Showing papers in "Human Fertility in 2004"
TL;DR: It is concluded that understanding the selective pressures driving coevolution between male and female reproductive traits remains a major challenge for researchers in this field.
Abstract: Although Darwin identified the evolutionary significance of competition between males in the context of reproduction, it is only in the past few decades that we have begun to appreciate the importance of competition at the gametic level. Sperm competition, defined as competition between the sperm of two or more males for fertilization of the same set of ova, is now recognised as a key selective force shaping male reproductive anatomy, physiology and behaviour across diverse animal groups, including mammals. The aim of this article is to provide a brief review of the selective consequences of sperm competition in mammals, with emphasis on recent theoretical advances and empirical controversies. Evidence of female influences on sperm competition outcomes in mammals is also discussed, and it is concluded that understanding the selective pressures driving coevolution between male and female reproductive traits remains a major challenge for researchers in this field.
117 citations
TL;DR: There is wide variation in the way this common procedure is performed, with room for improvement through published guidelines, and some of the controversial issues related to the procedure especially that of pelvic infection are raised.
Abstract: Transvaginal ultrasound guided oocyte retrieval (TVOR) during in vitro fertilization (IVF) treatment was first described in 1985. By virtue of its simplicity and effectiveness, it has gained widespread popularity and has now become the gold standard for IVF therapy. Nevertheless, despite the advantages, the aspiration needle may injure the adjacent pelvic organs and structures leading to serious complications. The most common complications are haemorrhage, trauma and injury of pelvic structures, and pelvic infection. Other complications described include adnexal torsion, rupture of endometriotic cysts, anaesthetic, and even vertebral osteomyelitis. In the last two decades, several reports have described the complications associated with this technique, and tried to address the risk factors and safety issues. However there is wide variation in the way this common procedure is performed, with room for improvement through published guidelines. This article reviews the most common complications reported in literature, summarizes the recommendations made to minimize their occurrence, and raises some of the controversial issues related to the procedure especially that of pelvic infection.
83 citations
TL;DR: The mechanisms responsible for producing abnormal spermatozoa in the human will improve knowledge about certain causes of male infertility and the impact of such sperm, if selected to perform ICSI, needs to be better understood so that any detrimental paternal effects can be avoided.
Abstract: With the successful use of Assisted Reproduction, in particular intracytoplasmic sperm injection (ICSI), to treat infertile couples we have become less discriminating with the quality of spermatozoa we use to treat our patients. Numerous studies have shown the presence of nuclear DNA strand breaks in human ejaculated spermatozoa. The reason why human spermatozoa, in particular from men with abnormal semen parameters, possess these abnormalities in their nuclear DNA is still not clear. Two processes that have been linked to the presence of nuclear DNA strand breaks in spermatozoa are anomalies in apoptosis during spermatogenesis or problems in the packaging of the chromatin during spermiogenesis. Understanding the mechanisms responsible for producing abnormal spermatozoa in the human will improve our knowledge about certain causes of male infertility. More importantly, the impact of such sperm, if selected to perform ICSI, needs to be better understood so that any detrimental paternal effects can be avoided.
81 citations
TL;DR: It is argued that the ethical and social aspects of PGD are often as innovative as the scientific and medical aspects of this technique, and that science cannot be described as "racing ahead" of society.
Abstract: Contemporary scientific and clinical knowledges and practices continue to make available new forms of genetic information, and to create new forms of reproductive choice. For example, couples at high risk of passing on a serious genetic condition to their offspring in Britain today have the opportunity to use Preimplantation Genetic Diagnosis (PGD) to select embryos that are unaffected by serious genetic disease. This information assists these couples in making reproductive choices. This article presents an analysis of patients' experiences of making the decision to undertake PGD treatment and of making reproductive choices based on genetic information. We present qualitative interview data from an ethnographic study of PGD based in two British clinics which indicate how these new forms of genetic choice are experienced by patients. Our data suggest that PGD patients make decisions about treatment in a complex way, taking multiple variables into account, and maintaining ongoing assessments of the multiple costs of engaging with PGD. Patients are aware of broader implications of their decisions, at personal, familial, and societal levels, as well as clinical ones. Based on these findings we argue that the ethical and social aspects of PGD are often as innovative as the scientific and medical aspects of this technique, and that in this sense, science cannot be described as "racing ahead" of society.
