Showing papers in "Human Fertility in 2018"
TL;DR: The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes and recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques.
Abstract: Fertility preservation in the female poses several challenges due to the invasive nature of the techniques available to achieve it. The guideline aims to bring together the evidence available for the measures for fertility preservation and their outcome. The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes. The techniques that the guideline considers are: (i) embryo and oocyte cryopreservation; (ii) ovarian tissue cryopreservation; (iii) GnRH agonist suppression and (iv) ovarian transposition. Although ovarian tissue cryopreservation is still considered experimental, the availability of this technique is gaining momentum as more live births from auto-transplanted tissue are reported. The guideline also highlights use of current treatment modalities for benign and malignant conditions that have a better fertility sparing profile. The guideline recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques. The role of psychological support in assisting women and girls with decision-making is highlighted. The guideline also highlights the risks associated with these techniques. Women need to be medically fit to undergo invasive procedures. Fertility preservation techniques are appropriate when treatment has curative intent. Fertility preservation is a subject of on-going research on outcomes of different techniques and at the time of publication, studies are still likely to emerge adding to the available literature.
67 citations
TL;DR: A brief commentary about the impact of gynaecologic cancer treatments on the reproductive capacity of affected women and the importance of the fertility preservation treatments to improve quality of life and psychological well-being is proposed.
Abstract: The aim of this article is to propose a brief commentary about the impact of gynaecologic cancer treatments on the reproductive capacity of affected women and the importance of the fertility preservation treatments to improve quality of life and psychological well-being. The experience of gynaecologic cancer and treatment affects sexual function and psychological well-being of patients. Therefore, the preservation of reproductive potential is central to quality of life. Despite the importance of fertility preservation for cancer survivors' quality of life and psychological well-being, there is still little information about these treatments. We suggest that further studies about the impact on quality of life and psychological outcomes of fertility preservation counselling and fertility preservation treatments should be conducted.
49 citations
TL;DR: This commentary illustrates the personal complexities faced by three older women and their families on learning not only of their genetic relationship to each other but also to 15 more donor-related siblings through ‘direct-to-consumer’ DNA testing.
Abstract: Increasing numbers of donor-conceived individuals (and/or parents) are seeking individuals genetically related through donor conception. One route is through ‘direct-to-consumer’ (DTC) DNA testing,...
45 citations
TL;DR: It is concluded that health care providers should be aware of the factors affecting the quality of life (QoL) and give counselling to improve couples’quality of life at infertility clinics.
Abstract: Infertility is a major life crisis affecting couples’ psychosocial and physical health We aimed to assess the quality of life in Turkish infertile couples This cross-sectional survey was carried out in 127 infertile couples admitted to a University Hospital The quality of life was measured using the fertility quality of life tool (FertiQoL) scale Women had lower overall quality of life than men Women and men who were married for fewer than 10 years had a significantly lower emotional score Women who had a history of infertility treatment, men who have lived in the town or village men with primary infertility and men who have had primary education or lower, had lower scores for mind/body subscale Social scores were found lower in women under the age of 30, women with middle or low income, men who were married for fewer than 10 years, men who did not have children for 5 years or more and men with primary infertility The tolerability and environment scores were significantly higher in women w
29 citations
TL;DR: The results suggest that G1793A substitution might be a protective genetic factor against male infertility, however, further case-control studies are required to provide a more robust conclusion.
Abstract: In this paper, we evaluate the association of the human methylenetetrahydrofolate reductase (MTHFR)-G1793A transition with male infertility using a case-control study, a meta-analysis and an in sil...
25 citations
TL;DR: In this article, the authors performed a retrospective cohort study to determine if a correlation exists between endometrial thickness measured on the day of ovulation trigger during an in vitro fertilization (IVF) cycle and pregnancy outcomes among non-cancelled cycles.
