Assisted Fertilization Techniques Research Articles

Bioethical assessment of embryo donation for research

Background: The present study aims to assess, from the bioethical tool, the use of embryos for scientific research and its impact on society. The research question is posed: "What bioethical aspects are related to the donation of excess embryos from cryopreservation laboratories?". The secondary objectives include determining the level of knowledge of the population about assisted reproduction techniques, identifying knowledge about the possible destinations of cryopreserved embryos and evaluating the positioning capacity of the population regarding ethical and moral issues. Methods: Observational study of a statistical nature through a questionnaire with relevant questions on the subject of bioethics in the investigation of surplus embryos from cryopreservation. The study population was composed of people of different sex and age, who are interested in gynecology issues. Results: The survey reveals that 55.8% knew about assisted fertilization techniques, 80.8% knew what IVF was, 69.2% were unaware of related laws, 84.6% understood informed consent in cryopreservation , 46% would not sign a long-term consent, 80.4% knew about cryopreservation, 82.7% support embryo freezing, 72.5% support embryo research, and there are divided opinions about its status : 60.8% cells, 51.9% human beings. Conclusion: The survey reveals that the participants have a general knowledge about assisted fertilization techniques and support the cryopreservation of embryos for research. However, there is a lack of knowledge about the laws that govern these techniques. Opinions are also divided on the nature and status of the frozen embryos. These results are relevant for the ethical debate and the regulation of practices related to embryos.

P-064 MicroRNAs as potential biomarkers for male infertility related to Testicular Germ Cell Tumors

Abstract Study question Could microRNAs represent efficient biomarkers to evaluate male infertility and the tendency of develop testicular germ cell tumors (TGCTs)? Summary answer The up-regulation of miR-193a-5p, miR-93-5p and let-7c-5p in TGCT patients with impaired spermiogram could represent a molecular signature of male infertility related to TGCTs. What is known already Testicular germ cell tumors (TGCTs) are the most recurrent tumors in young men with the highest incidence between the ages of 20 and 40 years and represent more than 60% of all cancers diagnosed in this age range. Several studies have shown a correlation between TGCTs and infertility, not only because infertility could be a consequence of testicular damage due to TGCTs but also because infertility may represent a risk factor for TGCTs. Therefore, it is important to find valid biomarkers that could be used to specifically identify infertility related to an increased risk of developing TGCTs. Study design, size, duration From March 2021 to January 2023, we collected 44 seminal plasma samples: 17 from TGCT patients who were undergoing sperm cryopreservation prior to chemotherapy, 14 with impaired spermiogram (IS) and 3 with normal spermiogram (NS) and 27 from control patients, 16 with IS and 11 with NS, undergoing assisted fertilization techniques. We evaluated the potential role of miRNAs as non-invasive biomarkers, analyzing the differential expression of 84 miRNAs in relation to cancer, infertility and both. Participants/materials, setting, methods Semen samples were placed 30’/37 °C, seminal plasma was purified using density-gradient centrifugation and stored at -80 °C. RNA was purified by Qiagen miRNeasy Serum/Plasma Kit and analyzed by miRCURY LNA miRNA SYBR®Green PCR_SerumPlasma, 96-well plate. We applied the 2−ΔΔCT method and statistical significance was evaluated by Significance Analysis of Microarrays, screened by p-values ≤ 0.05. We performed a Pearson correlation analysis applying two-sided p-values. miRTarBASE, MIENTURNET and Cytoscape were used for bioinformatics analysis. Main results and the role of chance In the four comparisons, we found 9 differentially expressed microRNAs. In particular, miR-221-3p, miR-222-3p, miR-204-5p and miR-205-5p down regulation would appear to be related to infertility, regardless to the cancer. Conversely, all TGCT patients shown an up-regulation of miR-376c-3p. Interestingly, up-regulation of miR-193a-5p, miR-93-5p and let-7c-5p specifically discriminates the infertile cancer patients vs other categories. Moreover, these three miRNAs showed a significant positive correlation both in cancer patients with impaired spermiogram and in infertile controls. This correlation demonstrates that their expression changes in the same way in the single samples and strongly suggests their role as early biomarkers of TGCT patients with impaired spermiogram. From the KEGG pathway analysis has emerged that DE miRNAs are involved in several signaling pathway, such as MAPK, mTOR, p53, PI3K-Akt, AMPK, FoxO, JAK-STAT, Ras, Estrogen signaling pathways, as well as cell cycle and cellular senescence. Moreover, from the Diseases Ontology analysis we found than those miRNAs are involved in germ cell tumor, male reproductive organ cancer, prostate cancer, male infertility and azoospermia. Limitations, reasons for caution The data must be validated by single assays in higher number of samples. These experiments are currently ongoing. Wider implications of the findings Three of the DE miRNAs are overexpressed in TGCT with impaired spermiogram patients. Specifically, they are over-expressed in TGCT with impaired spermiogram compared to infertile controls, so they may represent specific biomarkers able to discriminate, among the young men with infertility, those with higher risk of develop testicular cancer. Trial registration number Not applicable

Illegal use of fertilized eggs outside the womb (A comparative study)

Illegal use of fertilized eggs outside the womb (A comparative study)

Medically assisted procreation in times of COVID-19: what impact on health care system organization and the reproductive rights of couples?

