Free Access Articles
Reproductive technology and social justice: a view from Brazil
Debates on the practical and ethical dilemmas produced by the rapid changes in assisted reproductive technology (ART) are frequently focused on the consequences of new developments in Western Europe and North America. Discussions about ART in developing and middle-income countries tend to be centred on the use – and for some, the possible exploitation – of women's bodies as sources of biological materials and providers of services. They more rarely examine patterns of implementation of ART in these countries.Home monitoring of ovarian stimulation: an important step towards more patient-centred IVF
Since the early 1980s there has been constant evolution in the clinical management of IVF treatments. From the patient's perspective, significant innovations have included: (i) the replacement of oocyte retrieval through laparoscopy under general anaesthesia by ultrasound-guided out-patient transvaginal puncture; (ii) the introduction of GnRH analogues to suppress a premature rise in LH (avoiding the need for frequent LH peak monitoring); (iii) calibrated pens allowing patients to inject gonadotrophins themselves and avoiding dependency on nurses or hospital facilities; (iv) the introduction of milder and less complex stimulation protocols (significantly reducing side effects and the need for intense ovarian response monitoring and frequent hospital visits) (Nargund and Fauser, 2020); and (v) the recognition of the distinct burden of treatment and psychological stress associated with IVF (resulting in significant treatment drop out and reduced cumulative pregnancy chances per started IVF treatment).Fertility preservation during the COVID-19 pandemic: mitigating the viral contamination risk to reproductive cells in cryostorage
Reopening fertility care services across the world in the midst of a pandemic brings with it numerous concerns that need immediate addressing, such as the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the male and female reproductive cells and the plausible risk of cross-contamination and transmission. Due to the novelty of the disease the literature contains few reports confirming an association of SARS-CoV-2 with reproductive tissues, gametes and embryos. Cryobanking, an essential service in fertility preservation, carries the risk of cross-contamination through cryogenic medium and thus calls for risk-mitigation strategies.Reproduction, Technology and Society - a new section in RBMO
This issue sees the launch of Reproduction, Technology and Society (RTS), a new section of RBMO fully dedicated, as the name conveys, to issues at the interfaces between reproduction, technology, and society.A revolutionary joins the establishment: Reproductive Biomedicine Online turns 20
This commentary highlights the publishing revolution achieved by Robert Edwards in founding Reproductive Biomedicine Online. It corrects some inaccuracies in the account given by Roger Gosden in his recently published book Let There Be Life: An Intimate Portrait of Robert Edwards and His IVF Revolution.Preimplantation genetic testing as a component of root cause analysis of errors and reassignment of embryos in IVF
The risks of embryo/gamete mix-up are a threat to the integrity of the IVF process, with significant implications for affected families. The use of preimplantation genetic testing through single-nucleotide polymorphism array or next-generation sequencing technology can help to identify, characterize and ultimately help, in some cases, to find the root cause, and to mitigate the extent of these errors for a given patient or laboratory.Strong variation in progesterone production of the placenta in early pregnancy – what are the clinical implications?
We thank Dr Tesarik (Tesarik, 2020) for his interest in our study on the onset of placental progesterone production in patients receiving dydrogesterone for scheduling endometrial receptivity and for supporting early pregnancy in anovulatory (‘artificial’) frozen-thawed embryo transfer cycles (FET) (Neumann et al., 2020). In his letter, Dr Tesarik suggests that the luteo-placental shift can be delayed and that this delay could be a cause for miscarriage. Indeed, in our study a strong variation in placental progesterone production between individual singleton pregnancies can be observed (Figure 4A, Neumann et al., 2020).Can miscarriage caused by delayed luteoplacental shift be avoided?
I read with interest the article by Neumann et al. (2020) which showed that in anovulatory frozen embryo transfer (FET) using dydrogesterone instead of progesterone for luteal phase support, a significant increase in trophoblastic progesterone production occurs 23–29 days after embryo transfer in pituitary-suppressed women. When ovarian activity is not suppressed, the onset of placental progesterone production is accompanied by luteolysis, a phenomenon known as luteoplacental shift (LPS).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.Meet our new editor: Professor Laura Rienzi
Laura Rienzi is a Senior Clinical Embryologist and Laboratory Director at the GENERA Centres for Reproductive Medicine in Rome, Marostica, Umbertide and Naples in Italy. Laura has academic degrees in biology from the University of Rome 'La Sapienza' and in reproductive medicine from the University of Padua. Since 2016, she has been adjunct Professor of Biotechnology at the University of Urbino, Italy.Reproductive healthcare during a pandemic: a New York state of mind
The purpose of this Commentary is to assess whether the designation by New York State Department of Health of ‘sexual and reproductive health services as essential’ is consonant with the seemingly divergent objectives of providing patient-centred care and advancing national public health objectives in the resource-constrained setting of a global pandemic.Trends in ovarian hyperstimulation syndrome hospitalization rates in the USA: an ongoing concern
Ovarian hyperstimulation syndrome (OHSS) is a serious, almost exclusively, iatrogenic complication of ovarian stimulation. Many techniques have been developed over the past 25 years to decrease OHSS risks, and most have been in common use for 15–20 years. In view of these techniques, it could be hypothesized that severe OHSS rates would decrease or almost disappear. According to the US National ART Surveillance System, rates did not change significantly between 2000 and 2009, at 106 OHSS cases per 10,000 IVF cycles annually.SARS-CoV-2: diagnostic and design conundrums in the context of male factor infertility
The question of whether SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus-2 [SARS-CoV-2], leading to the COVID-19 infection) can be harboured in the testes and/or semen is currently unanswered. It is essential to understand the limitations of both antibody and real-time PCR tests in interpreting SARS-CoV-2 data in relation to analyses of semen and testicular tissue without appropriate controls. This article critically analyses the evidence so far on this, and the possible implications.Mild ovarian stimulation for IVF is the smartest way forward
The aim of IVF treatment is to achieve a healthy full-term baby, with minimal health risks to the woman and her child, and at reasonable cost to allow this treatment option to be within financial reach for many women around the world. Ovarian stimulation – which contributes a considerable proportion of the overall cost of IVF – aims to generate multiple follicle development, allowing for the retrieval of multiple oocytes to improve success rates. Complex ovarian stimulation regimens have become an integral part of most IVF programmes.Generating translatable evidence to improve patient care: the contribution of human factors
Generating translatable evidence to improve patient care has proved challenging in reproductive medicine, with many ‘add-on’ treatments in routine assisted conception clinical practice that have not been reliably tested. This has consequences for patient care; specifically, IVF pregnancy rates have not improved. A change of culture is required in our profession, from indiscriminately applying the latest ‘add-on’ to large-scale participation in generating reliable translatable evidence.Male fertility: a window on the health of this generation and the next
In this issue of RBMO Martín-Calvo and colleagues (Martín-Calvo et al., 2019) provide clinical data showing that higher paternal pre conception folate intake was significantly associated with a longer gestation time. Previous studies in mice have shown that manipulation of paternal dietary folate was associated with increased birth defects and identified marked changes in the sperm epigenome associated with health of the offspring (Lambrot et al., 2013). Whilst the potential epigenetic mechanisms remain to be elucidated fully in animals and are, at best, unclear in humans, this study puts the focus of examination on the contribution of the male to overall health of future generations.May the colleague who truly has no conflict of interest now please stand up!