Abstract: Our objective was to determine if a correlation exists between endometrial thickness measured on the day of ovulation trigger during an in vitro fertilization (IVF) cycle and pregnancy outcomes among non-cancelled cycles. We performed a retrospective cohort study looking at 6331 women undergoing their first, fresh autologous IVF cycle from 1 May 2004 to 31 December 2012 at Boston IVF (Waltham, MA). Our primary outcome was the risk ratio (RR) of live birth and positive β-hCG. We found that thicker endometrial linings were associated with positive β-hCG and live birth rates. For each additional millimetre of endometrial thickness, we found a statistically significant increased risk of positive β-hCG (adjusted RR: 1.14; 95% CI: 1.09-1.18) and live birth (RR: 1.08; 95% CI: 1.05-1.11). There was no association between endometrial thickness and miscarriage (RR: 0.99; 95% CI: 0.91-1.07). Similar results were seen when categorizing endometrial thickness. Compared with an endometrial thickness >7 to <11 mm, the likelihood of a live birth was significantly higher for an endometrial thickness ≥11 mm (adjusted RR: 1.23; 95% CI: 1.11-1.37) and significantly lower for the ≤7 mm group (adjusted RR: 0.64; 95% CI: 0.45-0.90). In conclusion, thicker endometrial linings were associated with increased pregnancy and live birth rates.
24 citations
TL;DR: Improved information provision will result in greater awareness of egg sharing, with the potential to recruit more donors and meet the needs of recipients currently on long waiting lists, according to a systematic search of peer-reviewed journals.
Abstract: This review aims to provide an up-to-date knowledge of the psychosocial aspects of egg donation from the perspectives of the egg share donor and their recipient It explores the motives, experiences and attitudes of egg sharers and their views towards donor anonymity and disclosure Conclusions are made on how these findings can guide clinical practice and improve egg sharing numbers A systematic search of peer-reviewed journals of four computerized databases was undertaken Eleven studies were included in the review Psychosocial aspects towards donation were positive from the egg share donor and recipient Concerns raised were whether participating in the egg sharing scheme would impact on their success rates, as well as frustration expressed by a minority regarding the lack of knowledge of egg sharing outside of fertility clinics The 2005 legislative changes in the UK have not caused the anticipated dramatic decrease in egg donation; however, oocyte donation still falls short of demand Egg sharing provides a practical option for more patients to access IVF, whilst also providing more donor oocytes Improved information provision will result in greater awareness of egg sharing, with the potential to recruit more donors and meet the needs of recipients currently on long waiting lists
24 citations
TL;DR: A AQP3, DPP4 and TIMP3 whose expression patterns were down-regulated in Rif patients both by microarray and real-time PCR had a high correspondence with previous studies demonstrating that these genes may contribute to the defects in endometrial receptivity in RIF patients, and these RIF-associated mRNAs may help devise new diagnostic tools for endometrian receptivity.
Abstract: High endometrial receptivity in the window of implantation (WOI) is essential for successful implantation However, a diagnostic tool with high specificity for impaired endometrial receptivity remains to be developed We collected endometrium specimens during the WOI from patients with RIF and women who conceived after one IVF/ICSI attempt We conducted mRNA microarray on the samples followed by relevant comparative and functional analysis Microarray analysis revealed 357 dysregulated mRNAs between the two groups The majority of these mRNAs were found to encode membrane proteins by Gene Ontology (GO) analysis The major functional biological pathways associated with the down-regulated mRNAs were cytokine-cytokine receptor interaction, the p53 signalling pathway and the complement and coagulation cascades Up-regulated mRNAs were found mainly to participate in pathways such as PPAR signalling, hematopoietic cell lineage, phosphatidylinositol signalling system, ECM-receptor interaction and notch signalling AQP3, DPP4 and TIMP3 whose expression patterns were down-regulated in RIF patients both by microarray and real-time PCR had a high correspondence with previous studies demonstrating that these genes may contribute to the defects in endometrial receptivity in RIF patients Overall, these RIF-associated mRNAs may help devise new diagnostic tools for endometrial receptivity
24 citations
TL;DR: The disparities in parents’ experiences of undergoing surrogacy in different countries are highlighted, the frustrations some face in obtaining legal parenthood and the feelings of stress and anxiety this may cause.
Abstract: This study aimed to explore UK intending parent’s reasons for cross-border and domestic surrogacy, their preparations for the birth and the practical and legal challenges faced after the birth. An ...
