2010); it is also an important cause of infertility in women of reproductive age because of the associated anovulation (Homburg and Crawford, 2014).A demographic projection of the contribution of assisted reproductive technologies to world population growth
Enormous unmet needs for infertility treatment exist because access to assisted reproductive technologies is demographically skewed. Since the first IVF baby in 1978, the number of people conceived by reproductive technology has grown much faster than expected, reaching several million today and rapidly approaching 0.1% of the total world population. As more patients build families, and their children in turn become parents, the number owing their existence to assisted reproductive technologies, either directly or indirectly, will expand tremendously in future decades, but no attempts have been made hitherto to project the magnitude.Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies
Studies comparing risk of specific congenital malformations (CM) between multiple pregnancies resulting from IVF/intracytoplasmic sperm injection (ICSI) and those conceived naturally report conflicting results; furthermore, there is a lack of a complete overview. This meta-analysis aimed to address which types of CM are increased in IVF/ICSI multiple pregnancies compared with those conceived naturally. All studies testing the association between IVF/ICSI multiple pregnancies and specific CM identified in various databases were considered.Insights from clinical experience in treating IVF poor responders
‘Poor responders’ is a term used to describe a subpopulation of IVF patients who do not respond well to ovarian stimulation with gonadotrophins. While there is no standard definition of a poor responder, these patients tend to be of advanced maternal age (≥40 years), have a history of poor ovarian response with conventional stimulation protocols, and/or have low ovarian reserve. Despite the heterogeneity of this patient group, there are characteristics and needs common to many poor responders that can be addressed through a holistic approach.Comments on the ESHRE recommendations for the treatment of minimal endometriosis in infertile women
According to ESHRE recommendations for women with stage I/II endometriosis, if a decision is made to proceed to laparoscopy then operative laparoscopy (excision or ablation of the endometriotic lesions) should be performed rather than only diagnostic laparoscopy, to increase ongoing pregnancy rates. Also, for infertile women with stage I/II endometriosis doctors may consider complete surgical removal of endometriosis to improve live birth rate prior to assisted reproductive treatment. This last recommendation is not well established.Paving the way for a gold standard of care for infertility treatment: improving outcomes through standardization of laboratory procedures
Infertility affects over 70 million couples globally. Access to, and interest in, assisted reproductive technologies is growing worldwide, with more couples seeking medical intervention to conceive, in particular by IVF. Despite numerous advances in IVF techniques since its first success in 1978, almost half of the patients treated remain childless. The multifactorial nature of IVF treatment means that success is dependent on many variables. Therefore, it is important to examine how each variable can be optimized to achieve the best possible outcomes for patients.Effect of progesterone elevation in follicular phase of IVF-cycles on the endometrial receptivity
The premature rise of progesterone during the late follicular phase in stimulated IVF cycles is a frequent event, and emerging evidence shows that premature progesterone rise does negatively affect the outcome of assisted reproductive techniques. The effect of elevated peripheral progesterone levels in the late follicular phase seems to be on the endometrium and the window of implantation, which may lead to asynchrony between the endometrium and the developing embryo. In stimulated cycles, endometrial maturation is advanced on the day of oocyte retrieval, and patients with a progesterone level above 1.5 ng/ml on the day of final oocyte maturation have different endometrial gene expression profiles.The place of reconstructive tubal surgery in the era of assisted reproductive techniques
Assisted reproductive techniques yield high rates of success for women with tubal factor infertility. Because they are potentially effective for all categories of infertility, for two decades, clinical and basic research in infertility has been focused on IVF techniques and outcomes, rather than developing surgical techniques or training infertility subspecialists in tubal microsurgery. Nonetheless, in comparison with IVF, reconstructive tubal surgery is inexpensive and offers multiple opportunities to attempt conception.A pilot study to evaluate a device for the intravaginal culture of embryos
The aim of this comparative randomized embryology trial was to determine if an intravaginal culture device (IVC) can provide acceptable embryo development compared with conventional IVF. Ten women between the ages of 27 and 37 years with an indication for IVF treatment were included in this study. After ovarian stimulation, oocytes were randomized to fertilization in the IVC device or using conventional IVF. Fertilization rates were higher in the IVF group compared with the IVC device (68.7% ± 36 % versus 40.7% ± 27%), respectively, whereas cleavage rates were similar (93% ± 1.5% versus 97% ± 6%) for both groups.What's in a name? Variations in terminology of third-party reproduction