A vividly remembered conversation from quite a few years ago with someone influential in Dutch society began ‘I am sure you academics do very important scientific work, but the problem is that we as society notice so little health benefits resulting from these discoveries. Since universities are primarily paid by tax payers' money, what's our return on this investment?’ It took quite some time to get to grips with this message, but it did lead to the profound realization of how far away from mainstream society we often operate.Is there an association between oocyte number and embryo quality? A systematic review and meta-analysis
The aim of assisted reproduction technology (ART) is to help an infertile couple have a healthy baby born at term. Multifollicular growth induced by ovarian stimulation can lead to the collection of multiple oocytes, which, in turn, seems to increase pregnancy chances after ART. Hence, clinicians have for years been trying to obtain an adequate number of oocytes while minimizing the risk of ovarian hyperstimulation syndrome. Some have advocated that a higher number of collected oocytes is associated with improved outcomes (Baker et al., 2015; Macklon et al., 2006; van der Gaast et al., 2006).The female post-cancer fertility-counselling clinic: looking beyond the freezer. A much needed addition to oncofertility care
The number of girls and young women surviving cancer is increasing. It has been estimated that each year 43 new cancer cases are diagnosed per 100,000 people of both sexes between the ages of 20 and 39 years. Cancer is more common in women than men (Fidler et al, 2017). The consequences of being diagnosed with a malignant disease are serious, not just for the individual but also at a societal and economic level. While treatment is often successful, the impact of the disease on the life course is significant, as multiple long-term side effects of cancer treatment, and the psychological fallout of facing such a diagnosis at a young age, continue to resonate in later life.Advanced fibroid study: paying homage to John Sampson
A recent article supports our longstanding view that all intramural fibroids can cause disturbance of uterine function. This may be reflected in the symptom of menorrhagia or fertility-related issues, as well as pregnancy losses at all gestational stages. However, it was disappointing that there was no reference to either the mechanism by which fibroids disturb uterine function nor to the gynaecologist who described this more than 100 years ago, namely John Sampson. In fact, Sampson's findings about the unique venous drainage mechanism from the endometrium explains how menstrual loss is contained in normal physiology, but which can be excessive when the protective ‘anaemic’ zone is disturbed.GLP-1 receptor agonists versus metformin in PCOS: a systematic review and meta-analysis
This meta-analysis aimed to evaluate the efficacy and safety of glucagon-like peptide 1 (GLP-1) receptor agonists for women with polycystic ovary syndrome (PCOS) by comparing their effect with that of metformin. Electronic databases (PubMed, EMBASE, Cochrane Library, WanFang Database, CNKI) dating from their establishment to June 2018 were searched to find all randomized controlled trials (RCTs) reporting the efficacy of GLP-1 receptor agonists versus metformin for patients with PCOS. Therapeutic variables included menstrual cycle, sex hormone and clinical manifestations, glucose metabolism and other metabolic indexes.Use of progestins to inhibit spontaneous ovulation during ovarian stimulation: the beginning of a new era?
