Availability Of Assisted Reproductive Technologies Research Articles

Paternal Age Amplifies Cryopreservation-Induced Stress in Human Spermatozoa.

The global fall in male fertility is a complicated process driven by a variety of factors, including environmental exposure, lifestyle, obesity, stress, and aging. The availability of assisted reproductive technology (ART) has allowed older couples to conceive, increasing the average paternal age at first childbirth. Advanced paternal age (APA), most often considered male age ≥40, has been described to impact several aspects of male reproductive physiology. In this prospective cohort study including 200 normozoospermic patients, 105 of whom were ≤35 years (non-APA), and 95 of whom were ≥42 years (APA), we assessed the impact of paternal age on different endpoints representative of sperm quality and cryopreservation tolerance. Non-APA patients had superior fresh semen quality; DNA fragmentation was notably increased in APA as compared to non-APA individuals (21.7% vs. 15.4%). Cryopreservation further increased the DNA fragmentation index in APA (26.7%) but not in non-APA patients. Additionally, APA was associated with increased mtDNAcn in both fresh and frozen/thawed sperm, which is indicative of poorer mitochondrial quality. Cryopreservation negatively impacted acrosome integrity in both age groups, as indicated by reduced incidences of unreacted acrosome in relation to fresh counterparts in non-APA (from 71.5% to 57.7%) and APA patients (from 75% to 63%). Finally, cryopreservation significantly reduced the phosphorylation status of proteins containing tyrosine residues in sperm from young males. Therefore, the present findings shed light on the effects of paternal age and cryopreservation on sperm quality and serve as valuable new parameters to improve our understanding of the mechanisms underlying sperm developmental competence that are under threat in current ART practice.

‘It’s about time’: policymakers’ and health practitioners’ perspectives on implementing fertility care in the Gambian health system

BackgroundInfertility is a major health issue worldwide, yet very few examples of interventions addressing infertility in the Global South have been documented to date. In The Gambia, West Africa, infertility is recognised as a burden and the health authorities have included it in several health policies and the new National Reproductive Health Strategy however, a detailed operationalisation plan for fertility care has not yet been established. Here, we aim to understand and document the factors that influence the implementation of fertility care in The Gambia.MethodsWe conducted 46 semi-structured interviews with policymakers, implementers, and health practitioners in both the public and private sectors from July to November 2021. The interviews were transcribed, anonymised and analysed with NVivo Pro version 1.6.1. The analysis was initially inductive, with themes arising from the coding categorised according to the WHO health systems building blocks framework.ResultsThis study identified several barriers to a successful implementation of fertility care in The Gambia, including (i) a lack of routinely collected infertility data; (ii) an absence of financial protection mechanisms for patients, and/or a specific budget for infertility; (iii) limited cooperation between the public and private sectors in the provision of fertility care; and (iv) gaps in fertility care training among health practitioners. Conversely, enablers included: (i) strong national infertility leadership; and (ii) the integration of infertility care within public reproductive health services.ConclusionThe Gambian health system is not yet in the position to support a comprehensive fertility care package in its public health facilities. Several aspects of the implementation of fertility care must be considered in operationalising the health strategy including the systematic collection of infertility data, fertility awareness, and the provision of specialised fertility care training. Furthermore, a stronger partnership between the public and private sectors must be developed. Given the increasing availability of assisted reproductive technologies in the sub-Saharan Africa region, and the tendency to locate these technologies in the private sector, further research is needed to understand and identify the processes underlying the implementation of fertility care and to foster better integration with the existing health system.

Comparative analysis of women aged over 35 after in vitro fertilisation and natural fertilisation: a case control study

Background: Postponing motherhood is a worldwide trend. As a woman ages, the ability to get pregnant naturally decreases. The postponement of motherhood is related to the increased availability of assisted reproductive technology, which is associated with a higher incidence of maternal health problems. Aim of the study: To compare the health problems encountered during pregnancy, childbirth and early postpartum, and to examine the health status of the newborn, in women over 35 years of age who received in vitro fertilisation (IVF) or conceived naturally. Material and methods: A retrospective comparative case-control study was carried out based on the analysis of medical records from women who gave birth after 35 years of age. The study was conducted in two hospitals of the third level of reference in Warsaw, Poland. A group of women who gave birth after IVF (n=240) was compared with a control group who gave birth following natural fertilisation (n=240). Results: Women after IVF were statistically more likely to be obese (5% vs 0.2%, p=0.001), to have received infertility treatment (18% vs 1%, p=0.000) before pregnancy, and to experience cholestasis during pregnancy (4% vs. 1%, p=0.019). There was a higher incidence of multiple pregnancies [twins (10% vs 1%, p=0.0001) and triplets (0.5%, p=0.0001)], and deliveries by caesarean section (61% vs 51%, p=0.027) in women from the IVF group. The groups did not differ with respect to preterm delivery, duration of pregnancy, or 1st, 2nd and 3rd periods of labour. Mothers in the IVF group had a statistically longer perinatal hospital stay (7±8 vs 5±4 days, p=0.001). Conclusions: Women over 35 years of age after IVF have a higher rate of caesarean sections and multiple pregnancies. Obesity before pregnancy and cholestasis during pregnancy are also more common in this group. There is no difference between the health status of newborns from mothers after in vitro or natural fertilisation.