Introduction:The emergency caused by the spread of COVID-19 has overwhelmed health care facilities and required the reorganization of health systems in many nations worldwide.Objective:The article aims to illustrate the measures aimed at containing the spread of SARS-CoV-2 and their impact on those seeking medically-assisted procreation procedures.Materials and Methods:By drawing upon international sources and documents from ethics committees and scientific societies about the COVID-19 pandemic and MAP, the article aims to expound upon and assess the measures issued by the Italian government in order to counter the spread of COVID-19.Results:The coronavirus disease 2019 (COVID-19) has had a major impact on infertile couples. Since the pandemic broke out, Italy, like most European countries, has interrupted most ordinary activities of the centers operating in the field of assisted fertilization.Discussion:Such measures are based on the principles of responsibility and solidarity, essential to stave off the saturation of health systems, curb contagion, but also to lay out a set of rules to starting a pregnancy while preserving the health of couples, operators and newborns. The authors also expound upon the rights claimed by couples seeking access to MAP (i.e. the right to become a parent, the couple’s right to health).Conclusions:We believe that access to assisted fertilization techniques by sterile and infertile couples should be part of the right to health rather than of the supposed right to become parents or the increase in the birth rate, also evoked as the COVID-19 pandemic unfolded. (www.actabiomedica.it)

Twin pregnancy in women with epilepsy.

We report data from the Raoul Wallenberg Australian Register of Antiepileptic Drugs in Pregnancy (APR) to see if there are significant differences in relation to the courses and outcomes of the twin pregnancies contained in the register, as compared with the singleton ones. The APR has been under the oversight of Melbourne institutional Human Ethics Research Committees; all women enrolled in the APR have provided written informed consent. Data from the APR were transferred to a spreadsheet and then analyzed using simple statistical techniques including logistic regression. The population studied comprised 44 twin and 2261 singleton pregnancies; thus, twin pregnancies accounted for 1.91% of all pregnancies studied. The women carrying twins tended to be older than the women with singleton pregnancies to a statistically significant extent, their pregnancies more often originated from assisted fertilization techniques, and their babies were more often delivered by cesarean section. There were no statistically significant differences in relation to antiepileptic drug (AED) therapy. Individual twins had statistically significantly lower mean birthweights than singleton babies and they were statistically significantly more often involved structurally malformed foetuses. In the first year of life, the twin pregnancies statistically significantly more often produced offspring that were affected by seizures in infancy. The data suggest that there may be an increased hazard of fetal malformation in the offspring of twin pregnancy in women with epilepsy, but that with contemporary standards of management of epilepsy and pregnancy, there is unlikely to be an increased hazard of seizure-affected pregnancy.

The Role of Zinc in Male Fertility.

Several studies proposed the importance of zinc ion in male fertility. Here, we describe the properties, roles and cellular mechanisms of action of Zn2+ in spermatozoa, focusing on its involvement in sperm motility, capacitation and acrosomal exocytosis, three functions that are crucial for successful fertilization. The impact of zinc supplementation on assisted fertilization techniques is also described. The impact of zinc on sperm motility has been investigated in many vertebrate and invertebrate species. It has been reported that Zn2+ in human seminal plasma decreases sperm motility and that Zn2+ removal enhances motility. Reduction in the intracellular concentration of Zn2+ during epididymal transit allows the development of progressive motility and the subsequent hyper activated motility during sperm capacitation. Extracellular Zn2+ affects intracellular signaling pathways through its interaction with the Zn2+ sensing receptor (ZnR), also named GPR39. This receptor was found in the sperm tail and the acrosome, suggesting the possible involvement of Zn2+ in sperm motility and acrosomal exocytosis. Our studies showed that Zn2+ stimulates bovine sperm acrosomal exocytosis, as well as human sperm hyper-activated motility, were both mediated by GPR39. Zn2+ binds and activates GPR39, which activates the trans-membrane-adenylyl-cyclase (tmAC) to catalyze cAMP production. The NHE (Na+/H+-exchanger) is activated by cAMP, leading in increased pHi and activation of the sperm-specific Ca2+ channel CatSper, resulting in an increase in [Ca2+]i, which, together with HCO3−, activates the soluble adenylyl-cyclase (sAC). The increase in [cAMP]i activates protein kinase A (PKA), followed by activation of the Src-epidermal growth factor receptor-Pphospholipase C (Src-EGFR-PLC) cascade, resulting in inositol-triphosphate (IP3) production, which mobilizes Ca2+ from the acrosome, causing a further increase in [Ca2+]i and the development of hyper-activated motility. PKA also activates phospholipase D1 (PLD1), leading to F-actin formation during capacitation. Prior to the acrosomal exocytosis, PLC induces phosphadidylinositol-4,5-bisphosphate (PIP2) hydrolysis, leading to the release of the actin-severing protein gelsolin to the cytosol, which is activated by Ca2+, resulting in F-actin breakdown and the occurrence of acrosomal exocytosis.

