Showing papers in "Human Fertility in 2007"
TL;DR: Women should be provided with assistance to lose weight, including psychological support, dietary advice, exercise classes and where appropriate, weight reducing agents or bariatric surgery, to restore fertility and improve metabolic markers.
Abstract: Obesity has a significant adverse impact on reproductive outcome. It influences not only the chance of conception but also the response to fertility treatment, and increases the risk of miscarriage, congenital anomalies and pregnancy complications in addition to potential adverse effects on long term health of both mother and infant. Women should aim for a normal BMI before starting any form of fertility treatment. Treatment should be deferred until the BMI is less than 35 kg/m2, although in those with more time (e.g., less than 37 years; normal serum FSH concentration) a weight reduction to a BMI of less than 30 kg/m2 is preferable. Clinicians should consider deferring treatment to women outside these guidelines. Women should be provided with assistance to lose weight, including psychological support, dietary advice, exercise classes and where appropriate, weight reducing agents or bariatric surgery. Even a moderate weight loss of 5-10% of body weight can be sufficient to restore fertility and improve metabolic markers.
159 citations
TL;DR: The literature does not support a role for intravenous albumin, administered around the time of oocyte retrieval, in preventing ovarian hyperstimulation syndrome (OHSS), and evidence is insufficient regarding a possible role for hexa-ethyl starch.
Abstract: The English-language literature was reviewed to examine the evidence base for strategies that have been used to prevent ovarian hyperstimulation syndrome (OHSS). Prediction of OHSS by pretreatment patient characteristics and ovarian response parameters is unreliable, with a significant number of OHSS cases occurring in patients not thought to be high risk, while the majority of 'high-risk' cycles do not result in OHSS. Alternatives to ovarian stimulation should always be considered, depending on the clinical situation. Monofollicular ovulation induction with a cautious step-up regime carries a lower risk of overstimulation than step-down regimes. In in vitro fertilization (IVF) cycles, a low starting dose of follicle-stimulating hormone (FSH) and the use of 5000 iu human chorionic gonadotrophin (hCG) for final follicular maturation may benefit patients at high risk of OHSS. The role of GnRH antagonists is unclear. In women with polycystic ovaries, who are undergoing ovarian stimulation for IVF, metformin co-treatment may reduce the risk of OHSS. Coasting of cycles with over-response is associated with a reduced risk of OHSS, although precise criteria for initiating and ending coasting are not definable at present. Elective cryopreservation of all embryos prevents late OHSS, but its value has been poorly researched. The literature does not support a role for intravenous albumin, administered around the time of oocyte retrieval, in preventing OHSS. Evidence is insufficient regarding a possible role for hexa-ethyl starch. hCG should not be used for luteal support, as it is associated with a higher risk of OHSS, and equivalent pregnancy rates are obtained with the use of progesterone.
76 citations
TL;DR: The literature on religion/spirituality and infertility from 1985 to the present is reviewed using Medline, CINAHL, PBSC, IBSS and ISI Web of Knowledge to draw attention to the religious perspectives of infertility and reproductive technologies.
Abstract: In spite of the growing body of literature that has focused on medical, psychological, social, and cultural consequences of infertility, issues such as religious and spiritual dimensions of infertility have received little attention. Considering that infertility is a multifaceted problem and results in multiple losses, we argue that health professionals need to consider all aspects of holistic care when caring for women with fertility problems. Holistic care considers not only the psychological, social and cultural needs of individuals, but also their religious and spiritual needs. Women may use their religious/spiritual beliefs to cope with crisis, and to find meaning and hope in their suffering. This article reviews the literature on religion/spirituality and infertility using Medline, CINAHL, PBSC, IBSS and ISI Web of Knowledge from 1985 to the present. It focuses on religious and spiritual care as one aspect of holistic care of women with fertility problems, and draws attention to the religious perspectives of infertility and reproductive technologies. It highlights the spiritual dimension of the infertility experience in previous research, and concludes with a discussion on the gaps in the literature and the implications of including religious and spiritual issues in infertile women's care.