16 citations
TL;DR: It was important for recipients to know the identity of the donor, some did not see this as important for the child and thus the level of information that parents have about the donor and that which the child has, can differ.
Abstract: Whilst studies have examined the experiences of women who use clinic donors, to date there has been limited research investigating women's motivations and experiences of searching for a sperm donor online. A total of 429 women looking for a sperm donor on Pride Angel (a website that facilitates contact between donors and recipients) completed an online survey. Fifty-eight percent (249) saw advantages of obtaining donated sperm online with the most common advantage reported as being able to connect with and meet the donor (n = 50 (24%)). A third (n = 157 (37%)) of the participants gave disadvantages, the most common reported was encountering 'dishonest donors' (n = 63 (40%)). Most recipients (n = 181 (61%)) wanted the donor to be 'just a donor' (i.e. to provide sperm and have no further contact). Whilst it was important for recipients to know the identity of the donor, some did not see this as important for the child and thus the level of information that parents have about the donor, and that which the child has, can differ. Finding a donor online blurs the distinction between categories of 'anonymous', 'known' and 'identity release' donations. Whilst the survey had a large sample size, the representativeness of the sample is not known.
16 citations
TL;DR: The observed beneficial effects could be the result of a more stable environment provided by the TLM system.
Abstract: In this prospective cohort study, the effects of a time-lapse monitoring system on embryo quality and clinical pregnancy outcomes were assessed. A total of 608 patients undergoing in vitro fertilization between April 2013 and June 2014 at our institution were recruited for this study and group-matched into a time-lapse monitoring (TLM) (N = 304) or a standard incubator (SI) (N = 304). The patients' characteristics in the TLM and SI groups were not significantly different. The TLM group showed a significantly higher transferable embryo ratio at Day 3 (61.65% vs. 52.87%; p < 0.0010, RR =1.10 [1.02, 1.19]), a higher number of transferable embryos (4.71 ± 2.38 vs. 4.09 ± 2.35; p = 0.0053, SMD =0.26 [0.06, 0.46]) and number of good-quality embryos cryopreserved at Day 3 (2.72 ± 2.35 vs. 2.11 ± 2.33; p = 0.0056, SMD =0.26 [0.06, 0.46]). In addition, the implantation and clinical pregnancy rates were not statistically significant between the TLM and SI groups. However, the TLM group had a higher ongoing pregnancy rate (67.32% vs. 57.22%; p = 0.0410) and live birth rate (65.37% vs. 55%; p = 0.0380) compared with the SI group. The observed beneficial effects could be the result of a more stable environment provided by the TLM system.
TL;DR: Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism.
Abstract: Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management. Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism. GnRH antagonist was shown in few studies to be effective in treatment of early severe OHSS although further research is required to assess its role in this context. Appropriate outpatient set up and protocols are essential to provide safe outpatient management for women with severe OHSS.
TL;DR: This commentary aims to explain some of the discrepancies, and emphasize why human embryo metabolism tells us that the composition of HECM, as well as the role of the MEA as a unique model, should be re-evaluated.
Abstract: DNA methylation is a biochemical process that modifies gene expression without changing the underlying DNA sequence, and this represents the molecular basis for imprinting and epigenetics. Recent reports have revealed alterations in DNA methylation profiles in the placenta of babies born from assisted reproductive technologies (ART). This supports several previous observations that suggested an increase in the prevalence of imprinting diseases following ART treatment, and also fits our observations regarding the metabolism and requirements of early human embryos. Human embryo culture media (HECM) are currently formulated according to requirements based on the mouse embryo model, and in fact need to pass the Mouse Embryo Assay test in order to be accepted by the relevant authorities, despite the fact that physiological (especially the time necessary to reach genomic activation) and biochemical requirements of mouse and human embryos are quite different. This commentary aims to explain some of the discrepancies, and emphasize why human embryo metabolism tells us that the composition of HECM, as well as the role of the MEA as a unique model, should be re-evaluated.
TL;DR: Knowledge about fertility preservation was limited among participants and positive attitudes towards fertility preservation significantly outweighed negative attitudes, and confidence of knowledge was significantly higher in women who underwent any FP procedure compared to those who did not.