Advances in oocyte and embryo cryopreservation for assisted reproduction prompted new approaches to ovarian stimulation. Attention has been paid to progesterone and its derivatives to block the LH surge, as oocyte vitrification removes possible harmful effects of progestins on endometrial receptivity. This review summarizes the current status of progestin use to inhibit ovulation during ovarian stimulation compared with conventional ovarian stimulation. Progestin-primed ovarian stimulation is shown to effectively inhibit spontaneous ovulation, without affecting the number of retrieved oocytes and embryo quality.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).Chief editor’s 2018 annual report
We have completed yet another exciting year at RBMO. Most importantly the broad scope of the journal's content and the close interaction between the editorial office staff and the editors and the authors remains a constant strength. In addition, we completely updated the layout of the journal: both the artwork and logo on the cover and also the layout of the papers themselves. We are very proud of the new look and feel of RBMO, which is now completely in line with the identity of the journal, the growth of the field and our level of ambition! During summer, the editorial office moved to Bourn Hall, Cambridge, UK, a most fitting location.Influence of oral vitamin and mineral supplementation on male infertility: a meta-analysis and systematic review
This meta-analysis and systematic review investigated evidence of the effect of oral micronutrient supplementation on male fertility. Following searches of PubMed, Ovid/Ovid Medline(r) and Embase, 18 randomized, double-blind, placebo-controlled trials were included in the meta-analysis (seven studies) and/or the systematic review (12 studies). The meta-analysis showed significant improvement in semen parameters for selenium (200µg/day and 100µg/day) (standard mean difference [SMD] 0.64 for oligozoospermia, 1.39 for asthenozoospermia), L-carnitine (2 g/day) and acetyl-L-carnitine (LAC; 1 g/day) combined (SMD 0.57 for asthenozoospermia), and co-enzyme Q10 (200 and 300 mg/day) (SMD 0.95 for oligozoospermia, 1.48 for asthenozoospermia, 0.63 for teratozoospermia).Origins of mosaicism and criteria for the transfer of mosaic embryos
Blastocysts classified as mosaic by preimplamtation genetic testing for aneuploidy (PGT-A) [usually through array comparative genomic hybridization (aCGH) or next-generation sequencing (NGS)] have been reported to implant less frequently and miscarry more frequently than embryos classified as euploid, but still be able to produce chromosomally normal and viable pregnancies (Fragouli et al., 2017; Greco et al., 2015; Munné et al., 2017; Spinella et al., 2018). As such, the Preimplantation Genetic Diagnosis International Society (PGDIS), Controversies in Preconception, Preimplantation and Prenatal Genetic Diagnosis (CoGEN) and others (Munné et al., 2016) have recommended that care providers prioritize euploid embryos over mosaic embryos for transfer and only consider mosaics for replacement when no euploid embryos are available.Imaging the ovary
Using mainly histological analyses of fixed ovarian tissues and ultrasound imaging of ovaries in vivo, earlier imaging studies have established the basic framework of ovarian folliculogenesis as well as luteal formation and regression. The ovary contains individual follicles as functional structures, together with corpora lutea, interstitial tissues, innermost medulla and the outmost layer of the surface epithelium. Most of the 800,000 primordial follicles found at birth in human females remain at the dormant stage.Chief editor's 2017 annual report
2017 was an exciting and rewarding year for RBM Online, as it continued to provide cutting-edge information regarding basic, translational and clinical aspects of infertility and related areas of reproductive health. Among the successes, most notably the impact factor reached a value well above 3 for the first time in the journal's history (Figure 1), placing it in the first quartile of all journals published in the categories ‘Obstetrics and Gynecology’ and ‘Reproductive Biology’.Can time-lapse parameters predict embryo ploidy? A systematic review
Embryo morphology assessment performs relatively poorly in predicting implantation. Embryo aneuploidy screening (PGS) has recently improved, but its clinical value is still debated, and the development of a cheap non-invasive method for the assessment of embryo ploidy status is a highly desirable goal. The growing implementation of time-lapse devices led some teams to test the effectiveness of morphokinetic parameters as predictors of embryo ploidy, with conflicting results. The aim of this study was to conduct a comprehensive review of the literature on the predictive value of morphokinetic parameters for embryo ploidy status.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.Effect of male body mass index on assisted reproduction treatment outcome: an updated systematic review and meta-analysis
Men with a body mass index (BMI) of 30 or over are more likely to have reduced fertility and fecundity rates. This systematic review and meta-analysis evaluated the effect of male BMI on IVF and intracytoplasmic sperm injection (ICSI) outcome. An electronic search for published literature was conducted in MEDLINE and EMBASE between 1966 and November 2016. Outcome measures were clinical pregnancy rates (CPR) and live birth rates (LBR) per IVF or ICSI cycle. Eleven studies were identified, including 14,372 cycles; nine reported CPR and seven reported LBR.Follicular flushing in patients with poor ovarian response: a systematic review and meta-analysis
A systematic literature review and meta-analysis was conducted to evaluate the effect of follicular flushing on clinical outcomes (primary outcome: mean number of cumulus–oocyte–complexes [COC]) in poor-response IVF patients). The bibliographic databases OvidMedline (includes Pubmed), Cochrane Library and Web of Science were searched electronically for randomized controlled trials (RCT) comparing follicular flushing with no flushing. Three RCT with a total of 210 patients could be included. The mean number of COC did not increase with flushing (weighted mean difference: −0.45 COC, 95% CI −1.14 to 0.25, I2 = 70%; P = 0.21; three RCT, n = 210).A search for molecular mechanisms underlying male idiopathic infertility
Infertility affects approximately 15% of the couples wanting to conceive. In 30 − 40% of the cases the aetiology of male infertility remains unknown and is called idiopathic male infertility. When assisted reproductive technologies are used to obtain pregnancy, an adequate (epi)genetic diagnosis of male infertility is of major importance to evaluate if a genetic abnormality will be transmitted to the offspring. In addition, there is need for better diagnostic seminal biomarkers to assess the success rates of these assisted reproductive technologies.Surging ahead