Concerns of Infertile Women Candidates for Egg Donation: A Qualitative Study

Objective: Women with premature ovarian insufficiency, menopause, gonadal dysgenesis, and genetic disorders as well as those with a history of recurrent in vitro fertilization failure may benefit from the assisted fertility techniques. These women experience concerns that directly affect their married life especially in egg donation treatment. This study was conducted to investigate the reproductive health concerns of infertile women who were candidates for egg donation. Materials and methods: This qualitative content analysis was conducted in 17 infertile women who were referred to Imam Khomeini Hospital Infertility Clinic from July 2018 to March 2019. The participants were selected through purposeful sampling. Data were collected through individual in-depth semi-structured interviews. A conventional qualitative content analysis approach was adopted for data analysis using the MAXQDA12 software. Results: The results of data analysis showed five themes, including threatened married life, lack of supportive situation, religious beliefs, psychosocial damage, and damaged feminine identity. Conclusion: Infertility is usually accompanied by a great psychological sadness referred to as "stress of infertility". Assisted reproductive techniques (ART) are also a source of stress for patients; therefore, it has a significant impact on the marital relationship and mental health of infertile women. Hence, there is a need for psychological support from the treatment team to reduce woman reproductive health concerns.

Consequences of manipulating gametes and embryos of ruminant species

During the past 12 years, ruminants have provided a focus for some significant advances in mammalian reproductive biotechnologies. Lambs were the first offspring generated after nuclear transfer of fetal or adult cells to enucleated oocytes, and many calves of pre-determined gender are today the result of commercialized semen sexing. In 1990, the birth of one calf provided living proof that even 'dead' spermatozoa can be paternal, whereas, more recently, a short-lived gaur calf and viable mouflon lamb represented a novel option for conservation of endangered species. As well as highlights, hazards have emerged, resulting in setbacks or developmental anomalies, such as those associated with the large offspring syndrome which encompasses a range of adverse fetal, placental and post-natal phenomena expressed in ruminants. In this review, the developmental and other consequences of applying manipulative procedures, such as assisted fertilization, semen sexing, cloning and gene transfer, to gametes and embryos from bovine, ovine and caprine species are considered. Although assisted fertilization techniques can overcome mammalian infertility, they also usurp natural gamete selection safeguards, but not always with impunity. In the case of manipulations such as cloning, and to a lesser extent gene transfer, it is evident that nuclear-cytoplasmic interactions and nuclear-mitochondrial DNA interdependences are at least partially damaged or destroyed with a view to reconstruction. Therefore, among surviving zygotes and embryos it is inevitable that the legacy is frequently one of altered genetic, epigenetic or cellular programmes and processes.

Pregnancy Rates and Pregnancy Outcomes after Hematopoietic Stem Cell Transplantation in Childhood: a Cross-Sectional Survey of the EBMT Pediatric WP