63 citations
TL;DR: Given the timescale of development of the haematological and biochemical abnormalities, egg donors who develop ≥20 follicles should be actively monitored for the first week after egg collection.
Abstract: This study aims to provide an estimate of women’s risk of ovarian hyperstimulation syndrome (OHSS) when undergoing superovulation to donate eggs for research. This is an essential prerequisite for appropriate informed consent. In the absence of sufficiently large numbers of egg donors to assess the risk, comparative data was obtained from women undergoing the same superovulation protocol for in vitro fertilization (IVF) treatment. In this prospective study 339 women, who developed � 20 follicles after superovulation in their first treatment cycle (total number of treatment cycles during the same period – 2417), were intensively monitored on five occasions, between human chorionic gonadotrophin and pregnancy test, according to our routine clinical protocol. Hospital admission was needed for 49 (14.5%) women, 13 (3.8%) needed intravenous fluids and 9 (2.7%) needed paracentesis. The admission rates were similar in pregnant and non-pregnant women (13.5% vs. 15%); the need for intravenous fluids and paracentesis were 3.2% vs. 2.3% and 6.3% vs. 2.3%, respectively. The peak increase in haematocrit occurred on Day 4 after hCG, and the mean day of hospital admission was Day 5. If an egg donor develops 520 follicles, she can be reassured that the risk of OHSS is very small (50.1%). If � 20 follicles develop, her risk of hospital admission due to OHSS is 515%. The absence of pregnancy in egg donors does not eliminate the risk of OHSS. Given the timescale of development of the haematological and biochemical abnormalities, egg donors who develop � 20 follicles should be actively monitored for the first week after egg collection.
45 citations
TL;DR: This study identifies an oestradiol level (≥15,000 pmol/L) and number of oocytes above which the odds of being admitted with OHSS increases significantly and these measurable parameters should be used to allow appropriate counselling and subsequent safe management of ART patients.
Abstract: Background: Ovarian hyperstimulation syndrome (OHSS) is a potentially life-threatening complication of Assisted Reproductive Technology (ART) treatment. The objective of this study was to assess the odds of OHSS hospital admission in relation to oestradiol levels on day of hCG administration and number of oocytes collected.Methods: We performed a 24 months retrospective analysis of a cohort of patients receiving ART treatment in a University teaching hospital including all patients requiring admission due to OHSS. Main outcome measures were oestradiol levels, number of oocytes collected and incidence of admission with OHSS.Results: OHSS requiring admission to hospital occurred in 1.8% of cases. While no patients with an oestradiol level at hCG ≤15,000 pmol/L developed OHSS, those with oestradiol levels ≥15,000 pmol/L had different risks of admission according to the number of oocytes collected: those with >30 oocytes were 6.7 times more likely to be admitted that those with <20 oocytes.Conclusions: This s...
45 citations
TL;DR: The evidence shows that it is possible to recruit semen donors who are required to be identifiable in the future, and points to an open system attracting different kinds of men than an anonymous system, and this has clear implications for future recruitment policies.
Abstract: Since 1 April 2005, gamete donors in the United Kingdom (UK) have to be willing, in the future, to be identified to offspring should the offspring want this. This change in law has lead to considerable anxiety about the future availability of donors. This paper presents an overview of the research evidence concerning semen donors' views on anonymity and openness, as it appears in referred journals since 1995. Research evidence that is available, but not yet been published in referred journals, is also reviewed. The nature of this evidence is analysed and criticized. Research on the views of potential semen donors is also reviewed, as is the evidence that is available from jurisdictions that have changed the law and required donor openness. The evidence shows that it is possible to recruit semen donors who are required to be identifiable in the future. The evidence, while not conclusive, points to an open system attracting different kinds of men than an anonymous system, and this has clear implications for...
40 citations
TL;DR: It is found some couples are able to reinvest in life goals and re-establish their relationships; however, there were a significant proportion of couples who were still struggling five years after their last attempt to adapt to life without the child they had anticipated.