74 citations
TL;DR: Given the many thousands of semen samples provided for analysis by men in primary care (many of which will never undergo assisted conception treatment), it is suggested that this may represent a wasted opportunity to provide screening (and treatment) for the infection using an appropriate test specimen and without the need for additional hospital visits.
Abstract: There is increasing evidence that the function of human spermatozoa can be significantly affected by direct exposure to the bacterium Chlamydia trachomatis. This may contribute to sub-fertility in infected individuals by a route that is independent of any damage to the reproductive epithelium. In addition, if a C. trachomatis infection is undiagnosed it could contribute to poor outcomes in assisted conception techniques such as in vitro fertilization. The antibiotics routinely used in IVF culture systems are largely ineffective against chlamydia, emphasizing the importance of screening patients prior to treatment. Moreover, given the many thousands of semen samples provided for analysis by men in primary care (many of which will never undergo assisted conception treatment), it is suggested that this may represent a wasted opportunity to provide screening (and treatment) for the infection using an appropriate test specimen and without the need for additional hospital visits.
40 citations
TL;DR: There was considerable professional uncertainty in a number of aspects of this sensitive area of service provision, which reflected professionals' difficulties in building and maintaining a relevant, adequate knowledge and skills base given the limited numbers of teenagers offered this service.
Abstract: Interviews were undertaken with 22 health and social work professionals. Their analysis was completed using "selective transcription", noting understanding of process, issues and themes, and building a picture against which to consider the analysis of subsequent interviews with teenagers and parents. Professionals were also asked to identify areas for feedback from these participants. This work was part of a larger study of (i) the perceptions of adolescent males and their parents of fertility preservation services following a cancer diagnosis, and (ii) national postal surveys of common practices, areas of variance and issues experienced by professionals in UK regional paediatric oncology centres and licensed assisted conception centres. A large number of concerns were identified, which reflected professionals' difficulties in building and maintaining a relevant, adequate knowledge and skills base given the limited numbers of teenagers offered this service. The lack of appropriate training about the legal and consent frameworks, and the processes involved was also highlighted across all professional groups as was the confusion around professional and legal responsibilities for follow up. Thus, there was considerable professional uncertainty in a number of aspects of this sensitive area of service provision. Consideration needs to be given to the needs for national guidance, for training, support and updating, for liaison between the different health and social care sectors that may be involved, and for appropriate information systems. These need to be in place for each stage of the process, from diagnosis through to eventual discharge from the health system.
38 citations
TL;DR: This study under-represents the views of women and their partners who had considered, but then rejected, egg sharing.
Abstract: Introduction: This paper reports on a qualitative empirical study of the experiences of women (and their partners) attending one UK assisted conception unit, who have considered egg sharing. Aims: In the absence of any published research of the experiences of people contemplating egg sharing and the considerable concerns that egg sharing had generated (for an overview see Blyth, 2002 ), the major purpose of the study was to examine the experiences not only of those who had considered and proceeded with egg sharing but also those who had considered, but had then decided against, egg sharing. In addition, since the views of male partners are frequently overlooked in studies of assisted conception treatment (cf. Ahuja, Mostyn, & Simons, 1997 ) the project actively sought the involvement of the women's partners. The study was designed to explore couples' motivation for egg sharing, their experiences of treatment, attitudes regarding...
36 citations
TL;DR: Women contemplating the end of IVF treatment appear to be satisfied with the clinician's attitude, the decision making process and the decision made, while information provided during the final consultation is felt to be adequate for decision making.
Abstract: This study was undertaken to assess patient satisfaction with the decision making process as well as with the decision made at the end of in-vitro fertilization (IVF) treatment. Couples who had decided to end treatment after unsuccessful IVF at a single hospital within the last 24 months were invited to complete a questionnaire. Valid questionnaires were returned by 71 (51%) out of a total of 139 couples. Sixty-nine (97%) questionnaires were completed by the female partner. Most women (73%) felt that they were adequately informed about the issues important to the decision. Fifty-eight women (81%) were involved with the decision making process; 38 (58%) felt supported by the clinic doctor and 41 (62%) were satisfied with the decision made. In response to a number of questions about information provision, few women (18 – 24%, depending on the individual question) felt that they had received enough information from the IVF clinician about advantages and disadvantages of stopping treatment and options such as...