2017 was a very successful year for RBMOnline, most notably with the announcement of an Impact Factor of 3.249, the highest yet achieved by the journal since its inclusion in the ranking nearly 10 years ago, and matched by improvements in other ranking metrics such as CiteScore, Article Influence and SNIP. This outcome reflects the increased quality of the papers published in the journal and places it in sixth position in the ranking of reproductive biology titles. As part of the continuing development of the journal, we welcomed Richard Anderson to the team of editors (Anderson, 2017), joining Mina Alikani, Juan Garcia Velasco and Martin Johnson, and allowing the Chief Editor more time to focus on strategic considerations.Role of Withania somnifera (Ashwagandha) in the management of male infertility
To manage male infertility caused by hormonal imbalance, infections and other predicaments, multifarious treatment strategies are emerging worldwide. Contemporary treatments, such as assisted reproductive techniques, are costly with low success rates of only 10–30%; however, herbal remedies are gaining more attention as an alternative or supplementary therapeutic modality for male infertility. The beneficial effects induced by oral intake of the roots of a small evergreen shrub, Withania sominifera (Ashwagandha) on semen quality of infertile men have previously been studied.Dignity again
Two recent contributions to this journal discuss a challenge to Stanford's time-lapse embryo monitoring patent, currently before the European Patent Office (EPO). Sterckx, Cockbain and Pennings (2017) would like to keep the morphokinetics of embryo division in the public domain; they argue that time-lapse monitoring (TLM) is a diagnostic method in the sense of European patent law and therefore unpatentable. In response, Pearce (2017) suggests that the jurisprudence of the EPO unambiguously says that TLM is not a diagnostic method.Risk of pelvic inflammatory disease after intrauterine insemination: a systematic review
The aim of this study was to ascertain the incidence of pelvic inflammatory disease (PID) after intrauterine insemination (IUI). A systematic review was conducted using three different approaches: a search of IUI registries; a search of published meta-analyses; and a search of prospective randomized trials. Search terms were ‘IUI’, ‘complications’, ‘infection’ and ‘PID’. Two IUI registers were identified that met the inclusion criteria, totalling 365,874 cycles, with 57 PID cases being reported.The uterine fibroid/myoma tumour: analysis of the global research architecture using density-equalizing mapping
Uterine fibroids can severely impact a woman’s quality of life, result in significant morbidity and are a leading indication for hysterectomy. Many aspects of the disease remain largely obscure. Despite these knowledge gaps, no detailed maps of the global fibroid research architecture have yet been generated. This study used the NewQIS approach to assess worldwide research productivity, encompassing numerous aspects of the scientific output, quality and socioeconomic features. Regression analysis indicated an increase in fibroid research activity in the investigated time periods.Progress in the diagnosis and management of adolescent endometriosis: an opinion
Until recently, adolescent endometriosis has been considered a rare, often transient, condition not particularly serious for the young patient. Against this background, and not without disagreement by some, we have pointed out that early onset endometriosis (EOE) may at times be severe, necessitating quick diagnosis and proper treatment (Brosens et al., 2013b, 2014). To substantiate this viewpoint, we carefully searched published research, including some early paediatric research, and identified peritoneal reflux from neonatal uterine bleeding (NUB) occurring in 3–5% of female neonates, as a biologically plausible and likely cause of EOE (Brosens and Benagiano, 2013, 2016; Brosens et al., 2013a; Gargett et al., 2014).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.Extragonadal primordial germ cells or placental progenitor cells?
Primordial germ cells (PGCs), the precursors of the gametes, are now claimed to segregate within the extra-embryonic tissues of three species of placental mammals. In this brief Commentary, I raise the question of whether the so-called PGCs are not PGCs at all, but rather, progenitor cells that build the fetal–placental interface in Placentalia.GnRHa trigger and luteal coasting: a new approach for the ovarian hyperstimulation syndrome high-risk patient?
Final oocyte maturation using gonadotrophin-releasing hormone agonist (GnRHa) is increasingly common as it almost eliminates the risk of developing ovarian hyperstimulation syndrome (OHSS) in high-responder patients. The first studies using this approach showed a poor reproductive outcome when only vaginal progesterone was used as luteal phase support, due to the luteolysis that will develop as a result of LH withdrawal. Timely luteal administration of human chorionic gonadotrophin (HCG) will counterbalance the low LH concentrations and therefore maintain progesterone production from the corpora lutea, however, some patients with a high number of follicles will develop OHSS using this approach.Perinatal outcomes after stimulated versus natural cycle IVF: a systematic review and meta-analysis
Pregnancies resulting from assisted reproductive techniques are at higher risk of adverse perinatal outcomes compared with spontaneous conceptions. Underlying infertility and IVF procedures have been linked to adverse perinatal outcomes. It is important to know if ovarian stimulation influences perinatal outcomes after IVF. A systematic search for relevant studies was conducted up to November 2016 on the following databases: PubMed, EMBASE, DARE and Cochrane Central Register of Controlled Trials.A clinical assay for reactive oxygen species – ready for primetime?
Reactive oxygen species (ROS) have been demonstrated to have damaging effects on human sperm function. The measurement of ROS as an adjunct to traditional semen analysis has clinical relevance as part of the diagnosis of male infertility. The assay best suited to the clinical laboratory environment for detecting ROS generation remains somewhat controversial. A recent report on a multicenter study evaluating the reduction of nitroblue tetrazolium (NBT) to formazan precipitate as an indirect reporter of ROS-generating activity in spermatozoa, seminal plasma and semen has received a critique raising questions as to the sensitivity and specificity of the assay for detecting ROS.Chimeras intended for human gamete production: an ethical alternative?