Abstract: Little is known about how patients cope when treatment fails and they are faced with the prospect of life without their ‘own’ child. Initial observations suggest that, for some, the effects can be traumatic and long lasting. Thirty-five ‘narrative’ interviews were carried out with patients and partners for whom treatment had failed five years previously. Transcripts were subject to formal thematic analysis. A significant factor, which emerged from a formal analysis of transcripts, was the role of ‘hope’. Treatment offers the hope that they may have a child, and this provides the motivation for treatment; alongside the urgent need to pre-empt future regrets. Once the support provided by hope is removed, patients can struggle to make sense of their lives. It would appear that some form of closure regarding the ending of treatment is required. Research found some couples are able to reinvest in life goals and re-establish their relationships; however, there were a significant proportion of couples who were s...
29 citations
TL;DR: Current data suggests that the mechanisms of atherothrombosis have separate pathways in South Asian and Caucasian women, and its relevance to future atherogenic events is unclear.
Abstract: Polycystic ovary syndrome (PCOS), insulin resistance and overall mortality due to diabetes and coronary artery disease are higher in South Asians than in Caucasians. Aims: We compared the prevalence of the C677T and A1298C single nucleotide polymorphisms in the methylenetetrahydrofolate reductase gene in South Asian and Caucasian women, its association with folate and homocysteine (Hcy) metabolism, and its relevance to future atherogenic events. Methods and results: 71 women were recruited for the study: South Asian PCOS (21) plus controls (9) and Caucasian PCOS (25) plus controls (16). Anthropometric and laboratory parameters were compared. South Asian PCOS women were significantly hyperandrogenic and exhibited a greater degree of insulin resistance. Caucasian PCOS women had higher plasma Hcy concentrations with a 1.9 times higher frequency of the T allele than the South Asian PCOS group. In the presence of this variant allele, plasma Hcy levels appear to be higher in both PCOS groups. The South Asians h...
29 citations
TL;DR: Most participants' confidence increased markedly as a result of attending an educational seminar, and this increased confidence also impacted positively on the intention to share information about DI with future children.
Abstract: This paper argues that infertility can result in a range of negative emotional reactions, including a lack of confidence. This is more marked when donor insemination (DI) is used because of the additional shame this is associated with. Parents who do not feel confident may be less likely to share information about their use of DI with others and their child. Legislation in several countries has been introduced to abolish donor anonymity, but this has does not necessarily have an impact on parental confidence. In order to evaluate whether educational preparation programmes can impact on parental confidence and their intention to share information about DI, the confidence levels of 60 participants of three seminars were examined at three different points in time: before, immediately after and several months after attending the programme. Results indicate that most participants' confidence increased markedly as a result of attending an educational seminar. Furthermore, this increased confidence also impacted...
29 citations
TL;DR: It is important to remember that when assisted reproductive techniques are used for men with CF, there is the inevitability of transmitting a mutated cystic fibrosis transmembrane (CFTR) gene, which increases the risk of producing an affected child and can have serious long-term implications.
Abstract: Cystic fibrosis (CF) is the most common life-shortening autosomal recessive disorder of Caucasians. Most of the men with CF (>95%) have congenital bilateral absence of vas deferens (CBAVD), which makes them infertile. However, with advances in assisted reproductive techniques, it is now potentially possible for these patients to father their own biological children. Spermatozoa may be retrieved from either the epididymis or the testes and combined in vitro with oocytes retrieved from the female partner. Epididymal sperm may be collected either by microsurgical or percutaneous epididymal sperm aspiration. It is important to remember that when assisted reproductive techniques are used for such patients, there is the inevitability of transmitting a mutated cystic fibrosis transmembrane (CFTR) gene, which increases the risk of producing an affected child and can have serious long-term implications. It is therefore mandatory to offer genetic counselling to the men with CF (and CBAVD) and their partners before carrying out assisted reproductive techniques. In the literature, there are a very few studies on fertility treatment of these men. However, even though the reported number of live births in men with CF is small, given the current technology, there are definitely more opportunities for these men to become parents.