Assessment of availability of assisted reproductive technologies in Ukraine and the world

In Ukraine, in order to achieve the Sustainable Development Goals, the State Strategy for the Implementation of the State Policy for the Provision of the Population with Medicines for the Period until 2025 has been approved, which includes improving the availability of drugs to improve the quality of life. Assisted Reproductive Technologies (ART) are gaining widespread implementation and funding from the budget in the world.
 Goal – the aim of the work was to analyze the state and dynamics of ART cycles in Ukraine for 1999–2019 and to estimate the cost of ART in Ukraine and to develop a methodology for estimating the availability of ART and comparison with European countries.
 Materials – international and domestic publications on the assessment of the availability of drugs, the cost of ART. Research methods: system analysis, data synthesis and generalization of information, webometric analysis, statistical analysis of data on the number of ART cycles for 1999-2018, analysis of ART costs.
 It is determined that the indicator of the number of ART cycles per 1 million population increased 29.9 times for 1999–2018, which is due to the increase in the number of ART centers conducted ART cycles in relation to the decrease in the population of Ukraine.
 It was found that 85% of ART centers are concentrated in only 4 cities (Kyiv, Lviv, Odessa, Kharkiv), which reduces the accessibility of the population to ART cycles, especially in the conditions of quarantine and pandemic COVID-19. It was found that in 1999–2018 the number of ART centers increased 7.7 times, but only 10.8% of ART centers have state funding, which indicates the low availability of ART for budget funds.
 It was found that the structure of ART cycles changed significantly. The average costs for the most common ART cycles IVF and ICSI in Ukraine as of the end of 2019 have been determined. It has been shown that only 26% of ART centers provide information on the cost of ART cycles, and web pages need to be filled with information on the cost of ART cycles to ensure that patients are properly informed.
 It is shown that in Ukraine as of 2020 the costs of ART cycles are 24 425–30 516 UAH (917,25–1 010,57 Euro) depending on the type of cycle from the perspective of the payer. It is estimated that the availability of ART is 1.5–9.98 depending on the type of ART cycle, the cost of ART cycles is 6–10 times higher than the average family income, when in European countries the availability of ART is much lower 1,5–4.2, which showed higher availability of ART in European countries from payer prospect.

Rethinking parenthood within assisted reproductive technology: The need for regulation in Nigeria.

In Nigeria, reproduction is highly valued, with many people desiring to produce a child 'in their own image and likeness'. Previously, aspiring parents often resorted to adoption. Today, the availability of assisted reproductive technologies (ARTs) has provided options other than adoption for those desiring to procreate. Through ARTs, aspirations for a family may be attained through an exchange of reproductive goods and services, and not necessarily through traditional heterosexual relationships. ARTs have altered the perception of parenthood as it exists in Nigeria, and courts face a difficult task in defining parenthood within Nigerian jurisprudence, as they can only adjudicate based on extant law. Although ARTs provide greater individual choices for fulfilling the desire to procreate, they raise a number of ethical and legal issues that evolving legal systems, such as that in Nigeria, are ill-equipped to manage. This paper describes the traditional assignment of parenthood under indigenous laws and other sources of law within the Nigerian jurisprudence. We carried out an in-depth study of the Nigerian legislative framework and found that there are no laws directly regulating parenthood, procreation and ARTs in Nigeria. We also found that the extant laws are only tangentially related and do not answer the relevant questions sufficiently well, especially concerning succession, nationality and assignment of responsibility in collaborative reproduction. We conclude by highlighting the need for and recommending a regulatory framework on ARTs with a particular focus on providing a definition for parenthood achieved through ARTs in Nigeria.