Abstract: Recent advances in cancer therapy have resulted in an increased number of long-term cancer survivors. However, because of their treatment, women might be confronted with impaired fertility. The options of fertility preservation (FP) techniques are increasing. The goal of this study was to assess knowledge about, and attitudes towards, fertility preservation in young female cancer patients. A cross-sectional online survey was conducted including 155 former female cancer patients from English and German speaking countries. The survey consists of questions about attitude towards, and knowledge about, fertility preservation. Results show that knowledge about fertility preservation was limited among participants. Positive attitudes towards fertility preservation significantly outweighed negative attitudes. Knowledge and attitude did not differ according to language or different healthcare systems. Confidence of knowledge was significantly higher in women who underwent any FP procedure compared to those who did not. Greater emphasis should be placed on counselling opportunities, the provision of adequate information and supporting material. A better understanding of these issues will hopefully enhance patients’ decision-making about FP options and assist the development of strategies to improve quality of care.
TL;DR: The two new automated assays, with their potentially improved technical performance, require detailed examination and comparison under different conditions, and the determination of categories of responses to ovarian stimulation, require re-evaluation for these new tests.
Abstract: The measurement of AMH has now become widespread practice within the field of fertility treatment and research, despite technical issues with some of the original assays. The two new automated assays, with their potentially improved technical performance, require detailed examination and comparison under different conditions. In addition, the determination of categories of responses to ovarian stimulation, require re-evaluation for these new tests. The performance of the assays across numerous laboratories, and over a protracted timeframe, has been examined through the UK NEQAS published results. The automated assays show high quality performance figures over a broad concentration range, with exceptionally low variance figures, and they also yield very similar absolute concentration values. Critical response diagnostic concentrations have been re-evaluated by determination of age-related concentrations from within large population datasets.
TL;DR: Office hysteroscopy-guided selective chromoperturbation in infertile patients is a valid technique to evaluate tubal patency and the uterine cavity, andSide effects or late complications and pregnancy rate were recorded three and six months after the procedure.
Abstract: The aim of this study was to evaluate accuracy, tolerability and side effects of office hysteroscopic-guided chromoperturbations in infertile women without anaesthesia. Forty-nine infertile women underwent the procedure to evaluate tubal patency and the uterine cavity. Women with unilateral or bilateral tubal stenosis at hysteroscopy with chromoperturbation, and women with bilateral tubal patency who did not conceive during the period of six months, underwent laparoscopy with chromoperturbation. The results obtained from hysteroscopy and laparoscopy in the assessment of tubal patency were compared. Sensitivity, specificity, accuracy, positive-predictive value and negative-predictive value were used to describe diagnostic performance. Pain and tolerance were assessed during procedure using a visual analogue scale (VAS). Side effects or late complications and pregnancy rate were also recorded three and six months after the procedure. The specificity was 87.8% (95% CI: 73.80–95.90), sensitivity was 8...
TL;DR: The use of Bemfola®, across all 4724 cycles, could result in a drug wastage reduction of up to 376,800 IUs with an associated cost saving of £100,011.
Abstract: Bemfola® is a recombinant follicle-stimulating hormone (FSH) used during infertility treatment One main differentiator between FSH products is their delivery device; consisting of multi-dose pens (Gonal-f®), vials or multi-dose preparations (Menopur®), or adjustable daily disposable dose pens (Bemfola®) To determine the potential impact of delivery device on drug wastage during infertility treatment this study retrospectively analysed Gonal-f® and Menopur® prescription and usage data from five UK clinics Incurred drug wastage was then compared to potential Bemfola® drug wastage Data collected included: (i) number of treatment cycles; (ii) daily FSH dose; (iii) length of treatment; (iv) dose adjustment following ultrasound scan; (v) FSH formulation(s) prescribed and (vi) agonist/antagonist protocol used Treatment with Gonal-f® (4078 cycles) and Menopur® (646 cycles) resulted in an average drug wastage of 160 and 294 IU per treatment cycle Use of Bemfola® instead of Gonal-f® and Menopur® may r
TL;DR: There was an increased frequency of DAZ microdeletion in blood samples from oligozoospermic and near azoospermic patients and the frequency of sex chromosome aneuploidy also increased, correlating with the severity of infertility in the studied groups.