The terminology used to discuss third-party reproduction, as with other new biomedical processes, can ease or impede communication and even influence behaviour. In an effort to sensitize analysts and stakeholders to variations in terminology and to facilitate communication on issues arising from international surrogacy arrangements, this paper examines variations in terms used. We introduce some of the issues previously raised by scholars concerned with analysis of discourse related to third-party reproduction.Bisphenol A, oocyte maturation, implantation, and IVF outcome: review of animal and human data
Recent data have raised concerns about the detrimental effect of chronic exposure to environmental chemicals. Some chemicals affect the endocrine system (endocrine disruptors) and have been linked to several diseases, including infertility. One such endocrine disruptor is bisphenol A (BPA), a monomer widely used in the plastic industry, with nearly ubiquitous exposure. In this review, data on the effects of BPA on female fertility are summarized. Specifically, its effect is considered on folliculogenesis, oocyte maturation, embryo quality, and implantation, both in animal and human models.Impact of high serum progesterone during the late follicular phase on IVF outcome
With ovarian stimulation for IVF, serum progesterone concentration may increase during the last few days of stimulation. Several factors, mainly the intensity of the ovarian response to gonadotrophins, have been identified to explain progesterone elevation but many other issues remain uncertain. The aim of this narrative, nonsystematic review is to address the nonconsensual issues of the reasons and consequences of premature progesterone elevation during ovarian stimulation. The determination of the optimal threshold above which progesterone elevation may have an impact on IVF outcome is still a matter of debate because it is likely related to the patient's profile.Potential impact of human mitochondrial replacement on global policy regarding germline gene modification
Previous discussions regarding human germline gene modification led to a global consensus that no germline should undergo genetic modification. However, the UK Human Fertilisation and Embryology Authority, having conducted at the UK Government’s request a scientific review and a wide public consultation, provided advice to the Government on the pros and cons of Parliament’s lifting a ban on altering mitochondrial DNA content of human oocytes and embryos, so as to permit the prevention of maternal transmission of mitochondrial diseases.Parenting post IVF: is age not so relevant after all?
In 2010, the removal and placing for adoption of an Italian child born by IVF to a father aged 70 and a mother aged 57 provoked lively debate. The Italian courts (including, most recently, the Court of Cassation) have denied that the decision to remove the child was a consequence of her parents’ age. Rather, they claim, her removal was solely motivated by a concern for her welfare, with a range of instances of poor parenting cited in support of this conclusion. Notwithstanding such formal pronouncements, we argue that concerns regarding parental age have clearly played an influential role in the way that successive courts have approached the case and, further, that the courts’ reasoning is flawed in several respects.Effectiveness of indometacin to prevent ovulation in modified natural-cycle IVF: A randomized controlled trial
Modified natural-cycle IVF has a lower pregnancy rate per started cycle as compared with IVF with ovarian stimulation due to, for example, premature ovulation. Indometacin administered before ovulation prevents follicle rupture. Therefore, addition of indometacin may improve the effectiveness of modified natural-cycle IVF. This double-blind, randomized, placebo-controlled trial with indometacin or placebo in 120 women aged 27–36 years compared the number of patients without premature ovulation as compared with the number of patients with one or more ovulations in a maximum of six cycles.Cassandra’s prophecy: education, education, education
This is a commentary on the personal account of Jane Everywoman. It reflects on her experiences and thoughts. The author adds context from her own work with the Progress Educational Trust, the Daisy Network Premature Menopause Support Group and the National Infertility Awareness Campaign. Examples of the mixed messages and the confusion surrounding fertility, infertility and the possible solutions which appear in the media have been included to further illustrate many of the issues raised by Jane.Cassandra’s prophecy: why we need to tell the women of the future about age-related fertility decline and ‘delayed’ childbearing
This anonymized paper describes the author’s experience of age-related infertility and unintended childlessness. It outlines her journey from diagnosis to treatment success and clinical pregnancy through assisted reproduction using oocyte donation, followed by subsequent early miscarriage. It makes subjective observations about treatment she received and presents her impressions of how discourses of knowledge dissemination, communication and care were constructed in the organizations she encountered.Multiple pregnancy, fetal reduction and selective termination