27 citations
TL;DR: It has been shown that an elective single embryo transfer programme can be adopted in daily practice and that it decreases the multiple pregnancy rate, in this programme to around 7% with acceptable overall pregnancy and delivery rates.
Abstract: The high incidence of multiple pregnancies is the main reason for adverse treatment outcome in assisted reproduction. A good strategy to avoid multiple pregnancies is elective single embryo transfer and cryopreservation of spare embryos. Important factors in an elective single embryo transfer programme are good counselling of the patients and the selection of embryos with high implantation potential. In the infertility clinic at Helsinki University Central Hospital the elective single embryo transfer programme was started in 1997 and in 2000 the transfer policy turned to single embryo transfer as primary option. In 2003 60% of fresh transfers were elective single embryo transfers and 66% of frozen transfers were single embryo transfers. It has been shown that an elective single embryo transfer programme can be adopted in daily practice and that it decreases the multiple pregnancy rate, in our programme to around 7% with acceptable overall pregnancy and delivery rates. In Finland the increased use of singl...
24 citations
TL;DR: An overview of the reasons why people should or should not have children is provided, and of two attempts to define what the authors can do to make sure that the lives of the children they have are as good as they can be.
Abstract: This article provides an overview of the reasons why people should or should not have children, and of two attempts to define what we can do to make sure that the lives of the children we have are as good as they can be. It is suggested that the answers to these questions are more complex than we tend to think, and that rational arguments can be found to support many mutually conflicting reproductive policies.
22 citations
TL;DR: The significance of pregnancy intention for health policy, health research, and for the health care providers is highlighted, and the importance of adopting a subjective approach to improve the understanding of women's experiences of conception is highlighted.
Abstract: This paper seeks to explore women's experiences of conception, and to deconstruct the dichotomy between the terms "planned" and "unplanned" pregnancy. It draws on interviews with 19 primagravidae conducted as part of a wider qualitative study of women's experiences of pregnancy and childbirth. Although the concept of pregnancy intention is widely regarded as ambiguous, and by some immeasurable, this paper draws on interview data to develop four categories of pregnancy intention. The first category (the planned pregnancy) is unambiguous and reflects the type of planned approach currently advocated by health professionals. The second category (the laissez-faire pregnancy) reflects the experiences of women who stop using contraception but adopt a more relaxed approach to pregnancy planning. The third category (the recalcitrant pregnancy) is far more ambiguous and describes the experiences of those who want to be pregnant but for whom it would not be socially acceptable to plan a pregnancy. The final category (the accidental pregnancy) is unambiguous and deals with pregnancies that could be described as unexpected, and arising due to genuine contraceptive failure. This paper concludes by highlighting the significance of pregnancy intention for health policy, health research, and for the health care providers. The importance of adopting a subjective approach to improve our understanding of women's experiences of conception is also highlighted.
TL;DR: In setting up a new IVF unit, a comprehensive quality control programme was established to monitor laboratory performance and to detect any problems that potentially may have resulted in a sub-optimal service.
Abstract: The ability to create an optimal environment for the culture of oocytes and embryos is important to ensure that embryo viability, and therefore pregnancy outcome, is not compromised. Laboratory performance can be monitored using a quality control system. In setting up a new IVF unit, a comprehensive quality control programme was established to monitor laboratory performance and to detect any problems that potentially may have resulted in a sub-optimal service. The measures employed were designed to optimize the environment for human embryo culture by providing aseptic conditions and security for the gametes and embryos, whilst providing a safe working environment for laboratory staff. Equipment function, consumables and environmental parameters were assessed prior to the commencement of treatment in the new unit. A mouse embryo bioassay was used to assess the ability of the new laboratory and equipment to support mammalian embryo development. Prior to the start of clinical treatments a quality control program highlighted equipment that was functioning sub-optimally, which had the potential to cause problems had it been left undetected. Once clinical treatment commenced, quality control monitoring was continued to ensure that the laboratory functioned to a consistently high standard.