27 citations
TL;DR: Data do not indicate a significant difference in pregnancy rates between open and laparoscopic techniques for lesser degrees of tubal damage, but if a decision is made to open the badly damaged tubes of a patient, then an open microsurgical technique should be employed.
Abstract: Of couples with subfertility, 25% have complete or partial blockage of the fallopian tube. Since the advent of in vitro fertilization (IVF), the role of tubal surgery has diminished. However, this type of surgery continues to be undertaken on selected patients with mild tubal disease, and in those with severe tubal disease, in centres where IVF is not available. This systematic review was undertaken to compare pregnancy outcomes after laparoscopic surgery with that of open microsurgical technique. Studies comparing laparoscopic techniques with conventional microsurgery requiring laparotomy for treatment of distal tubal disease were included. The relevant trials were identified from Cochrane Menstrual Disorders and Subfertility Groups of Specialised Register of Controlled Trials (searched up to July 2005). The following strategies were adapted using the OVID platform, MEDLINE (1966 to July 2005), Cochrane Central Register of Control Trials, CENTRAL, and EMBASE (1980 to July 2005). Outcomes analysed were: ‘...
TL;DR: Concerns raised include embryo destruction, quality of gametes derived in this way, possibility for children with two male biological parents, movement towards germ line gene therapy and ‘designer babies’, and the future impacts on health service provisions are outlined.
Abstract: Murine embryonic stem cells have recently been shown to be capable of differentiating in vitro into oocytes or sperm. Should these findings be duplicated using human embryonic stem cells, this would raise a number of social and ethical concerns, some specific to these particular developments, others shared with other aspects of stem cell research. This review outlines the properties of stem cells and their conversion to gametes. Concerns raised include embryo destruction, quality of gametes derived in this way, possibility for children with two male biological parents, movement towards germ line gene therapy and ‘designer babies’, and the future impacts on health service provisions. It is important that public discussion of some of these issues should take place.
TL;DR: The aim of this paper is to highlight the gap between existing research evidence and nursing and midwifery practices in caring for women following successful in vitro fertilization and gamete intrafallopian transfer, and to suggest directions for research within these disciplines.
Abstract: The aim of this paper is to highlight the gap between existing research evidence and nursing and midwifery practices in caring for women following successful in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT), and to suggest directions for research within these disciplines. We argue that although the number of couples in the UK experiencing fertility problems has risen, 1.4% of all births in the UK are as the result of infertility treatments (HFEA, 2005/2006); yet there is little research into the experiences of motherhood for women who successfully achieve pregnancy following IVF or GIFT. Consequently, there is negligible research evidence for nurses and midwives practicing in this area, and British healthcare staff appear to be unaware of the specific needs of infertile women during pregnancy, birth and early motherhood. In this paper we review the existing literature on this group of women, which falls into three areas: studies into the psychosocial development of the child conceived via IVF/GIFT/donor insemination; comparative studies into experiences of women following successful infertility treatment and women who conceive naturally; and studies into the experiences of women following successful IVF treatment. We review this literature to argue for research into the needs of infertile women following successful IVF/GIFT, to inform evidence for practice.
TL;DR: The body of the uterus is left in place, so that future pregnancies can occur and the difficulties that those working in reproductive medicine may face are explained.
Abstract: Radical trachelectomy is an operation developed as an alternative to radical hysterectomy for patients with small-volume, early stage cervical cancer, who wish to retain their fertility. The body of the uterus is left in place, so that future pregnancies can occur. Patients who have undergone radical trachelectomy may face problems conceiving naturally and may request assisted conception. This article explains the operation and the difficulties that those working in reproductive medicine may face.
TL;DR: There is an urgent need for any legal barriers to the therapeutic use of pornographic materials to be understood and examined, including those around the role of parents/carers.