Abstract: The occurrence and diagnosis of Y-chromosome microdeletions, specifically deletions of the DAZ (Deleted in Azoospermia) genes are an important issue in male infertility Screening Y chromosome microdeletion is mainly done using polymerase chain reaction (PCR) on blood leukocytes However, there is some evidence indicating that presence of DAZ in somatic cells might not be indicative of its presence in the germ cell lineage Therefore, a total of 130 men with poor semen quality were examined for presence of DAZ microdeletion in their leukocytes From these, sperm from 40 randomly selected men with no DAZ microdeletions in their leukocytes (n = 10 oligozoospermia; n = 10 asthenozoospermia; n = 10 oligoasthenozoospermia; and n = 10 near-azoospermia) were were compared to sperm from men of normal semen quality (n = 10) using combined primed in situ labelling and fluorescent in situ hybridization (PRINS-FISH) technique as well as screening for sex chromosome aneuploidy There was an increased frequency
TL;DR: The provision of fertility preservation is lacking and improvements can be made in the number of referrals from oncology, the provision of cryopreservation and the Provision of NHS funding.
Abstract: This survey examined the provision of fertility preservation for female oncology patients prior to cancer treatments, given their well-established gonadotoxic effects Questionnaires were sent to all assisted conception units in the UK enquiring about the provision of oocyte or embryo cryopreservation, as well as funding for female oncology patients In addition, data were obtained from the Human Fertilisation and Embryology Authority (HFEA) on the number of cryopreservation cycles in 2013-2014 Of the 60 responding units, 53 (88%) offered fertility preservation However, only 6 (11%) units performed more than 25 oocyte or embryo cryopreservation cycles per year, with 33 units (62%) treating fewer than 10 women per year A total of 44 (90%) reported some National Health Service (NHS) funding, but only 12 (23%) had funding granted automatically and only 26 (49%) could offer NHS funded treatment exempt from their local eligibility criteria for in vitro fertilisation (IVF) The HFEA data reported 154 NHS funded oocyte cryopreservation cycles in 2014 We conclude that the provision of fertility preservation is lacking and improvements can be made in the number of referrals from oncology, the provision of cryopreservation and the provision of NHS funding Developing a national fertility preservation network and close liaison with oncology and Clinical Commissioning Groups are recommended
TL;DR: Results showed that exogenous BDNF at 0.133 nM could significantly influence viability, motility, NO concentration, mitochondrial activity and LPO content, while secretions of insulin and leptin by human sperm were increased in cells exposed to the exogenousBDNF.
Abstract: The neurotrophin family of proteins and their receptors act as important proliferative and pro-survival factors in differentiation of nerve cells and are thought to play key roles in the development of reproductive tissues and normal function of spermatozoa. The objective of the present study was to evaluate the effect of Brain-Derived Neurotrophic Factor (BDNF) on the sperm viability and motility, lipid peroxidation (LPO), mitochondrial activity and concentration of leptin, nitric oxide (NO) and insulin in normozoospermic men. Semen samples from 20 normozoospermic men were divided into three groups: (i) control, (ii) BDNF and (iii) BDNF + K252a. BDNF and K252a were added in the dose of 0.133 and 0.1 nM, respectively. Viability was assessed by eosin–nigrosin staining technique, and motility was observed by microscopy. NO concentration and mitochondrial activity were measured with flow cytometry, and LPO was analyzed using enzyme-linked immunosorbent assay (ELISA) kits. Results showed that exogenou...
TL;DR: It is concluded that BV does not appear to have an adverse impact on outcomes in women being treated with ICSI for male factor infertility and is not associated with miscarriage and preterm birth.
Abstract: This study aimed to assess the possible association of bacterial vaginosis (BV) and early miscarriage in 408 women undergoing intracytoplasmic sperm injection (ICSI) for reasons of male infertility...