Human eggs for basic, fertility and stem-cell research are in short supply. Many experiments that require their use cannot be carried out at present, and, therefore, the benefits that could emerge from these are either delayed or never materialise. This state of affairs is problematic for scientists and patients worldwide, and it is a matter that needs our attention. Recent advances in chimera research have opened the possibility of creating human/non-human animal chimeras intended for human gamete production (chimeras-IHGP).Human-animal chimeras: circumventing rather than discussing ethical concerns comes at a price
This issue of RBMOnline features a highly interesting paper on chimeras intended for human gamete production by philosopher César Palacios-González (2017). The paper breaks new ground by linking two ethically charged scientific developments. Whilst several groups are aiming to create stem cell-derived gametes through tissue culture in the laboratory (Hendriks et al., 2015), others are working on interspecies chimeras as a possible future route to obtaining human stem cell-derived organs from animals, both for research and for transplantation purposes.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.Inositol supplementation in women with polycystic ovary syndrome undergoing intracytoplasmic sperm injection: a systematic review and meta-analysis of randomized controlled trials
Polycystic ovary syndrome (PCOS) is a complex and heterogeneous disease that involves menstrual dysfunction and reproductive difficulty, as well as metabolic problems. Use of the Rotterdam criteria will probably increase its already high prevalence, and currently, it is the most common endocrinopathy in women, affecting 7–14% of women of childbearing age worldwide (Bozdag et al., 2016).Pathogenesis of adenomyosis: an update on molecular mechanisms
Adenomyosis is a uterine disorder becoming more commonly diagnosed in women of reproductive age because of diagnostic imaging advancements. The new epidemiological scenario and the clinical evidence of pelvic pain, abnormal uterine bleeding and infertility are changing the classic perspective of adenomyosis as a premenopausal disease. In the last decade, the evaluation of multiple molecular mediators has improved our knowledge of pathogenic mechanisms of adenomyosis, supporting that this is an independent disease from endometriosis.‘Money for nothing’. The role of robotic-assisted laparoscopy for the treatment of endometriosis
During the last decades, laparoscopic surgery has been accepted as the technique of choice for the treatment of endometriosis, because it provides long-term outcomes comparable to those achieved by laparotomy, with the established advantages of a minimally invasive technique, including better visualization, shorter hospital stay, faster recovery and better cosmetic results (Adamson et al., 1992; Daraï et al., 2010; Luciano et al., 1992; Vercellini et al., 2003).First birth following spindle transfer for mitochondrial replacement therapy: hope and trepidation
In this issue, Zhang et al. (2017) report the birth of a healthy boy after mitochondrial replacement therapy (MRT) by spindle transfer to prevent transmission of mitochondrial disease from mother to child. The case was first publicized in the lay press (Hamzelou, 2016; see also editorial by Johnson, 2016) and then presented during the 2016 Annual Meeting of the American Society for Assisted Reproduction (ASRM) in October 2016 (Zhang et al., 2016a). It followed an earlier report of an unsuccessful attempt at MRT by pronuclear transfer by the same group (Zhang et al., 2016b).Ovarian tissue cryopreservation in female-to-male transgender people: insights into ovarian histology and physiology after prolonged androgen treatment
Female-to-male transgender people (trans men), are faced with the risk of losing their reproductive potential owing to gender affirming hormone treatment and genital reconstructive surgery. Transgender people also tend to start sex reassignment treatment at a young age, when reproductive wishes are not yet clearly defined nor fulfilled (De Sutter, 2001). About one-half of trans men, however, express the desire to have children (Wierckx et al., 2012). It is, therefore, recommended by the most recent Standards of Care of the World Professional Association for Transgender Health to clearly discuss fertility and fertility preservation before any treatment (Coleman et al., 2012).Anti-Müllerian hormone kinetics in pregnancy and post-partum: a systematic review
The aim of this systematic review is to critically appraise the available evidence regarding the kinetics of anti-Müllerian hormone (AMH) during pregnancy and post-partum. A systematic literature search was conducted in MEDLINE, Embase, CENTRAL, Scopus and Web of Science on 14 December 2015, aiming to identify studies providing data on the serum concentration of AMH in women at various stages of gestation and post-partum. There was a total of 1719 participants across eight studies. Seven out of the eight studies reported a decline in serum AMH concentration with advancing gestational age.Ovarian stimulation protocols for IVF: is more better than less?
Conventional ovarian stimulation protocols for IVF are designed to achieve maximum oocyte yields. Conventional protocols, however, are associated with patient discomfort, increased risk of ovarian hyperstimulation syndrome and higher costs. In recent years, mild stimulation protocols have risen in popularity. These protocols typically use lower doses (≤150 IU/day), shorter duration of exogenous gonadotrophins, or both, compared with conventional protocols, with the goal of limiting the number of retrieved oocytes to less than eight.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.Multiple-dose and double-dose versus single-dose administration of methotrexate for the treatment of ectopic pregnancy: a systematic review and meta-analysis
In this systematic review and meta-analysis, the effectiveness and safety among different dosage of methotrexate protocols for the treatment of unruptured tubal ectopic pregnancy was evaluated. Six studies of randomized contorlled trials were identified through searches conducted on PubMed, Embase and Cochrane Library between January 1974 and March 2016. The overall success rate of multiple-dose protocol was similar to the single-dose protocol (RR 1.07, 95% CI 0.99 to 1.17, I2 = 0%). The difference between double-dose and single-dose groups was not significant (RR 1.09, 95% CI 0.98 and 1.20, I2 = 0%).Counselling considerations for chromosomal mosaicism detected by preimplantation genetic screening