Introduction: In the last decade transplant activity increased constantly and consequently the number of long-term survivors. Most applied conditioning regimes are known to impair normal puberty development and can lead to infertility. Pregnancies in women who had undergone a HSCT as well as in partners of transplanted men have been documented. However, the true incidence of pregnancies and its related complications in patients transplanted during their childhood remains unknown. The Pediatric WP of the EBMT conducted a study aiming to analyze pregnancy rates and to evaluate pregnancy outcomes in survivors of childhood HSCT. Material and Methods: In this study, we first evaluate the available data on the EBMT registry. To collect additional data a survey was conducted between July 2017- June 2018. 203 centers with pediatric activity reported to the EBMT patients were asked to fill-out the survey with 36 items related to treatment plan, pregnancies and pregnancies outcome. Adoptions were not considered in the study. Results: Data obtained from the EBMT database “Promise” reported that 62'988 pediatric patients were transplanted in the EBMT centers from 1995 to end of 2016. In 484 (0.76%) patients a conception after HSCT has been reported. 341/484 patients (70%) had an allograft, 134 of them (40%) were males. 143/484 had an autologous, 53 of them (37%) were male. The median age of patients was 15.02 years (range 0.6 - 17.9 years), was similar for male and females regardless of whether they were auto or allogeneic transplanted. 283 patients (58%) had conditioning regimes containing alkylating agents, irradiation or both.Data obtained from the conducted survey provide precise information of 27 (13 %) EBMT centers from 16 countries about 114 pregnancies of 99 patients and their partners. Pregnancies were in 30/99 (30%) from partners of post HSCT male patients and 60/99 (70%) were of post HSCT females. Underlying diseases for HSCT were reported in 82 of all 99 patients. 47/82 (57%) had a malignant disease and35/82 (43%) had a non-malignant disease. 29/99 (29%) had a reduced conditioning regime, 70/99 (71%) a myeloablative conditioning regime. 25/82 (30%) received TBI as part of the conditioning regimes. Regarding conception in patients post TBI, 12/23 (52%) became naturally pregnant (2/12 had 2 Gy only), 9/23(39%) required assisted fertilization and 2 used cryopreserved sperms. In patients conditioned without TBI, 54/59 (92%) had a natural conception, 4/59 (7%) required assisted fertilization and 1 used cryopreserved sperms. In 90/99 (90%) patients pregnancy resulted in a livebirth. 13 of the 90 livebirths (14%) were preterm, with a higher proportion than in normal the population (5.5-11%) and 6 of the 90 livebirths (6%) presented a low birthweight which is comparable to the normal population (6.5%).Conclusion: This study confirms a low pregnancy rate in survivors of childhood HSCT. Natural conception was possible when patients are conditioned without TBI. After TBI, pregnancy assisted fertilization techniques may increase pregnancy rate. The number of live births and complications indicate the need to advise survivors of childhood HSCT about the potential risks and outcome of pregnancy and advise them appropiately. DisclosuresBader:Cellgene: Consultancy; Neovii: Research Funding; Medac: Patents & Royalties, Research Funding; Riemser: Research Funding; Novartis: Consultancy, Speakers Bureau.

A retrospective population-based cohort study to evaluate the impact of an older sibling with undescended testis and hypospadias on the known maternal and fetal risk factors for undescended testis and hypospadias in Ontario, Canada, 1997–2007

There are several reported risk factors for undescended testis (UDT) and hypospadias (HYP). Also, a family history of UDT or HYP has not been accounted for in prior studies, and doing so may influence these independent risk estimates. A population-based retrospective cohort study was conducted using linked administrative databases in Ontario, Canada, to identify all live male newborns born between 1997 and 2007, and it was determined whether they underwent an orchidopexy or HYP repair within 5 years of birth. Baseline maternal and fetal risk factors were obtained using appropriate ICD codes. A statistical analysis using a generalized estimating equation with a logit link was performed, adjusting for clustering in mothers with a previous child born in the 5 years before the proband with UDT or HYP, to evaluate the adjusted risk factors of UDT and HYP. A total of 709,968 male infants were followed up from birth for 5 years, of which 5830 underwent an orchidopexy and 2722 had an HYP repair. On multivariable analysis, factors associated with a higher risk of UDT included prematurity, small for gestational age (SGA), associated HYP, gestational hypertension, use of assisted fertility techniques, increased maternal age, Cesarean section, previous sibling with UDT, and disorders of sexual differentiation (DSDs). After adjusting for clustering in mothers with a previous baby with UDT, DSD, associated HYP (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.0-4.1), and a previous sibling with UDT (OR, 3.6; 95% CI, 2.5-5.2) remained significant risk factors. The risk factors on multivariable analysis predicting the risk of HYP included SGA, prematurity, higher income families, and associated anomalies such as UDT. After adjusting for clustering in mothers with a previous sibling with HYP, SGA (OR, 1.8; 95% CI, 1.0-3.1), higher income families (OR, 1.5-1.6), associated UDT (OR, 7.1; 95% CI, 4.9-10.0), and a previous sibling with HYP (OR, 12.8; 95% CI, 9.1-18.1) remained significant risk factors. Studies estimating risk factors for UDT and HYP have used variable methodologies to identify index cases and perform statistical analysis. This study suggests that having an older sibling with UDT or HYP is a significant independent risk factor. Performing an analysis adjusting for clustering in mothers with a previous child with UDT or HYP leads to loss of statistical significance for other described risk factors. Underlying genetic or similar environmental exposures may be a key risk factor for UDT and HYP, which confounds known maternal and fetal risk factors for these anomalies.