The avoidance of twin or higher-order multiple pregnancies is in the best interest of families, medical practitioners and health services, given the health hazards and costs associated with higher-order multiples. This commentary explores the background to and ideas in the paper by Legendre et al., (2013), which makes the case for separate consideration of the various issues around selective termination of a multiple pregnancy and fetal reduction. The exploration does so mainly within the context of UK law and practice, but has international relevance.Effect of co-incubation of oocytes with a decreasing number of spermatozoa on embryo quality
Shortened exposure of oocytes to spermatozoa has been reported to improve embryo quality. This technique requires extra manipulation of gametes in order to remove oocytes from the spermatozoa. This study presents a fertilization method that does not require additional manipulation and interference of oocytes during fertilization. To determine the benefits of this method, a prospective controlled study using sibling oocytes was conducted. The oocytes of patients were randomly allocated to study and control groups.The HFEA in context
While the regulatory role of the HFEA, its independence and its shortcomings are debated in the context of a fiscal economic crisis, the larger sociological importance of the Authority may be overlooked. Harder to calculate than its annual budget and more elusive than its technical remit as a licensing body, the cultural value of the HFEA as a historical and symbolic entity that was born out of a pioneering debate unique to the UK must be included in a discussion of its future role. Against its perceived shortcomings as an expensive and outdated quango is the importance of the Authority as a public instrument for enhancing the future of translational bioscience.Polarization microscopy and rescue ICSI
A fraction of standard IVF cycles is afflicted by total fertilization failure. For several years, attempts have been made to develop strategies for rescuing these cycles in order to reduce the physical, psychological and economic burden imposed by an assisted reproduction technology treatment. Rescue ICSI is the approach by which failed fertilized oocytes can be microinjected on day 1 post insemination with the aim of achieving fertilization and thereby preventing cycle cancellation. In a study presented in this issue, Moon and colleagues perfected the rescue ICSI methodology by adopting polarized light microscopy as a tool to identify and treat only failed fertilized oocytes not penetrated by spermatozoa.Morphological systems of human embryo assessment and clinical evidence
Success rates with IVF have improved remarkably since the procedure was first established for clinical use with the first successful birth in 1978. The main goals today are to perform single-embryo transfer in order to prevent multiple pregnancies and achieve higher overall pregnancy rates. However, the ability to identify the most viable embryo in a cohort remains a challenge despite the numerous scoring systems currently in use. Clinicians still depend on developmental rate and morphological assessment using light microscopy as the first-line approach for embryo selection.IVF versus ICSI for the fertilization of in-vitro matured human oocytes
Traditional dogma suggests that intracytoplasmic sperm injection (ICSI) should be performed to ensure successful oocyte fertilization in an in-vitro maturation (IVM) cycle. This study postulated that there would be no difference in the fertilization rate when ICSI was compared with IVF. This hypothesis was tested in a randomized trial of IVF versus ICSI in IVM. A total of 150 immature oocytes were collected in eight cycles of IVM for patients diagnosed with polycystic ovarian syndrome (PCOS). Patients were primed with minimal FSH before transvaginal oocyte aspiration.Serum HCG measured in the peri-implantation period predicts IVF cycle outcomes
The current study assessed the relationship between serum concentrations of human chorionic gonadotrophin (HCG) measured in the peri-implantation period and various outcome measures following blastocyst transfer in IVF cycles. The study group included 767 autologous IVF cycles, each with the transfer of two fresh blastocysts in a 6-year study period, ending 31 December 2009. Outcome measures were ectopic pregnancy, biochemical pregnancy loss, ongoing pregnancy, spontaneous abortion and multiple pregnancy.The clinical benefit and safety of current and future assisted reproductive technology
Since the first birth by IVF was achieved in 1978, the techniques involved in assisted reproductive technology have grown at an enormous rate. However, new technology has rarely been robustly validated before clinical use and developing scientific understanding of the available techniques has done little to alter their use. Furthermore, there are inconsistencies in the available clinical studies and endpoints. The benefits of some technologies already established for routine use are currently dubious and there are clear ethical concerns with providing them to patients when their scientific basis is not clear.