TL;DR: Almost half of UK IVF clinics make no attempt to either detect or treat chlamydial infection prior to embryo transfer, suggesting that embryo transfer does pose a significant risk factor for pelvic inflammatory disease.
Abstract: Uterine instrumentation can provoke pelvic inflammatory disease in women infected with Chlamydia trachomatis. During an IVF treatment cycle, a fine plastic catheter is passed into the endometrial cavity to transfer the embryos. The objective of this survey was to find out what measures are being taken by IVF clinics to prevent ascending infection. Postal questionnaires were sent to 75 clinics in the UK, asking about their sexually transmitted infection screening policies and their protocols on antibiotic prophylaxis. Seventy clinics (93%) responded, of which 37 (53%) neither screen the female partner for C. trachomatis, nor give appropriate antibiotic prophylaxis. Approximately half of UK IVF clinics make no attempt to either detect or treat chlamydial infection prior to embryo transfer. More research is required to evaluate whether embryo transfer does pose a significant risk factor for pelvic inflammatory disease.
TL;DR: An approach to the validation of cell culture media and reagents which is a vital process in the overall quality assurance that is increasingly demanded for cells and tissues used in humans.
Abstract: It is difficult to predict the influence that a particular combination of processes and culture media may have on cells and tissues manipulated in vitro. Accordingly, it is important that the procedures, media and reagents used in the manipulation of cells for clinical application are specified and have been appropriately assessed for safe and reliable use. This presents an approach to the validation of cell culture media and reagents which is a vital process in the overall quality assurance that is increasingly demanded for cells and tissues used in humans.
TL;DR: The data suggests that new nursing roles, which are based on "traditional" nursing and "new" technical skills, are fragile and may not be shared across a professional community.
Abstract: This paper discusses data from a case study of fertility nursing practice. An ethnographic case study approach using participant observation and nine semi-structured interviews with staff and patients was undertaken. The data were analysed thematically and these themes are discussed in this paper. We present the meaning a small group of nurses working in a fertility unit in the UK attach to new roles and the ways in which changes in practice may be influenced. The nurses in this study believed that nature of the task demanded changes to practice and they identified personal, interpersonal and socio-cultural factors which influenced these changes. These new roles facilitated greater continuity of care for patients. This paper discusses the effects of these new roles on knowing and intimacy in nurse - patient relationships. The data suggests that new nursing roles, which are based on "traditional" nursing and "new" technical skills, are fragile and may not be shared across a professional community.
TL;DR: This article attempts to highlight the difficult choices and ethical challenges confronting patients and clinicians in an effort to balance the recognition of parental autonomy with the obligation of clinics to consider the welfare of any child born as a result of this treatment.
Abstract: Preimplantation genetic diagnosis is a form of very early prenatal diagnosis. The technique combines assisted reproductive technology with molecular genetics and cytogenetics to allow the identification of abnormalities in embryos prior to implantation. Since its introduction in 1990 this approach has been applied to an increasing number of single gene disorders, chromosomal rearrangements, and more recent indications such as aneuploidy screening and HLA matching. Since its inception the technology has attracted much attention: geneticists have expressed concerns about the robustness and validity of diagnosis based on single cell analysis, perinatologists were anxious about the effect of embryo biopsy on normal fetal development; and philosophers and ethicists have argued the cases for and against embryo selection. This article attempts to highlight the difficult choices and ethical challenges confronting patients and clinicians in an effort to balance the recognition of parental autonomy with the obligat...
TL;DR: It is concluded that a well managed SIUI programme that selects patients appropriately, monitors them intensively and has in place effective strategies to manage over-responders safely, should be able to deliver at least a 15% live birth rate per cycle started with only a 5% cycle cancellation rate.
