Free Access Articles
Empathetic application of machine learning may address appropriate utilization of ART
The value of artificial intelligence to benefit infertile patients is a subject of debate. This paper presents the experience of one aspect of artificial intelligence, machine learning, coupled with patient empathy to improve utilization of assisted reproductive technology (ART), which is an important aspect of care that is under-recognized. Although ART provides very effective options for infertile patients to build families, patients often discontinue ART when further treatment is likely to be beneficial and most of these patients do not achieve pregnancy without medical aid.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.Cryopreservation and transplantation of ovarian tissue exclusively to postpone menopause: technically possible but endocrinologically doubtful
Transplantation of cryopreserved ovarian tissue has been shown to induce pregnancies and puberty successfully. Therefore, using cryopreserved ovarian tissue to postpone menopause (tissue hormone therapy [THT]) seems to be an interesting option to avoid conventional menopause hormone therapy (MHT). Pregnancy induction and replacing MHT by THT, however, are completely different topics as different requirements need to be met. First, MHT requires long-lasting and continuous hormone production. It still needs to be proven if the transplanted tissue is active for at least 5 years with a continuous follicle growth to avoid phases with low oestrogen production, which would otherwise cause menopausal symptoms and could reduce the postulated benefit for women's health.Non-invasive assessment of in-vitro embryo quality to improve transfer success
Although IVF has been performed routinely for many years to help couples with fertility problems and in relation to modern breeding of farm animals, pregnancy rates after transfer to a recipient have not improved during the last decade. Early prediction of the viability of in-vitro developed embryos before the transfer to a recipient still remains challenging. Presently, the predominant non-invasive technique for selecting viable embryos is based on morphology, where parameters such as rates of cleavage and blastocyst formation as well as developmental kinetics are evaluated mostly subjectively.To pill or not to pill in GnRH-antagonist cycles: the answer is in the data already!
The planning of IVF treatment by scheduling menstruation and hence initiation of ovarian stimulation using sex-steroid pre-treatment is commonly used. Pooling data from six randomized-controlled trials encompassing 1343 patients, with and without combined oral contraceptive pill pre-treatment, suggests that the ongoing pregnancy rate per randomized woman is significantly lower in patients with oral contraceptive pill pre-treatment (relative risk [RR]: 0.80, 95% confidence interval [CI]: 0.66–0.97; rate difference [RD]: −5%, 95% CI: −10% to −1%; fixed effects model).Implications of the legalization of non-commercial surrogacy for local kinship and motherhood in Vietnamese society
Until recently, surrogacy was banned in Vietnam for all cases. The government, however, has altered its position on reproductive technology and will soon legalize non-commercial surrogacy among relatives. Motherhood is highly venerated in Vietnamese society and, under this local kinship conception, gestational process is of paramount importance in establishing a connection between the fetus and the woman. The implications of this new government decision for local kinship, motherhood and the individuals concerned will be discussed.Dual ovarian stimulation is a new viable option for enhancing the oocyte yield when the time for assisted reproductive technnology is limited
Ovarian stimulation improves assisted reproductive technology outcome by increasing the number of oocytes available for insemination and in-vitro handling. A recent Duplex protocol features a dual stimulation, with the second stimulation started immediately after the first oocyte retrieval. Remarkably, the Duplex protocol is unexpectadly well tolerated by women and provides twice as many oocytes and embryos as a regular antagonist protocol in less than 30 days.Italian Constitutional Court removes the prohibition on gamete donation in Italy
In 2004, The Italian Constitutional Court prohibited treatments involving gamate donation, embryo donation, embryo cryopreservation (except under exceptional circumstances), and the transfer of more than three embryos. Basically three statements were made by the Court: the ban violates a couple's fundamental right to health, to self-determination and to have a child. Here, the consequences of such a decision and the legal challenges that ensued are discussed.Ovarian reserve screening before contraception?