The evolution of preimplantation genetic screening (PGS) for aneuploidy to blastocyst biopsy and more sensitive 24-chromosome screening techniques has resulted in a new diagnostic category of PGS results: those classified as mosaic. This diagnosis presents significant challenges for clinicians in developing policies regarding transfer and storage of such embryos, as well as in providing genetic counselling for patients prior to and following PGS. Given the high frequency of mosaic PGS results and the wide range of possible associated outcomes, there is an urgent need to understand how to appropriately counsel patients regarding such embryos.Obituary: Robert A Godke Jr (1945–2015)
Robert A Godke Jr (“Bob”), Louisiana State University Boyd Professor, passed away on 8 October, 2015 after a valiant battle with pancreatic cancer. Professor Godke leaves an extraordinary legacy at LSU and around the world. Over the course of his 40-year career as a Professor of Reproductive Physiology, Bob published over 300 articles and lectured extensively both nationally and internationally. He earned numerous research awards, including LSU Research Master in 1990, the USDA Distinguished Researcher Award in 1992, and the highest LSU honor, a Boyd Professorship, in 1996.Thanks to our Referees
At the time of going to press, the following people have completed reviews for articles submitted for publication between 1 November 2014 and 1 November 2015.What do we know about endometrial receptivity in women with endometriosis? A molecular perspective
Endometriosis is a relatively wide-spread benign but debilitating gynaecological disorder affecting women of reproductive age. Endometriosis develops following the implantation of endometrial tissue at ectopic locations, mainly peritoneal and on the surface of pelvic organs (Giudice, 2010). The prevalence of this disease varies from 4–50% in different populations (Cramer and Missmer, 2002; Eskenazi and Warner, 1997), and occurs in up to 50% of women with pelvic pain and/or infertility (Giudice, 2010; Meuleman et al., 2009).Meet our new Editor
Dr Mina Alikani PhD is a Clinical Embryologist, currently working as a Laboratory Director and consultant in New York, USA. Her interest in this field was piqued in 1978, with the announcement of the world's first IVF birth. Having recently immigrated to the United States, she entered university, choosing biology as her major. Mina's early enthusiasm for developmental biology and embryology led her to the laboratories of Professor Lajos Pikó at the local Veteran's Administration Hospital, in Northridge, Southern California, where, as a young volunteer, she learned how to work with mice and isolate and culture early mouse embryos.Meet our new editor
Professor Juan A Garcia-Velasco MD PhD completed his medical training at Complutense University in Madrid, Spain in 1990 and his residency training in Obstetrics and Gynecology at La Paz Hospital, Madrid, Spain in 1995. He then joined Instituto Valenciano de Infertilidad (IVI) for a year in its early days (1996), followed immediately by a Fellowship in Reproductive Endocrinology and Infertility at Yale University, USA, where he worked under the guidance of Professor Aydin Arici (1997–1998). There he became enthusiastic about the relevance of molecular biology to human reproduction, and did extensive research in the field of cell adhesion and endometriosis.Baby factories taint surrogacy in Nigeria
The practice of reproductive medicine in Nigeria is facing new challenges with the proliferation of ‘baby factories’. Baby factories are buildings, hospitals or orphanages that have been converted into places for young girls and women to give birth to children for sale on the black market, often to infertile couples, or into trafficking rings. This practice illegally provides outcomes (children) similar to surrogacy. While surrogacy has not been well accepted in this environment, the proliferation of baby factories further threatens its acceptance.Implementation of cleanroom technology in reproductive laboratories: the question is not why but how
Two articles recently published in Reproductive BioMedicine Online described how fertility centres in the USA and Brazil implemented air quality control to newly designed facilities. In both case scenarios, a highly efficient air filtration was achieved by installing a centred system supplying filtered air to the IVF laboratory and other critical areas, combining air particulate and volatile organic compound (VOC) filtration. Evaluating retrospective data of over 3000 cycles from both centres, live birth rates were increased by improvements in air quality and laboratory environment.Polymorphism of CAG and GGN repeats of androgen receptor gene in women with polycystic ovary syndrome
One characteristic of polycystic ovary syndrome (PCOS) is hyperandrogenism, which may be related to the activity of androgen receptor (AR). This study was designed to investigate the polymorphism of CAG and GGN repeats in the AR gene in women with PCOS. The frequency distributions of CAG and GGN repeat alleles, as well as their X-inactivation patterns, were compared between 76 age-matched normal women (control group) and 80 women with PCOS (PCOS group). The expression of AR mRNA in the ovarian tissues of seven patients with PCOS and five normal women was also tested using real-time quantitative PCR.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.Validation of next-generation sequencing for comprehensive chromosome screening of embryos
Massively parallel genome sequencing, also known as next-generation sequencing (NGS), is the latest approach for preimplantation genetic diagnosis. The purpose of this study was to determine whether NGS can accurately detect aneuploidy in human embryos. Low coverage genome sequencing was applied to trophectoderm biopsies of embryos at the blastocyst stage of development. Sensitivity and specificity of NGS was determined by comparison of results with a previously validated platform, array-comparative genomic hybridization (aCGH).Response: transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women's health than menopause hormone therapy?
We want to thank Von Wolff and colleagues for their correspondence (von Wolff et al., 2015) concerning our recent paper (Yding Andersen and Kristensen, 2015) in which we describe a novel way of postponing menopause by transplanting the woman's own ovarian tissue cryostored during earlier reproductive years. Freezing of ovarian tissue is now technically available and increasingly used in connection with fertility preservation for young women receiving gonadotoxic treatment. The question posed is whether it is advisable to also use this technique for postponing menopause?Transplantation of ovarian tissue to postpone menopause – is it really more advantageous for women's health than menopause hormone therapy?