Abstract: Increased awareness of the importance of fertility concerns to teenage cancer survivors is leading to growing numbers of male teenagers being offered sperm banking at the time of diagnosis. This is...
TL;DR: Despite high levels of satisfaction among couples, there is scope for further improvement in terms of pre-referral fertility investigations, and potential changes to the existing system should be considered.
Abstract: This study aimed to audit pre-referral investigations in primary care, and survey patients' views on the referral process from primary to secondary care. Referral letters and case notes of 250 consecutive couples referred to the Aberdeen Fertility Centre were audited in order to establish whether mid-luteal serum progesterone, rubella status and semen analysis had been performed. Couples attending a specialist hospital clinic for the first time completed a questionnaire on their experience of the referral process and consultation. Mid-luteal progesterone was performed in 105 (51%) cases, rubella status checked in 42 (20%) cases and semen analysis arranged in 70 (34%) cases. Overall, 274 (93%) patients were satisfied or very satisfied with the hospital consultation compared to 216 (84%) who utilisedthe general practitioner (GP) consultation (p ≤ 0.001); 79 (59%) women and 91 (68%) men wanted the current system of GP referral to continue (p < 0.001); and 74 (56%) women and 69 (52%) men (p < 0.001) favoured ...
TL;DR: The proportion of patients who were offered counselling, the proportion of those who then received counselling, how useful they found it, and to establish the main reasons why patients may opt not to receive counselling were determined.
Abstract: Infertility and its treatment can be a very stressful experience. Some countries have legislations governing the provision of counselling for assisted conception treatments. All licensed IVF clinics in the UK are required to offer patients counselling.Objectives: To determine the proportion of patients who were offered counselling, the proportion of those who then received counselling, how useful they found it, and to establish the main reasons why patients may opt not to receive counselling.Methods: An internet-based survey of users of an independent infertility website. Two-hundred-and-forty-four patients participated in the survey, of which 62% received treatment in the UK.Conclusions: Seventy-three per cent of all couples were offered, or obliged, to receive counselling compared to 91% of those patients treated in the UK. Of the patients who took part in the survey, only 30% received counselling; over half of those patients found it either ‘very helpful’ or ‘helpful’. No differences were observed in t...
TL;DR: Franklin et al. as mentioned in this paper reviewed a study by social scientist Paul Rabinow and social scientist Celia Roberts on the impact of gender on women's reproductive health on women.
Abstract: Sarah Franklin & Celia RobertsPaul RabinowPrinceton University Press, 2006 ISBN 0-691-12193-1, 282 pp., Price £14.95/$22.95 (paperback) £41.95/$65.00 (hardback)To review a study by social scientist...
TL;DR: The elective transfer of a single fresh embryo, followed if necessary by a single thawed embryo, in women at high risk of a multiple birth does not reduce the live birth rate and all but prevents the conception of twins and triplets.
Abstract: In the UK, the live birth rate after IVF in women aged less than 36 is >25%. The multiple birth rates in these women are excessive (20% to 25%). The perinatal mortality rate is increased significantly with IVF twins and triplets (8/1000 singletons, 20/1000 twins and 34/1000 triplets). Multiple pregnancies and births significantly increase the risks to the mother and the children, adversely affect family life and are economically disadvantageous to the couple and the wider community. The elective transfer of a single fresh embryo, followed if necessary by a single thawed embryo, in women at high risk of a multiple birth does not reduce the live birth rate and all but prevents the conception of twins and triplets.
TL;DR: With much of Europe now offering elective single embryo transfer (SET) as the norm, continued high multiple embryo transfer and twin pregnancy rates are impossible to justify, a consensus statement brings together the views of providers of treatment.