Gamete Donation: Are Children Entitled to Know Their Genetic Origins? A Comparison of Opposing Views. The Italian State of Affairs

Abstract Medically assisted fertilization techniques give rise to a wide array of issues, such as the rights to secrecy, partial anonymity or to the full disclosure of information about the donors’ identities. The authors espouse the right of donor-conceived children to know their biological origins, and delve into opposing views, either in favour of the gamete donors’ right to anonymity or against it. Be that as it may, the right to know one’s biological origins has been gaining a foothold as part of the broader right to personal identity. The latter is in fact codified and upheld in numerous international treaties and conventions as a fundamental human right. The authors expound upon the Italian legislation, which is designed to enforce total donor anonymity. Against that backdrop, the authors weigh the suitability of further regulating access to sensitive, identifying information about the procreation methods involved in each case.

MP66-09 IS HAVING A SIBLING WITH UNDESCENDED TESTIS OR HYPOSPADIAS YOUR BIGGEST RISK FACTOR FOR BEING BORN WITH THESE ANOMALIES: A MULTIVARIABLE ANALYSES OF KNOWN RISK FACTORS FOR UNDESCENDED TESTIS AND HYPOSPADIAS ADJUSTED FOR CLUSTERING IN MOTHERS WHO HAVE A PREVIOUS CHILD WITH THESE ANOMALIES

You have accessJournal of UrologyPediatrics: Testis, Varicocele & Stones1 Apr 2017MP66-09 IS HAVING A SIBLING WITH UNDESCENDED TESTIS OR HYPOSPADIAS YOUR BIGGEST RISK FACTOR FOR BEING BORN WITH THESE ANOMALIES: A MULTIVARIABLE ANALYSES OF KNOWN RISK FACTORS FOR UNDESCENDED TESTIS AND HYPOSPADIAS ADJUSTED FOR CLUSTERING IN MOTHERS WHO HAVE A PREVIOUS CHILD WITH THESE ANOMALIES Roderick Clark, Kuan Liu, Adiel Mamut, Amit Garg, Salimah Shariff, and Sumit Dave Roderick ClarkRoderick Clark More articles by this author , Kuan LiuKuan Liu More articles by this author , Adiel MamutAdiel Mamut More articles by this author , Amit GargAmit Garg More articles by this author , Salimah ShariffSalimah Shariff More articles by this author , and Sumit DaveSumit Dave More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have identified risk factors for undescended testis (UDT) and hypospadias (HYP), but few have adjusted their estimates using multivariate modeling techniques. The objective of this study was to utilize an administrative database to measure the adjusted estimates of known maternal and fetal risk factors for UDT and HYP, while accounting for the effect of having a previous sibling with these anomalies. METHODS This retrospective population-based cohort study used several linked provincial databases held at the Institute for Clinical Evaluative Sciences, in the province of Ontario, Canada, to identify all males born between 1997-2007 with a diagnosis of UDT and HYP. To ensure validity of the diagnosis, the cohort only included patients who had a surgical procedure for UDT or HYP on follow up. Baseline maternal and fetal risk factors obtained using ICD 9-10 codes, were assessed using generalized estimating equations with a logit link, adjusting for clustering amongst mothers with previous children with UDT or HYP. RESULTS In 5830 boys with UDT, multivariable analysis identified prematurity and small for gestational age, associated HYP, multiple gestation, gestational hypertension, use of assisted fertility techniques, increased maternal age, babies born to immigrant mothers and a need for caesarean section as significant risk factors. In 2722 boys with HYP, significant risk factors included small for gestational age and prematurity, associated UDT, multiple gestation and babies born to immigrant mothers. After adjusting for a previous sibling with UDT, all these maternal and fetal risk factors lost statistical significance, except associated anomalies like DSD (OR: 82.3 95% CI 54.4-124.5 p<0.01) or HYP (OR: 2.04 95% CI 1.0-4.1 p= 0.04). After adjusting for a previous sibling with HYP, only small for gestational age (OR: 1.80 95% CI 1.03-3.1 p=0.03) and associated UDT (OR: 7.09 95% CI 4.87- 10.33 p<0.01) remained as significant risk factors. CONCLUSIONS While a combination of maternal and fetal factors were identified as risk factors for UDT and HYP in our multivariable analysis, after adjusting our analysis for individuals with a previous sibling with these conditions, only few fetal factors remained as significant risk factors. These results indicate that an underlying genetic predisposition for HYP and UDT could be a confounding factor when analyzing studies, which estimate risk factors for UDT and HYP without accounting for clustering in mothers who have had children with these anomalies © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e865 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Roderick Clark More articles by this author Kuan Liu More articles by this author Adiel Mamut More articles by this author Amit Garg More articles by this author Salimah Shariff More articles by this author Sumit Dave More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

La especificación del derecho a la vida del no nacido en el sistema interamericano de derechos humanos. Una aproximación desde el caso “Artavia Murillo”