The recent article in RBM Online entitled ‘Novel use of the ovarian follicular pool to postpone menopause and delay osteoporosis’ (Yding Andersen and Kristensen, 2015) addresses a very innovative topic. However there is one essential question which also needs to be addressed: is the physiological, endogenous hormone production induced by transplanted ovarian tissue – tissue menopause hormone therapy (THT) – more advantageous for women's health than a conventional menopause hormone therapy (MHT)?Live births following karyomapping – a “key” milestone in the development of preimplantation genetic diagnosis
Twenty-five years ago, during the early days of preimplantation genetic diagnosis (PGD), the use of the polymerase chain reaction (PCR) for single-cell genetics was in its infancy. Reamplification of short fragments of DNA with a second set of internal or “nested” primers for mutation detection was possible (Coutelle et al., 1989; Holding and Monk, 1989), but plagued with the problems of contamination and allele dropout (ADO). Separate clean-room facilities for sample preparation were therefore essential.HFEA response to ‘A plea for caution and more research in the “experimental” use of ionophores in ICSI’
I am writing in response to the recent article in Reproductive Biomedicine Online, by van Blerkhom et al. (2015), which helpfully highlights the work of the Human Fertilisation and Embryology Authority's (HFEA) Scientific and Clinical Advances Advisory Committee (SCAAC) in this area but appears to misunderstand the committee's role.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.Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis
This systematic review investigated the effect of paternal obesity on reproductive potential. Databases searched were Pubmed, Ovid, Web of Science, Scopus, Cinahl and Embase. Papers were critically appraised by two reviewers, and data were extracted using a standardized tool. Outcomes were: likelihood of infertility, embryo development, clinical pregnancy, live birth, pregnancy viability, infant development, sperm; concentration, morphology, motility, volume, DNA fragmentation, chromatin condensation, mitochondrial membrane potential (MMP), and seminal plasma factors.Accidentally delayed oocyte pickup – a challenge to the current paradigm
Textbooks indicate that human ovulation occurs 38–39 hours after the administration of human chorionic gonadotrophin (HCG) in the setting of IVF. This known wisdom leads to the current practice of oocyte retrieval no later than 37 hours after HCG administration. The issue of the timing of HCG administration in relation to follicular size and hormonal response has received much attention (Chen et al., 2014), whereas only a few studies have been performed to examine the difference between the retrieval of oocytes earlier than 36 h following HCG administration, or later than 36 h but prior to 38 h (Garor et al., 2015; Raziel et al., 2006).Deep impact: sequencing embryo biopsy specimens at increasing depth
Despite major advances in assisted reproductive technologies (ART), it remains the case that more than half of all IVF treatments do not ultimately result in the birth of a child. It is clear that the majority of embryos created through IVF are not capable of producing a viable pregnancy, with most failing to implant in the uterus or miscarrying soon afterwards (Fragouli et al., 2013).Is there a clinical future for GV manipulation?
In this issue of RBMOnline, Zhang and Liu present their latest work involving mammalian germinal vesicle (GV) transfer (Zhang and Liu, 2015). This study extends the prior work of these authors and others in examining this technique (Liu et al., 2003; Takeuchi et al., 2001; Zhang et al., 1999). One finding of developmental interest is the observation that when reciprocal GV transfers between human and mouse oocytes were performed, the maturation process and spindle formation followed the expected form of the species donating the ooplast.Spermatogenesis, DNA damage and DNA repair mechanisms in male infertility
Spermatogenesis is a complex process of proliferation and differentiation during male germ cell development involving mitosis, meiosis and spermiogenesis. Endogenous and exogenous physical, chemical and biological sources modify the genome of spermatozoa. The genomic integrity and stability of the sperm is protected by DNA repair mechanisms. In the male germline cells, DNA repair mechanisms include nucleotide excision repair, base excision repair, DNA mismatch repair, double strand break repair and post-replication repair.The codon 72 polymorphism of the TP53 gene and endometriosis risk: a meta-analysis
Endometriosis is a chronic, inflammatory and common gynaecological disease. This study investigated the association between TP53 codon 72 polymorphism and the risk of endometriosis. A search for relevant articles was conducted in PubMed, Embase, CNKI, Wanfang, Weipu databases and Google Scholar. The strength of the relationships between TP53 codon 72 polymorphism and the risk of endometriosis was assessed by odds ratios (OR) and with 95% confidence intervals (CI). Sixteen case–control studies in 15 articles were included.Response: Another consideration in minilaparotomy for myomectomy
First of all we would like to thank Dr Kim and colleagues for their interest in our article (Palomba et al., 2015) and for their comments. In common with all papers submitted for publication in peer-reviewed journals, the published version of our paper incorporates suggestions and feedback received from referees. Thanks to the advice of two independent and, we assume, suitably qualified referees, we structured the data analysis and the discussion so that our article was well balanced with respect to different surgical techniques for myomectomy.Another consideration in minilaparotomy for myomectomy
When we read the recent article by Palomba and colleagues (Palomba et al., 2015), we found that their systematic review did not compare all the risks and benefits of minilaparotomy versus laparoscopic minimally invasive surgery for myomectomy. Gynecologists are interested in surgical techniques for treatment of uterine disorders (Jeong, 2014), and should consider the advantages and safety of minilaparotomy for myomectomy. When laparoscopy-assisted hysterectomy was developed, gynecologists compared laparoscopy and laparotomy for hysterectomy.To pill or not to pill in GnRH-antagonist cycles: still an open debate
We read with interest the commentary by Griesinger and colleagues (Griesinger et al., 2015) concerning our recent mini-review in RBMOnline (Garcia-Velasco and Fatemi, 2015). Although we fully agree with the authors' last sentence (‘randomized studies should be performed to prove or disprove…’), we would like to clarify that apart from the well-known methodological explanations about pooling data in a meta-analysis, and even considering that it is the most convincing tool in evidence-based medicine, unless it is a solid study we cannot take it as the ultimate truth.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).A plea for caution and more research in the ‘experimental’ use of ionophores in ICSI
Other than the fear of a negative pregnancy outcome, fear of fertilization failure is probably one of the foremost motives for the growing practice of using ICSI, rather than conventional insemination, for all couples undergoing IVF. However, even with the insertion of a morphologically normal sperm from an individual of known fertility, there are instances, albeit relatively rare, where no fertilization occurs, as indicated by absent pronuclear formation. Artificial oocyte activation, aimed at obtaining at least one zygote, is considered when all mature oocytes are supposedly affected.Impact of ovarian endometrioma on ovarian responsiveness and IVF: a systematic review and meta-analysis
In this systematic review and meta-analysis, the effect of ovarian endometrioma on ovarian responsiveness to stimulation and on assisted reproduction outcomes was evaluated. Nine published studies (1039 cases) were included. The number of oocytes retrieved (mean difference [MD] −1.50; 95% CI, −2.84 to −0.15, P = 0.03), metaphase II (MII) oocytes retrieved (MD −3.61; 95% CI −4.44 to −2.78, P < 0.00001) and total embryos formed (MD −0.66; 95% CI −1.13 to −0.18, P = 0.007) were significantly lower in women with ovarian endometrioma than the control group.Oocyte donor information – how much is enough?