Abstract: A retrospective report of pregnancy and birth rates achieved in 1010 cycles of stimulated intrauterine insemination (SIUI). Over the years there has been an increasing emphasis on safety, particularly towards reducing the number of high order multiple pregnancies. SIUI is a complex form of assisted conception and requires a high level of clinical judgement to maintain an optimal balance between maximising pregnancy and birth rates and minimising complications, of which the most serious is multiple pregnancy. Extrapolating from these results, it is concluded that a well managed SIUI programme that selects patients appropriately, monitors them intensively and has in place effective strategies to manage over-responders safely, should be able to deliver at least a 15% live birth rate per cycle started with only a 5% cycle cancellation rate. Although SIUI birth rates are lower than IVF rates, the much lower cost of SIUI means that this treatment can be more cost-effective than IVF. However SIUI remains more risky than IVF and, despite careful management, high order multiple pregnancy rates will occasionally occur. It is estimated that the rate of unavoidable high order multiple pregnancies (triplets and above) is 4 per 1000 cycles started.
TL;DR: The historical context of this work is discussed, some current work in the fields of IQ, antisocial behaviour and sexuality are looked at and the ethical implications are addressed both for the understanding of ourselves and in relation to possible applications in areas such as assisted reproduction and the law.
Abstract: In its 2002 report on the ethical context of behavioural genetics the Nuffield Council on Bioethics concentrated on the genetics of variation within the normal range for behavioural dispositions The report discusses the historical context of this work and looks at some current work in the fields of IQ, antisocial behaviour and sexuality It then addresses the ethical implications of this work, both for our understanding of ourselves and in relation to possible applications in areas such as assisted reproduction and the law
TL;DR: This review considers some recent human rights cases in the field of assisted reproduction and explores how the UK courts are seeking to weave their way through the complex legal and ethical issues in this sensitive field to balance the competing rights of those seeking infertility treatment, gamete donors and their offspring.
Abstract: This review considers some recent human rights cases in the field of assisted reproduction and explores how the UK courts are seeking to weave their way through the complex legal and ethical issues in this sensitive field to balance the competing rights of those seeking infertility treatment, gamete donors and their offspring.
TL;DR: Any debate over the removal of donor anonymity needs to recognize that the discourse of donating will differ from the discourse from any resultant child, and has implications for any contact with the donor and for counselling practice.
Abstract: Any debate over the removal of donor anonymity needs to recognize that the discourse of donating will differ from the discourse of any resultant child Donor discourse will not contain concepts of father/mother/parent/family whereas the child discourse will This has implications for any contact with the donor and for counselling practice
TL;DR: A postal survey to find out the current practice in the UK regarding the methods employed to assess tubal patency found that a hysterosalpingogram was the investigation of choice for both low risk and high risk women and that HyCoSy was performed in only a few centres in the US.
Abstract: We conducted a postal survey to find out the current practice in the UK regarding the methods employed to assess tubal patency. A questionnaire was developed to evaluate the methods used to assess tubal patency in women presenting with infertility with or without risk factors suggesting pelvic disease. A total of 496 questionnaires were sent and 174 responded (35%). The survey represented an overall view as both gynaecologists and radiologists from secondary and tertiary centres responded. In the responses from radiologists, a hysterosalpingogram was the investigation of choice for both low risk (61%) and high risk women (50%). However in the responses from gynaecologists, in patients with no past gynaecological history, the majority performed a hysterosalpingogram (58%) or hystero contrast sonography (HyCoSy) (14%) whereas in patients in whom pelvic pathology was suspected, most (84%) performed a laparoscopy and dye test. The survey also showed that HyCoSy was performed in only a few centres in the UK. T...
TL;DR: Key insights which present a challenge to organizational and professional cultures that require emotions to stay outside the workplace are summarised and recent research in neuro-psychology is used to demonstrate the centrality and complexity of emotional work in health care.
Abstract: This paper considers the developing interest and understanding in emotional intelligence and the emotional components of work that are occurring in many areas of occupation and industry. Key insights which present a challenge to organizational and professional cultures that require emotions to stay outside the workplace are summarised. Recent research in neuro-psychology is then used to demonstrate the centrality and complexity of emotional work in health care. The relative absence of research and scholarship that locates the emotions as a central and challenging dimension of health and social care work is discussed.