Abstract: The hazards of multiple pregnancy present the biggest risk to the health and welfare of children born as a result of in vitro fertilization (IVF). A comprehensive analysis of the consequences of multiple pregnancies has recently been published. The HFEA report produced by the Expert group on multiple births after IVF (http://www.hfea.gov.uk/en/483.html) has provided irrefutable evidence that the extraordinary rise in the prevalence of twin births in the UK is, in the main, due to fertility treatment, particularly IVF. Over 40,000 IVF cycles now take place in the UK each year, with average pregnancy rates following treatment now over 25% per cycle initiated. One in four pregnancies derived from IVF results in a twin birth – a tenfold increase in risk over natural conception. Given the major immediate and long-term consequences for women and, particularly, the children associated with twin birth, this level of demand on maternity, neonatal paediatric and child health services presents major problems for the statefunded health sector. A multiple pregnancy should not be regarded as the ideal outcome of IVF treatment. While two healthy babies may be born, twin pregnancies can result in adverse outcomes for both mother and child. With IVF-associated conceptions now accounting for in excess of 1% of UK births, the aim must be to ensure that these children are afforded the maximum chance of a healthy start in life. The direct link between the number of embryos transferred to the uterus during IVF treatment and the chance of twin pregnancy is beyond dispute. It is the view of the organizations contributing to this document that, with much of Europe now offering elective single embryo transfer (SET) as the norm, continued high multiple embryo transfer and twin pregnancy rates are impossible to justify. Measures to reduce the burden of twin pregnancies will need to take into account the many and complex influences on clinical and laboratory practice in the UK. This consensus statement brings together the views of providers of treatment (clinicians, scientists
TL;DR: This paper will argue that the Human Fertilisation and Embryology Act should be amended so that the point of no return for withdrawal of consent to the use of gametes is the creation of an embryo with thosegametes (fertilization).
Abstract: Disputes over stored embryos are inevitably difficult to resolve, as we have seen in the case of Natalie Evans and Howard Johnston. The Department of Health is currently reviewing the Human Fertilisation and Embryology Act 1990 following a public consultation in August 2005. In this paper, I will argue that the Act should be amended so that the point of no return for withdrawal of consent to the use of gametes is the creation of an embryo with those gametes (fertilization). By point of no return, I mean the point at which donors/providers should no longer be able to withdraw consent. I will argue that no distinction should be drawn between donors – those who give gametes for others to use for procreative purposes – and providers – those who use their own gametes for their own procreative purposes. I will also look at how egg-sharers (who both donate and provide gametes) should be regarded, and whether an exception should be made for embryo donors.
TL;DR: It is argued that the time is right for interested professionals to enter the debate, especially in view of proposed revisions to the Human Fertilisation & Embryology Authority's code of conduct which requires clinics providing ART to consider the ‘welfare of the child’.
Abstract: The inability of local National Health Service trusts to uniformly provide assisted reproduction technology (ART) services has resulted in what has come to be known as a 'postcode lottery'. Older women and those with responsibility for children at home, often have to fund their own treatment. Recently, with the birth of babies to much older women, the mass media have debated whether those past menopausal age should be helped to achieve a pregnancy in this way. We argue that the time is right for interested professionals to enter the debate, especially in view of proposed revisions to the Human Fertilisation & Embryology Authority's code of conduct which requires clinics providing ART to consider the 'welfare of the child'. With that change in mind, we set out the case for imposing upper age limits on those receiving ART in the United Kingdom.
TL;DR: Findings are reported on from a qualitative study in which 18 semi-structured interviews were performed with geneticists and gynaecologists in Italy, Sweden and the UK about the attitudes to and experiences of medical professionals as regards PGD.
Abstract: Studies have been made on attitudes to and experiences of women and men who have undergone pre-implantation genetic diagnosis (PGD), or who are regarded as potential users of this diagnostic method. Few studies have been conducted regarding the attitudes to and experiences of medical professionals as regards PGD. This paper reports on findings from such a qualitative study in which 18 semi-structured interviews were performed with geneticists and gynaecologists in Italy, Sweden and the UK. Interviewees emphasized, among other things, the importance of choice provision. Interviewees also told stories that indicated the many ways through which choice was feared to be hampered - or was hampered. A similar emphasis on the importance of PGD as one more alternative to choose between, for 'high-risk' couples, is not found in studies on the experiences, attitudes and views of potential, or actual, users of PGD.