Women are increasingly delaying conception to later years. Hormonal contraception induces artificial cyclicity, which does not, like natural cyclicity, reflect normal, physiological ovarian behaviour. Therefore, long-term users of hormonal contraceptives, in particular, fail to derive potential diagnostic benefits from changes in menstrual cyclicity, which usually alerts patients and physicians to developing ovarian pathology. Timely diagnosis of ovarian problems is further hampered, as anti-Müllerian hormone is suppressed by hormonal contraceptives, making the accurate assessment of functional ovarian reserve more difficult.The social context for surrogates' motivations and satisfaction
This Commentary takes up two of the main findings by Imrie and Jadva's study, namely surrogates' satisfaction with the post-surrogacy contact with intended parents and their motivation for surrogacy. It argues that the findings are in keeping with other qualitative research on surrogacy and that this similarity is not the result of the similarity of surrogates' psychological makeup. The Commentary highlights the centrality of social meanings and definitions, and following Howard Becker, insists on taking into account the collective doings that inform and shape individual feelings and behaviour.Limitations of a time-lapse blastocyst prediction model: a large multicentre outcome analysis
The goal of embryo selection models is to select embryos with the highest reproductive potential, whilst minimizing the rejection of viable embryos. Ultimately, any embryo selection model must be tested on clinical outcome. We therefore retrospectively tested a published blastocyst prediction model on a large combined set of transferred embryos with known clinical outcome. The model was somewhat effective in that we found a relative increase of 30% for implantation in the model-selected group of embryos.HFEA reprieved – For the moment!
In this issue, we publish three commentaries (English, 2013; Franklin, 2013; Murdoch, 2013) on the value and future of the UK Human Fertilisation and Embryology Authority (HFEA). The HFEA was established by the 1990 Human Fertilisation and Embryology Act. It is “the UK’s independent regulator overseeing the use of gametes and embryos in fertility treatment and research. The HFEA licenses fertility clinics and centres carrying out in vitro fertilisation (IVF), other assisted conception procedures and human embryo research” (HFEA, 2013).Embryonic DNA sampling without biopsy: the beginnings of non-invasive PGD?
The clinical usefulness of preimplantation genetic diagnosis (PGD) and screening (PGS) may be imperative, but it is not without its shortcomings. A number of arguments, some reasoned and others not, have been put forth against these technologies. To avoid transmission of genetic disease, patients and their doctors who may consider assisted reproduction, often choose post-conception testing with the option of termination of an affected pregnancy rather than commit to PGD. Moreover, while PGS may offer a method of selection for chromosomally normal embryos, alternative embryo selection modalities are usually favored over this technique.Selective termination, fetal reduction and analogical reasoning
Analogical reasoning is a basic method in bioethics. Its main purpose is to transfer the rule from an existing or known situation to a new and problematic situation. This commentary applies the lifeboat analogy to the context of selective termination and fetal reduction. It turns out that the analogy is only partially helpful as the main principle in the case of selective termination is the procreative beneficence principle. However, the wide person-affecting form of this principle doubly justifies selective termination: i.e.Ectogenesis: what could be learned from novel in-vitro culture systems?
Early mammalian development consists of two distinct phases separated by the event of implantation. Whereas much has been discovered about developmental mechanisms prior to implantation, the inability to culture and follow in real time cell behaviour over the period of implantation means that the second phase has not been explored in as much detail. Recently, a novel in-vitro culture system was described that permits continuous culture and time-lapse observations through the peri- and early post-implantation stages.Modelling a risk classification of aneuploidy in human embryos using non-invasive morphokinetics
This study determined whether morphokinetic variables between aneuploid and euploid embryos differ as a potential aid to select euploid embryos for transfer. Following insemination, EmbryoScope time-lapse images from 98 blastocysts were collected and analysed blinded to ploidy. The morphokinetic variables were retrospectively compared with ploidy, which was determined following trophectoderm biopsy and analysis by array comparative genomic hybridization or single-nucleotide polymorphic array. Multiple aneuploid embryos were delayed at the initiation of compaction (tSC; median 85.1 hours post insemination (hpi); P = 0.02) and the time to reach full blastocyst stage (tB; median 110.9 hpi, P = 0.01) compared with euploid embryos (tSC median 79.7 hpi, tB median 105.9 hpi).Endocrine-disrupting chemicals and male reproductive health
Endocrine-disrupting chemicals are substances present in the environment that can interfere with normal hormonal balance and thus exert potentially adverse health effects on the human organism. Male reproductive system development and function may be susceptible to the effects of such environmental toxicants. Bisphenol A, phthalates and alkylphenols are important components of multiple products and are thus ubiquitously present in the environment. It has been demonstrated under laboratory conditions that they can exert detrimental effects on the male reproductive system.The politics of human embryo research and the motivation to achieve PGD
This article reports a historical study of factors influencing the achievement of clinical preimplantation genetic diagnosis (PGD) in 1990, 22 years after its first demonstration in animals. During the 1970s, research on PGD continued in large farm animals, but serious interest in human PGD was not evident until 1986. First, interest in PGD during the 1970s waned with the advent of prenatal testing, which for gynaecologists was clinically more familiar, technically simpler and ethically less challenging than IVF.