El objeto de este artículo es estudiar la posición de la Corte Interamericana de Derechos Humanos respecto del derecho a la vida, a partir del análisis del caso Artavia Murillo y otros (fecundación in vitro) vs. Costa Rica, resuelto el 28 de noviembre de 2012, en el que la Corte declaró contraria a la Convención Americana sobre Derechos Humanos la prohibición de técnicas de fecundación asistida vigente en Costa Rica, y obligó al Estado a incluir estas técnicas “dentro de sus programas y tratamientos de infertilidad en su atención de salud”. Se pone de relieve que las normas relacionadas con el caso le proporcionaban a la Corte distintas alternativas de solución lógicamente posibles, y que el tribunal se decantó por una de ellas sobre la base de razones que vale la pena cuestionar. Entre otros argumentos se discutirá que, como afirmó la Corte, los desacuerdos científicos en torno al valor de la vida no nacida impongan a los Estados sujetos a la Convención la obligación de aceptar la fecundación in vitro como una práctica lícita que deben promover.

Gestación en parejas con infertilidad. Experiencia en el Hospital Nacional E. Rebagliati Martins, EsSalud

OBJETIVOS: Determinar la tasa de embarazos en una población de parejas atendidas por infertilidad o pérdida reproductiva, la patología más frecuente en estas parejas y el momento del estudio o tratamiento en que la mujer llegó a concebir. DISEÑO: Estudio retrospectivo, observacional, descriptivo, clínico. LUGAR: Unidad de Reproducción Humana de la Red Asistencial Rebagliati, EsSalud, sede docente universitaria. MATERIAL Y MÉTODOS: Revisión de las historias clínicas de todas las parejas atendidas por infertilidad o pérdida reproductiva por los médicos de la Unidad durante el año 2004, determinando sus características, factores relacionados al problema de la reproducción, estudio y tratamientos efectuados, gestaciones y momento del estudio o tratamiento en que ocurrió la gestación. RESULTADOS: Durante el año 2004, se atendió 564 parejas nuevas, de las cuales 218 gestaron, con una tasa de embarazo de 38,6%. Los factores involucrados en las parejas que llegaron a concebir fueron el tubáríco en 68,7%, ovárico en 41,2%, masculino en 29,4% y uterino en 27%. Cerca de lamitad de las mujeres que gestó lo hizo antes de llegar a ser intervenida quirúrgicamente; 5% lo hizo después de la histerosalpingografía, 5,2% luego de la prueba poscoital y 18,5% gestó mientras esperaba un turno operatorio. En 19,9% de las pacientes, la gestación ocurrió después de la intervención quirúrgica sola, principalmente después de una laparoscopía acompañada de histeroscopia. Otro 28,4% de mujeres gestó luego de la intervención quirúrgica seguida de inducción de la ovulación, haciendo un total de 48,3% las mujeres que gestaron luego de la intervención quirúrgica diagnóstica y terapéutica. CONCLUSIONES: La tasa de embarazo de 38,6% es una de las más altas registradas en la literatura, y no incluye técnicas de fertilización asistida. Creemos que el resultado se relaciona al trabajo en equipo, aplicación de guías clínicas consensuadas, interés de las parejas en su estudio, equipos y materiales hospitalarios satisfactorios y capacitación, docencia e investigación permanente.

Lifestyle and Outcomes of Assisted Reproductive Techniques: A Narrative Review.

Background:Studies reveal that lifestyles such as physical activity patterns, obesity, nutrition, and smoking, are factors that affect laboratory test results and pregnancy outcomes induced by assisted fertility techniques in infertile couples. The present study is a narrative review of studies in this area.Methods:In this study, researchers conducted their computer search in public databases Google Scholar general search engine, and then more specific: Science Direct, ProQuest, SID, Magiran, Irandoc, Pubmed, Scopus, cochrane library, and Psych info; Cumulative Index to Nursing and Allied Health Literature (CINAHL), using Medical Subject Headings (MeSH) keywords: infertility (sterility, infertility), lifestyle (life behavior, lifestyle), Assisted Reproductive Techniques (ART), antioxidant and infertility, social health, spiritual health, mental health, Alcohol and drug abuse, preventive factors, and instruments., and selected relevant articles to the study subject from 2004 to 2013. Firstly, a list of 150 papers generated from the initial search. Then reviewers studied titles and abstracts. Secondly, 111 papers were included. Finally, quality assessment of full text studies was performed by two independent reviewers. Researchers reviewed summary of all articles sought, ultimately used data from 62 full articles to compile this review paper.Results:Review of literature led to arrangement of 9 general categories of ART results’ relationship with weight watch and diet, exercise and physical activity, psychological health, avoiding medications, alcohol and drugs, preventing diseases, environmental health, spiritual health, social health, and physical health.Conclusion:The following was obtained from review of studies: since lifestyle is among important, changeable, and influential factors in fertility, success of these methods can be greatly helped through assessment of lifestyle patterns of infertile couples, and design and implementation of healthy lifestyle counseling programs, before and during implementing assisted fertility techniques.