TL;DR: The findings suggest that male factor infertility might be associated with an increased level of interleukin-6, and this was not found for the two other inflammatory markers.
Abstract: Male factor infertility is associated with an increased risk of disease and mortality, which has been related to markers of chronic systemic inflammation. The objective of this study was to investigate the association between male factor infertility and low-grade inflammation and furthermore to examine the lifetime prevalence of male factor infertility and overall infertility (also including female and couple infertility). The study population consisted of 2140 members of the Metropolit 1953 Danish Male Birth Cohort who had participated in the Copenhagen Aging and Midlife Biobank data collection in 2009-2011. Information on male factor infertility and overall infertility was obtained from a questionnaire, and low-grade inflammation was evaluated as the highest plasma levels of C-reactive protein, interleukin-6 and tumour necrosis factor-alpha in the population. The level of interleukin-6 was significantly higher among men with male factor infertility compared with other men adjusted for potential confounders. This was not found for the two other inflammatory markers. The lifetime prevalence of male factor infertility and overall infertility were 10.2% and 17.9%, respectively. The findings suggest that male factor infertility might be associated with an increased level of interleukin-6.
TL;DR: The unbiased prevalence of non-classic congenital adrenal hyperplasia (NCAH) due to 21-hydroxylase (21-OH) deficiency among hyperandrogenic women in a Russian population was 0.9%, and diagnostic value of basal serum 17-hydroxyprogesterone (17-OHP) level to diagnose this disease was evaluated.
Abstract: The aim of the study was to determine the prevalence of non-classic congenital adrenal hyperplasia (NCAH) due to 21-hydroxylase (21-OH) deficiency among hyperandrogenic women in a Russian population and to evaluate diagnostic value of basal serum 17-hydroxyprogesterone (17-OHP) level to diagnose this disease. A total of 800 consecutive Caucasian women presenting with elevation of at least one serum androgen and/or manifestation of one of the clinical androgenic symptoms were prospectively recruited and evaluated by basal 17-OHP. The diagnosis of NCAH due to 21-OH deficiency was considered in patients when basal level exceeded 5.0 nmol/L and CYP21A2 gene mutation analysis was performed in this case. Eight (1.0%) of the patients had NCAH due to 21-OH deficiency confirmed by genotyping. These women had a V281L mutation: five homozygous and three compound heterozygous with genotypes V281L/P453S, V281L/I2splice and V281L/I2splice. One patient was diagnosed with NCAH (genotype V281L/I2splice) before the...
TL;DR: Jean Purdy is almost forgotten as one of the British trio that introduced clinical IVF to the world but her name is brought to the attention of professionals in reproductive medicine and the patients they care for.
Abstract: Jean Purdy is almost forgotten as one of the British trio that introduced clinical IVF to the world. An unlikely pioneer, she qualified as a nurse but through indefatigable effort and unstinting loyalty to a programme that faced vitriolic opposition she became the clinical embryologist for the first IVF baby. In 1980, she helped to launch fertility services as the 'Technical Director' of Bourn Hall Clinic, near Cambridge. Although Robert Edwards and Patrick Steptoe generously credited her role in research and clinical care, a premature death in 1985 at age 39 robbed her of the reward of witnessing the blossoming of assisted reproductive technologies for patients around the world. This commentary seeks to recognize her contribution and bring her name to the attention of professionals in reproductive medicine and the patients they care for.
TL;DR: Fertility preservation in an adolescent female diagnosed with Myelodysplastic/pre-malignant Clone with Monosomy 7 with pathophysiology like that of chronic myeloid leukaemia with known genetic markers in the tumour cells is described.
Abstract: An improvement in long-term outcomes for malignancies and non-malignant conditions, together with a review of the NICE Guideline, has led to a need to provide clinical services to deal with the sequelae of disease, its treatment, and subsequent survival of young people diagnosed with cancer. In this article, we describe fertility preservation in an adolescent female diagnosed with Myelodysplastic/pre-malignant Clone with Monosomy 7 with pathophysiology like that of chronic myeloid leukaemia (CML) with known genetic markers in the tumour cells. We used random start controlled ovarian stimulation (COS) leading to oocyte collection and vitrification of metaphase II oocytes. Despite successful COS and vitrification, there remain numerous ethical considerations that merit more focussed discussion. Not least, in determining best practice for informed consent, but consideration of individualised protocols for ovarian stimulation, monitoring follicular development, together with prevention of ovarian hype...