TL;DR: This book brings together contributions from current world leaders in the field of perinatal medicine and the neuroendocrine control of reproduction and suffers the fate of many multi-author volumes, in that there is little coordination between the authors’ contributions.
Abstract: Birth, distress and disease is the product of a symposium held in 2002 and covers many important aspects of perinatal medicine and the role of the hypothalamic – pituitary – adrenal (HPA) axis in the regulation of placental function. This book brings together contributions from current world leaders in the field of perinatal medicine and the neuroendocrine control of reproduction. The book suffers the fate of many multi-author volumes, in that there is little coordination between the authors’ contributions. Whilst each chapter stands alone as an excellent review, the book lacks a cohesive structure. Many points are repeated in three or four chapters, which is rather disappointing, not to mention extremely annoying if one had paid a considerable sum for a relatively short book. Given that this book isn’t really about foetal distress or disease, the current title is, I feel, inappropriate. The subject matter is focused most heavily on the endocrine and neuroendocrine actions of corticotrophin releasing hormone (CRH), so perhaps Placenta – brain interactions would be a more appropriate title. There are eight chapters in the book, with an interesting introduction and overview from the editors. The opening chapter entitled ‘Placental expression of neurohormones and other neuroactive molecules’, by Wylie Vale and colleagues, is a comprehensive overview of the subject, detailing the range of neuroendocrine agents that are expressed in placenta and describing their role in regulating foetal – placental blood flow, myometrial contractility and, ultimately, the timing of parturition. This leads well into a description in the following chapter of the role of CRH in the regulation of human parturition. Chapter Three, ‘Maternal nutrition and metabolic control of pregnancy’, seeks to explore a role for nutritional modulation of neuroendocrine factors in pregnancy. I did not find the argument that inadequate nutrition could impact upon hormone production and subsequently determine pregnancy outcomes convincing, but the proposed mechanisms involving CRH, the insulin-like growth factors and leptin were well described and interesting. The fourth and fifth chapters of the book overlap heavily, and the contributions from John Challis and colleagues, and Jonathan Seckl and colleagues, respectively, cover essentially the same area. Nonetheless, these reviews of the contribution of glucocorticoids to the programming of disease in later life are excellent and each has a slightly different focus. Challis considers the role of glucocorticoids in activation of the foetal HPA axis and the use of antenatal steroids in preterm labour. Seckl describes in more detail how prenatal glucocorticoids increase risk of metabolic syndrome in adult life, and also introduces the idea that exposure to these hormones in foetal life may programme the brain and later behaviour. Again, this overlapped with the following short chapter on prenatal stress and infant development, although this contribution from Davis and colleagues had more of a focus on human infants rather than animal models. The final chapter of the book again picks up on this theme and considers the role of glucocorticoids on the length of gestation (repeating material from earlier chapters) and considers the impact of maternal stress on the development of temperament, behaviour and behavioural disorders of children. A chapter from Alan Watts is confusingly placed near the end of the book. This contribution describes in detail the HPA axis with a focus entirely on the brain. The chapter does not specifically explore interactions with the placenta or consider changes that occur in pregnancy, but is an excellent source of information. It would have been useful if it had followed on from the first chapter in the book, to set the scene for the chapters that are focused on pregnancy, development and HPA function in later life. One of the aspects of this book that I enjoyed and feel will be extremely useful for students, is the inclusion of highlighted text boxes that introduce the various neuroendocrine agents discussed in the chapters. These describe the nature of each hormone, relevant receptors, levels in biofluids and sites of expression. Sadly, these text boxes appeared only in the early chapters. Human Fertility, June 2007; 10(2): 131 – 132
TL;DR: In this paper, it is suggested that the cryopreservation and storage of oocytes and ovarian tissues be restricted only to women facing the prospect of premature ovarian failure, and that only a limited amount of autologous reproductive material can be stored for a single healthy woman, there is a risk of material depletion before reproductive success is attained.
