https://www.healthandenvironment.org/docs/RochesterBPAstudy2013.pdf

Bisphenol A and human health: a review of the literature.

BACKGROUND Pregnancy rates in women of advanced maternal age undergoing in vitro fertilization (IVF) are disappointingly low. It has been suggested that the use of preimplantation genetic screening of cleavage-stage embryos for aneuploidies may improve the ef- fectiveness of IVF in these women. METHODS We conducted a multicenter, randomized, double-blind, controlled trial comparing three cycles of IVF with and without preimplantation genetic screening in women 35 through 41 years of age. The primary outcome measure was ongoing pregnancy at 12 weeks of gestation. The secondary outcome measures were biochemical preg- nancy, clinical pregnancy, miscarriage, and live birth. RESULTS Four hundred eight women (206 assigned to preimplantation genetic screening and 202 assigned to the control group) underwent 836 cycles of IVF (434 cycles with and 402 cycles without preimplantation genetic screening). The ongoing-pregnancy rate was significantly lower in the women assigned to preimplantation genetic screen- ing (52 of 206 women (25%)) than in those not assigned to preimplantation genetic screening (74 of 202 women (37%); rate ratio, 0.69; 95% confidence interval (CI), 0.51 to 0.93). The women assigned to preimplantation genetic screening also had a significantly lower live-birth rate (49 of 206 women (24%) vs. 71 of 202 women (35%); rate ratio, 0.68; 95% CI, 0.50 to 0.92). CONCLUSIONS Preimplantation genetic screening did not increase but instead significantly reduced the rates of ongoing pregnancies and live births after IVF in women of advanced maternal age. (Current Controlled Trials number, ISRCTN76355836.)

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In vitro fertilization with preimplantation genetic screening.

This evidence-based review focuses on the impact of potentially modifiable, non-communicable lifestyle factors on reproductive performance in the general population and the infertile population undergoing assisted reproductive technology (ART) treatment. The impact of several lifestyle factors including; age, weight, smoking, diet, exercise, psychological stress, caffeineconsumption,alcohol consumptionandexposure toenvironmental pollutants areincluded in the review. The databases of Medline, PubMed and Cinahl were searched to identify relevant publications. There is strong evidence that age, weight and smoking impact on general health and adversely on reproductive performance. However there is a need for further research focusing specifically on the relationship between diet and various levels of exercise on reproductive performance. There are several other factors such as psychological stress, caffeine consumption, alcohol consumption and exposure to environmental pollutants that have been implicated but the evidence is equivocal. It is concluded that lifestyle modification can assist couples to conceive spontaneously or optimize their chances of conception with ART treatment.

The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review

To allow selection of embryos for transfer after in vitro fertilization, ovarian stimulation is usually carried out with exogenous gonadotropins To compensate for changes induced by stimulation, GnRH analog cotreatment, oral contraceptive pretreatment, late follicular phase human chorionic gonadotropin, and luteal phase progesterone supplementation are usually added These approaches render ovarian stimulation complex and costly The stimulation of multiple follicular development disrupts the physiology of follicular development, with consequences for the oocyte, embryo, and endometrium In recent years, recombinant gonadotropin preparations have become available, and novel stimulation protocols with less detrimental effects have been developed In this article, the scientific background to current approaches to ovarian stimulation for in vitro fertilization is reviewed After a brief discussion of the relevant aspect of ovarian physiology, the development, application, and consequences of ovarian stimulation strategies are reviewed in detail

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The science behind 25 years of ovarian stimulation for in vitro fertilization.

BACKGROUND Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement. METHODS Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy (TTP), fetal death, outcome of medically assisted reproduction (MAR) and mental well-being. RESULTS Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged TTP, infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect >40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity. CONCLUSIONS In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.

/pdf/demographic-and-medical-consequences-of-the-postponement-of-4e9aztmxkq.pdf

Demographic and medical consequences of the postponement of parenthood

The late 20th century trend to delay birth of the first child until the age at which female fecundity or reproductive capacity is lower has increased the incidence of age-related infertility. The trend and its consequences have also stimulated interest in the possible factors in the female and the male that may contribute to the decline in fecundity with age; in the means that exist to predict fecundity; and in the consequences for pregnancy and childbirth. In the female, the number of oocytes decreases with age until the menopause. Oocyte quality also diminishes, due in part to increased aneuploidy because of factors such as changes in spindle integrity. Although older male age affects the likelihood of conception, abnormalities in sperm chromosomes and in some components of the semen analysis are less important than the frequency of intercourse. Age is as accurate as any other predictor of conception with assisted reproductive technology. The decline in fecundity becomes clinically relevant when women reach their mid-30s, when even assisted reproduction treatment cannot compensate for the decline in fecundity associated with delaying attempts at conceiving. Pregnancies among women aged >40 years are associated with more non-severe complications, more premature births, more congenital malformations and more interventions at birth.

Fertility and ageing.

Successful management of infertility involves the use of appropriate diagnostic tests and treatments, and knowledge of prognostic factors such as age of the female partner and duration of infertility. The assessment of infertility may reveal disorders that cause morbidity in the normally fertile population, which might or might not contribute to the infertility. Endocrine dysfunction is a significant cause of infertility due to amenorrhoea and dysfunctional uterine bleeding, and hirsutism is a familiar problem in the normal population. Some genetic abnormalities cause infertility in males and females and create implications for the progeny of infertile couples. Sexually transmitted diseases cause illness and healthcare expenditure among young adults, and can also result in tubal infertility. Congenital disorders of the uterus and fibromyomas are not rare and they are frequently asymptomatic, but in some cases uterine anomalies may contribute to infertility and pregnancy loss. Autoimmunity underlies some common diseases, especially among females, and it can also be associated with pregnancy loss. When such widely distributed factors are identified during the diagnostic assessment of subfertile couples, it is important to distinguish between a coincidental association and a specific relationship to the infertility.

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L. H. Evers

Papers

Fertility and ageing.

Physiopathological determinants of human infertility