TL;DR: Adequately powered multicentre randomised trials are required to evaluate these techniques before considering clinical application, as there was major heterogeneity in study design and methodology for quantitative synthesis.
Abstract: Successful fertilisation is one of the key steps determining success of assisted conception Various factors including sperm or oocyte pathology and environmental factors have a significant impact on fertilisation rates This systematic review is aimed to evaluate the existing evidence about factors affecting fertilisation and strategies to improve fertilisation rates A literature search was performed using Ovid MEDLINE ® (Jan 1950-April 2016), EMBASE (Jan 1950-April 2016), Ovid OLDMEDLINE ®, Pre-MEDLINE (Jan 1950-April 2016) and the Cochrane Library Relevant key words were used to combine sets of results and a total 243 papers were screened Only qualitative analysis was performed, as there was major heterogeneity in study design and methodology for quantitative synthesis Factors affecting fertilisation were divided into sperm- and oocyte-related factors The methods to improve fertilisation rates were grouped together based on the approach used to improve fertilisation rates Optimising laboratory condition and procedural effects in techniques is associated with improved fertilisation rates Various techniques are described to improve fertilisation rates including assisted oocyte activation, physiological intracytoplasmic sperm injection (PICSI) and intracytoplasmic morphologically selected sperm injection (IMSI) This review highlights the promising strategies under research to enhance fertilisation rates Adequately powered multicentre randomised trials are required to evaluate these techniques before considering clinical application
TL;DR: PGD has emerged as a safe and effective alternative to prenatal diagnosis but with ever evolving technological advances, a robust system of data collection that incorporates techniques used and reporting of mutation-specific clinical outcomes is suggested.
Abstract: In 2013, the National Health Service Commissioning board centralized the funding in England for up to three cycles of pre-implantation genetic diagnosis (PGD) for couples who have, or are carriers of, a specific genetic disorder. This study presents the historical data of PGD cycles and their clinical outcomes in UK as extrapolated from the national data registry. Retrospective analysis of outcome of cycles undergoing pre-implantation genetic diagnosis in the UK over the past 20 years was performed from the Human Fertilisation and Embryology Authority database (n = 2974). Binary logistic regression was used to determine trends over time and adjusted for maternal age. Briefly, the number of PGD cycles has risen 127-fold from 1991 to 2012 with 3.6-fold increase (360% rise) from 2004 to 2012. A total of one in four embryos following pre-implantation genetic diagnosis did not reach embryo transfer and 92% of these were due to a failure to survive. The live birth rate has risen over 20 years and there ...
TL;DR: Five papers back-to-back in this issue of Human Fertility which address various aspects of fertility preservation for girls and women are published, reminding us that fertility preservation is not just an issue for oncologists and cancer patients but should be a routine part of care in all areas of medicine.