Abstract: Recent advances in oocyte and ovarian tissue cryopreservation technology have not only brought hope to women facing premature loss of ovarian function; it can also be utilized for healthy women seeking to extend their biological clocks. This is a major issue of contention in healthcare ethics. Proponents of this new technology argue that this enables women to fully pursue educational and career goals in their youth, whilst upon reaching middle age they would have more financial resources for their offspring. Nevertheless, this argument is flawed by the reality that even if the cryopreservation of oocytes and ovarian tissue were optimized, this would in no way be a guaranteed route for women to have biological children later in life. Moreover, because only a limited amount of autologous reproductive material can be cryopreserved and stored for a single healthy woman, there is a risk of material depletion before reproductive success is attained. Another prime consideration is the increased morbidity and mortality associated with clinical assisted reproduction in older women. Hence, it is suggested that the cryopreservation and storage of oocytes and ovarian tissues be restricted only to women facing the prospect of premature ovarian failure.
TL;DR: It was a pleasure to read this comprehensive text on all aspects of ovarian hyperstimulation syphilis and its role in women's health.
Abstract: Botros R. M. B. RizkCambridge University Press, 2006ISBN 0-521857-98-8, 232 pp., Price £40.00/US$70.00It was a pleasure to read this comprehensive text on all aspects of ovarian hyperstimulation sy...
TL;DR: Crawshaw, A Glaser, J Hale, A Pacey, S Pike, and J Stewart as discussed by the authors presented the prospect of possible infertility and sexual changes in the light of cancer.
Abstract: M Crawshaw, A Glaser, J Hale, A Pacey, S Pike, & J StewartCancerBackup, 2005ISBN 1-904370-97-7, 72 pp, Price £195Facing the prospect of possible infertility and sexual changes in the light
TL;DR: This comprehensive review of contemporary infertility counselling covers a whole gamut of fertility issues, and is extremely readable and informative.
Abstract: Sharon N. Covington & Linda Hammer BurnsCambridge University Press, 2006ISBN 0-521-61949-1, 658 pp.When I took delivery of this book, I felt somewhat overwhelmed by the sheer number of topics addre...
TL;DR: It is indicated that anovulatory patients benefit from ovulation induction with gonadotropins prior to IVF treatment, and the multiple pregnancy rate was 17%.
Abstract: Patients with anovulatory infertility, who received treatment at one unit over a four year period, were assessed to determine the pregnancy rate and the incidence of complications while undergoing ovulation induction with gonadotropins. The patients in this group who had further in vitro fertilization (IVF) treatment were followed up, and the outcome in IVF cycles was assessed. Data from a total of 75 patients, who had completed 91 episodes of treatment involving 273 cycles of ovulation induction over a 4-year period in a University-affiliated teaching hospital, was analysed retrospectively. The cumulative pregnancy rate was 34% after three ovulation induction cycles, and was 46% overall. The clinical pregnancy rate per cycle was 15.4%, and per ovulatory cycle was 21%. The multiple pregnancy rate was 12%, and there were no cases of ovarian hyperstimulation syndrome (OHSS). In this group of patients undergoing ovulation induction, the multiple pregnancy rate was 12% and there were no cases of ovarian hyperstimulation syndrome (OHSS). The multiple pregnancy rate was 17%. Our result indicate that anovulatory patients benefit from ovulation induction with gonadotropins prior to IVF treatment.
TL;DR: Key questions to pose while deciding whether new evidence from RCTs should influence subfertility patient care are reviewed.
Abstract: Randomized controlled trials (RCTs) are central to the understanding of treatment effectiveness and diagnostic test utility If they are to be relied upon in clinical practice, data from trials should have three main attributes: validity (be free from bias); clinical relevance (be based on patients similar to your own, reporting outcomes that matter to them); and importance (demonstrate effect sizes that are large enough to justify the costs and risks entailed) With these principles in mind, this brief article reviews key questions to pose while deciding whether new evidence from RCTs should influence subfertility patient care