One of the most contested debates in the field of reproductive donation concerns the question of how much information about gamete donors should be provided to gamete recipients. Part of what makes this question challenging is that there is only a limited pool of empirical research to draw from when making evidence-based arguments in favour of one policy or practice of information provision over another. Analysis of this evidence is further complicated by the fact that more evidence exists about recipients of sperm donation than recipients of oocyte donation.Open versus closed systems for vitrification of human oocytes and embryos
Vitrification is now the dominant approach for cryopreservation of human oocytes and embryos; however, serious disagreement persists, particularly about biosafety issues. Techniques are categorized as either ‘open’ or ‘closed’ according to occurrence of direct contact between the medium and liquid nitrogen during cryopreservation. Advocates of closed systems emphasize the potential danger of disease transmission mediated through liquid nitrogen, and praise the safety of their approach; those who use the open systems refer to the lack of evidence of disease transmission and regard their systems as more consistent and efficient.The oviduct: a neglected organ due for re-assessment in IVF
The oviduct has long been considered a ‘pipeline’, a tube allowing transit of spermatozoa and embryos; this perspective has been reinforced by the success of human IVF. Evidence accumulated over several decades, however, indicates that embryos can modulate the metabolism of tubal cells in their environment. Human IVF culture media is based on formulations that pass mouse embryo assays as quality control: the requirements of mouse embryos differ from those of human embryos, and therefore conditions for human IVF are far removed from the natural environment of the oviduct.Repro-sexual intersections: sperm donation, HIV prevention and the public interest in semen
In the scientific literature on fertility and assisted reproduction, and in the corresponding area of clinical practice, increasing attention has been paid to two groups: people living with the human immunodeficiency virus (HIV) and gay men. However, research on fertility in the context of HIV focuses almost exclusively on heterosexual couples, whereas studies on non-heterosexual reproduction rarely mention HIV, despite the fact that, in many western countries, HIV prevalence among men who have sex with men is higher than ever before and men who have sex with men are the only group in which new HIV infections are on the rise.Adenomyosis: a life-cycle approach
The life-cycle approach to endometriosis highlighted unexpected features of the condition; the same approach was therefore applied to gain insight into the clinical features of adenomyosis and to draw a comparison with endometriosis. This is possible today thanks to new imaging techniques enabling non-invasive diagnosis of adenomyosis. The specificity and sensitivity of magnetic resonance imaging and transvaginal ultrasound remain uncertain. Unlike endometriosis, little information is available on the presence of classic adenomyosis in adolescents, except for rare cystic forms that may not represent the true disease.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.Reporting of embryo transfer methods in IVF research: a cross-sectional study
If we accept that reproducibility is one of the principles of the scientific method (Siegel, 2011), then reporting the methods of research is equally important as disseminating its results. A good description of a study's methodology allows others to replicate the experiment accurately and verify previous findings. Current research, however, shows that scientific reporting can often be inadequate, even in the case of high-quality studies such as randomized controlled trials (Péron et al., 2012; Turner et al., 2012; Wang et al., 2011).No evidence of association between blastocyst aneuploidy and morphokinetic assessment in a selected population of poor-prognosis patients: a longitudinal cohort study
Recent studies involving a limited number of patients have indicated a correlation between aneuploidy and various morphokinetic parameters during preimplantation development. The results among different groups, however, have been inconsistent in identifying the parameters that are able to predict chromosomal abnormalities. The aim of this study was to investigate whether aneuploidy of human blastocysts was detectable by specific morphokinetic parameters in patients at increased risk of aneuploidy because of advanced maternal age, history of unsuccessful IVF treatments, or both.Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies
The clinical implications of congenital uterine anomalies (CUA), and the benefits of hysteroscopic resection of a uterine septum, were evaluated. Studies comparing reproductive and obstetric outcome of patients with and without CUA and of patients who had and had not undergone hysteroscopic resection of a uterine septum, were evaluated. Meta-analysis of studies indicated that the pregnancy rate was decreased in women with CUA (RR 0.85, 95% CI 0.73 to 1.00; marginally significant finding, P = 0.05).Effects of in-vitro or in-vivo matured ooplasm and spindle-chromosome complex on the development of spindle-transferred oocytes
To study the effects of in-vitro matured ooplasm and spindle-chromosome complex (SCC) on the development of spindle-transferred oocytes, reciprocal spindle transfer was conducted between in-vivo and in-vitro matured oocytes. The reconstructed oocytes were divided into four groups according to their different ooplasm sources and SCC, artificially activated and cultured to the blastocyst stage. Oocyte survival, activation and embryo development after spindle transfer manipulation were compared between groups.Double stimulations during the follicular and luteal phases of poor responders in IVF/ICSI programmes (Shanghai protocol)
Previous studies have shown that existing antral follicles in the luteal phase enable ovarian stimulation. In a pilot study, the efficacy of double stimulations during the follicular and luteal phases in women with poor ovarian response was explored (defined according to the Bologna criteria). Thirty-eight women began with mild ovarian stimulation. After the first oocyte retrieval, human menopausal gonadotrophin and letrozole were administrated to stimulate follicle development, and oocyte retrieval was carried out a second time when dominant follicles had matured.