Abstract: In the spring of 2001, I was diagnosed with a malignancy which required surgery and then a number of sessions of radiotherapy to cure. Thankfully it worked, and I am still here, but looking back it was quite a surreal and stressful experience; and certainly not one I would like to repeat. However, what was interesting about the whole affair was how it made me think about the obvious threat to my fertility – something I subsequently wrote about (Pacey, 2003). Fortunately, I was in charge of a large regional sperm bank at the time and so it was relatively easy for me to arrange the banking of my own sperm. However, not everyone is as lucky. Since then, I have been fortunate enough to have the opportunity to work voluntarily with the Teenage Cancer Trust and run workshops about fertility with young cancer patients from all over the UK. This has given me a unique insight into their own experiences and has even led to some research (Yeomanson, Morgan, & Pacey, 2013). In that study, we found that whilst male cancer survivors were generally satisfied about the frequency and timing of discussions about fertility, females were not. We hypothesised that this may reflect the approach to female fertility preservation by healthcare professionals or may simply be a consequence of the absence (at the time) of effective fertility preservation strategies for girls and women. Therefore, it is with great pleasure that we have been able to publish five papers back-to-back in this issue of Human Fertility which address various aspects of fertility preservation for girls and women. The first is a landmark policy and practice paper on the topic by the British Fertility Society. In this paper, Yasmin et al. (2018) propose a number of recommendations for UK practice. They also remind us that fertility preservation is not just an issue for oncologists and cancer patients but should be a routine part of care in all areas of medicine where the premature loss of fertility is a major threat. The second paper by Abdallah, Briggs, Jones, Horne, and Fitzgerald (2018) is a report of data collected by a combination of questionnaire, registry data and freedom of information legislation to demonstrate a relatively poor level of female fertility preservation in the UK. The third, a commentary by Vitale, La Rosa, Rapisarda, and Lagan a, (2018), argues that more studies are needed concerning the impact on quality of life and psychological outcomes of fertility preservation counselling and fertility preservation treatments in women with gynaecologic cancer. The fourth, by Peddie and Maheshwari (2018), describes the complexities involved in providing fertility preservation for a young girl of 14 years diagnosed with myelodysplastic/pre-malignant clone with monosomy 7 with pathophysiology like that of chronic myeloid leukaemia (CML). The final paper reports the results of an online survey undertaken by 155 former female cancer patients from English and German speaking countries. This shows that, whilst knowledge and attitude did not differ according to language or healthcare system, the confidence of knowledge was significantly higher in those women who had undergone fertility preservation compared to those who had not (Urech et al., 2018). I hope that these five papers provide a useful and timely collection of work which can influence this increasingly important aspect of reproductive medicine and open up more and better opportunities for girls and women to get timely access to fertility preservation when they need it. Finally, also in this issue, we publish the titles and authors of the abstracts from the recent (and excellent) Fertility 2018 meeting held in Liverpool. The full text of each abstract is available as a supplementary file.
TL;DR: It is suggested that cycles containing oocytes with severe ovoid ZPs had delayed embryo development, lower available embryo rate, compromised implantation, clinical pregnancy and live birth rates.
Abstract: The purpose of this study was to determine the incidence of oocytes with severe ovoid zona pellucida (ZP), investigate the development potential of their sibling oocytes and the clinical outcomes from affected cycles. The data were collected from our medical records. Cycles having at least one oocyte with severe ovoid ZP were defined as the ‘severe ovoid group’, cycles having at least one oocyte with mild ovoid ZP were defined as the ‘mild ovoid group’, whereas cycles without oocytes with ovoid ZPs were defined as the ‘control group’ (n = 150 for each group). The results showed that sibling embryos in the ‘severe ovoid group’ were characterized by delayed development and lower available embryo rate. The implantation, clinical pregnancy and live birth rates in this group were also significantly lower than that in the other two groups. There were five cycles in which only one embryo with severe ovoid ZP was transferred and two healthy babies were born. The mild ovoid group showed comparable embryo d...
TL;DR: This review did not find any improvement in clinical pregnancy rate with the intrauterine instillation of embryo culture supernatant prior to embryo transfer compared to no intervention in women undergoing ART and it remains uncertain regarding its effect on live birth rate.
Abstract: We planned a systematic review and meta-analysis of randomized clinical trials (RCTs) to examine the best available evidence regarding the intrauterine instillation of embryo culture supernatant prior to embryo transfer in ART. The outcomes were: (i) live birth; (ii) clinical pregnancy; (iii) multiple pregnancy; and (iv) miscarriage rates. Five RCTs were considered eligible and available for qualitative synthesis. Due to clinical heterogeneity, results from only two trials were combined for the meta-analysis. The live birth rate (risk ratio [RR], 0.47; 95% confidence interval [CI] 0.22–0.98; one study, 60 participants, low-quality evidence) was found to be significantly lower with intrauterine instillation of embryo culture supernatant compared to no intervention. The clinical pregnancy rate was similar between the embryo culture supernatant group and the control group (RR 1.02 RR, 95% CI 0.77–1.36; two trials, 156 participants, I2 = 0%). To conclude, this review did not find any improvement in cl...