Obstetric medicine

BACKGROUND Obstetric assistance made major advances in the last 20 years: improved surgical technique allows quicker caesarean sections, anaesthesiology procedures such as peripheral anaesthesia and epidural analgesia made safer operative assistance, remarkably reducing perioperative morbidity and mortality, neonatology greatly improved the results of assistance to low birth weight newborns. A new branch of medicine called “obstetric medicine” gained interest and experience after the lessons of distinguished physicians like Michael De Swiet in England. All together these advances are making successful pregnancies that 20 years ago would have been discouraged or even interrupted: that’s what we call high risk pregnancy. High risk of what? Either complications of pregnancy on pre-existing disease or complications of pre-existing disease on pregnancy. Nowadays, mortality in pregnancy has a medical cause in 80% of cases in Western countries (Confidential Enquiry on Maternal Deaths, UK, 2004). DISCUSSION The background is always changing and we have to take in account of: increase of maternal age; widespread use of assisted fertilization techniques for treatment of infertility; social feelings about maternity desire with increasing expectations from medical assistance; immigration of medically “naive” patients who don’t know to have a chronic disease, but apt and ready to conceive; limited knowledge of feasibility of drug use in pregnancy which may induce both patients and doctors to stopping appropriate drug therapy in condition of severe disease. Preconception counseling, planning the pregnancy, wise use of drugs, regular follow-up throughout the pregnancy and, in selected cases, preterm elective termination of pregnancy may result in excellent outcome both for mother and foetus. CONCLUSIONS Highly committed and specifically trained physicians are required to counsel these patients and to plan their treatment before and during pregnancy.

Candida glabrata Sepsis Associated With Chorioamnionitis in an In Vitro Fertilization Pregnancy: Case Report and Review

We report a case of Candida glabrata sepsis associated with chorioamnionitis in an in vitro fertilization-assisted pregnancy. There is a strong association between C. glabrata chorioamnionitis and assisted fertility techniques. Candida glabrata chorioamnionitis presents unique management challenges.

Contemporary aspects of male gamete (dys)function: aiming towards optimizing the treatment of fertilization disorders

At its inception, in vitro fertilization (IVF) was a relatively straightforward procedure encompassing the in vitro insemination of surgically retrieved oocytes and the trans-cervical uterine placement of the ensuing embryos with the goal of overcoming tubal infertility. Since that time, IVF has become the ultimate treatment modality for all infertility indications when standard treatments have failed. While IVF has revolutionized our clinical armamentarium, it has also served as a remarkable scientific tool allowing direct visualization of male and female gamete interaction and assessment of human embryo development, thus enabling reproductive specialists to dissect and better understand the early human reproductive processes. In its earliest stages, IVF was directed at the treatment of female infertility focusing on the role of the oocyte, later to be eclipsed by assisted fertilization techniques that revolutionized the treatment of male factor infertility. The advent of assisted fertilization techniques, from the most simplistic approaches to direct sperm injection, has made it possible for suboptimal male gametes to penetrate the oocyte vestments. The latter technique has shed light on the ultimate function of the spermatozoon and the fascinating process of syngamy. Moreover, the ability to temporally monitor the cleaving embryo in vitro has enabled us to ascertain the individual steps involved in the development of the conceptus from syngamy to blastocyst as well as to shed light on hitherto unapproachable infertility etiologies. After over 30 years of IVF and 20 years of intracytoplasmic sperm injection (ICSI), it seems appropriate to focus on our present understanding and the state of scientific knowledge of the male gamete. The present issue of Views and Reviews will describe the history and development of ICSI — the ultimate technique to treat male infertility — and review the current indications for assisted fertilization in terms of therapeutic outcome, safety, and future perspectives (1Palermo G.D. Neri Q.V. Monahan D. Kocent J. Rosenwaks Z. Development and current applications of assisted fertilization.Fertil Steril. 2012; 97: 248-259Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar). Other contributions will describe the currently available assays to screen for male factor infertility and sperm function. Although the semen analysis has been utilized for several decades as the cornerstone for assessing male fertility (dys)function, interpretation and clinical correlations still remain a challenge (2De Jonge C. Semen Analysis: Looking for an upgrade in class.Fertil Steril. 2012; 97: 260-266Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar). The recent understanding of the sperm epigenetic status in regards to protamination, specific localization/modifications of retained histones, and DNA methylation may delineate the role of the male gamete on embryogenesis and eventually in the establishment of totipotency of the embryo. This may help to unravel hitherto undiagnosable causes of impaired fertility and possibly provide insights into transmission of genetic risks (3Carrell D.T. Epigenetics of the male gamete.Fertil Steril. 2012; 97: 267-274Abstract Full Text Full Text PDF PubMed Scopus (176) Google Scholar). In fact, it has been documented that the nucleus of mature spermatozoa contains a complex population of RNAs that are transcriptionally inert. These small molecules which appear to orchestrate extraordinary spermiogenic modifications, may also aid in discriminating and assessing spermatozoal function that may serve as investigational and diagnostic tools for male infertility (4Hamatani T. Human spermatozoal RNAs.Fertil Steril. 2012; 97: 275-281Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar). It has become evident that the role of the spermatozoon as a simple mobile device to deliver the male genome should be reconsidered and reinterpreted as a cell characterized by its unusual shape, extraordinary motility, resilience to environmental aggressors, and capable of its own reshaping during spermatogenesis. Upon reaching the oocyte, the spermatozoon triggers egg activation, orchestrates in a preprogrammed pattern peri- and post-fertilization events in the oocyte, thus, inevitably controlling early embryo development. Ideally, the utilization of novel diagnostic techniques will not only improve our abilities to assess sperm (dys)function, they will also allow us to discriminate the spermatozoon’s contribution to early embryo development.

Multiple pregnancies among women engaged in agriculture in Norway

Background. Methods. Results. !30 years, and were more likely to undergo invitro fertilization (IVF). Combined grain farming and seaso nal late blight warnings did not influence theprevalence of DZ pregnancies. Unexpectedly, the same climate variable, in combination with horticulture,was negatively associated with DZ pregnancies (PR 0.3; 95% confidence interval 0.1–0.7).Conclusion. Active Norwegian farmers seem to have a somewhat higher natural occurrence of DZ pregnanciesthan mothers in non-farming sectors of the agricultural population. After the late 1970s this situationwas reversed, mainly because the latter group consisted of more older first-time mothers, and probablywith a higher need of assisted fertility treatment. Interpretations are difficult concerning the inverse relationbetween DZ pregnancy and climatic conditions in horticulture.We identified 2,131 (11.2 per 1,000) multiple pregnancies, 1,322 (6.9) were classified as DZ. Theprevalence of DZ pregnancies was declining until the late 1970s, and increased thereafter. The agriculturalpopulation of Norway is heterogeneous along two dimensions, with a difference between farmers and nonfarmers(mainly engaged in forestry), and a difference according to degree of maternal work input on thefarm holding. Farmers, in particular active farmers, had more DZ pregnancies than non-farmers early in thestudy period; this ratio was reversed late in the study period. Non-farmers had a much higher temporalincrease in the proportion of first-time mothers who were By record linkage of national registers in Norway, we identified 246,043 farm holders andspouses born between 1925 and 1971 in agricultural censuses and the population register. In this population,190,258 pregnancies were recorded in the Medical Birth Registry 1967-91. The prevalences ofmultiple pregnancy, subdivided in DZ and monozygotic (MZ) pregnancies, were examined in strata ofseveral determinants. Exposure, defined as the combination of grain farming and categories of seasonalfungal warnings, was based on data on farm activity and on local fungal warnings in the growth seasons.Adjusted prevalence ratios (PR) served as estimates of association.SUMMARY The worldwide occurrence of dizygotic (DZ) multiple pregnancies has increased since 1980as a consequence of assisted fertilization techniques. An opposite influence by environmental factors yetunidentified has been a suspected explanation of decreased multiple pregnancies in several countriesduring 1960-1980. The aim of our study was to describe multiple, in particular DZ, pregnancy patterns inthe Norwegian agricultural population between 1967 and 1991, and to investigate the hypothesis that grainproduction under climatic conditions favoring fungal growth causes a decline in DZ pregnancies.

Propagation of the Sperm Genome

Abstract: Among infertile men the degree of spermatogenesis varies from a barely compromised sperm number in the ejaculate to complete absence-the condition known as azoospermia. The scarcity of gametes often represents a major hindrance to overcoming spermatogenic failure through the use of assisted fertilization techniques. Therefore, we attempted to replicate the fertilizing spermatozoon by ‘male genome cloning’ in order to empower an individual spermatozoon. Spermatozoa injected into mature ooplasts were capable of maintaining and replicating a haploid male genome as haploid androgenotes. Isolated nuclei from such androgenotes entered into syngamy with female PNs following nuclear transfer fertilization. By utilizing mouse 8-cell stage androgenotes, we were able to obtain 6 blastocysts per single spermatozoon, and consequently live offspring. Thus, we were able to enhance the reproductive performance of single spermatozoa, indicating a possible future application of male gamete genome profiling prior ...