Accessibility and availability of assisted reproductive technology for people living with HIV in Europe: a thematic literature review

ABSTRACT As antiretroviral therapies have transformed HIV into a manageable chronic disease, many individuals have or will choose to have children, and the use of assisted reproductive technology can serve as an effective risk-reducing strategy. In this thematic literature review, we examine the state of research on access to and availability of assisted reproductive health technologies for people living with HIV in Europe, with the aim of identifying gaps for further research. We find that the existing literature is focused on serodiscordant couples consisting of an HIV-positive man and an HIV-negative women. This is in part because more treatment options are available for men living with HIV than women, reflecting underlying gender discrimination in treatment. The existing scholarship largely ignores reproductive options for seroconcordant couples or single individuals, or for men and women with underlying infertility. Finally, very little research addresses the question of financial affordability, which is a known barrier to infertility treatment.

Assisted reproductive technology and women’s choice to pursue professional careers

We examine the impact of assisted reproductive technology on women’s choice to pursue professional careers. We hypothesize that the availability of assisted reproductive technology increases the expected benefits of a professional degree by allowing women to delay childbearing in their 20s and 30s while establishing their careers, thereby reaping greater financial benefit from human capital investment. State-level timing differences in the enactment of laws which mandated infertility treatment coverage in employer-sponsored health plans allow us to exploit state, year, and cohort variation in women’s ages at the time the laws are passed. These insurance mandates dramatically increase access to assisted reproductive technology. Using a triple difference strategy, we find that a mandate to cover assisted reproductive technology does increase the probability that a woman chooses to invest in a professional degree and to work in a professional career.

Morals or markets? Regulating assisted reproductive technologies as morality or economic policies in the states

ABSTRACTBackground: The availability of assisted reproductive technologies (ARTs) in the medical marketplace complicates our understanding of reproductive public policy in the United States. Political debates over ARTs often are based on fundamental moral principles of life, reproduction, and kinship, similar to other reproductive policies in the United States. However, ARTs are an important moneymaking private enterprise for the U.S. biotechnology industry. This project investigates how the U.S. states regulate these unique and challenging technologies as either moral policies or economic policies. Methods: This study employs ordinary least squares (OLS) regression to estimate the significance of morality and economic policy variables on ART policies at the state level, noting associations between state-level political, economic, and gender variables on restrictive and permissive state-level ART policies. Results: Economic variables (reflecting the biotechnology industry) and advocacy for access to ART on behalf of infertility patients increase the chances of states passing policies that enable consumer use of ARTs. Additionally, individual ART policies are distinct from one another in the ways that morality variables increase the chances of ART regulations. Surprisingly, the role of religious adherence among state residents varied in positive and negative relationships with individual policy passage. Conclusions: In general, these results support the hypothesis that ART laws are associated with economic as well as moral concerns of the states—ARTs lie at the intersection of issues of life and reproduction and of scientific innovation and health. What is most striking about these results is that they do not follow patterns seen in the legislation of abortion, contraception, and sexuality in general—those reproductive policies that are considered “morality policy.” Similarly, economic variables are not consistently significant in the expected direction.

Congenital Tuberculosis after in-vitro Fertilization in a Woman Previously Undiagnosed with Tuberculosis Salpingitis

Congenital tuberculosis (TB) is rarely seen with only several hundred cases reported in the literature. Because genitourinary TB causes infertility, rates of congenital TB have been low. However, the increased availability of assisted reproductive technology allows emergence of congenital TB if mothers are not properly evaluated and treated before implantation of the embryos. Diagnosis of congenital TB is difficult due to nonspecific symptoms, and a high index of suspicion is required for early diagnosis in infants. Here we present a 3-month-old infant with congenital tuberculosis after in vitro fertilization (IVF).

New Zealand University students’ knowledge of fertility decline in women via natural pregnancy and assisted reproductive technologies

Female fertility declines with age. University students are the group of people most likely to postpone parenthood, yet several international studies have shown that they overestimate their fertility. We designed a questionnaire based on a previous study in Israel, where university students were asked to answer questions related to their awareness of fertility decline in spontaneous and in vitro fertilisation (IVF) pregnancies, and methods they considered would prolong their reproductive lifespan. Our study has shown that New Zealand University students overestimated the rates of pregnancy for both spontaneous natural and IVF pregnancies. Students are mainly aware of the availability of assisted reproductive technologies (ARTs), but overestimate their effectiveness. Few students mentioned non-medical or well-being initiatives as measures to prolong parenthood. It is important that university students are aware of the rate of fertility decline in women, as although ARTs can be effective at times, they are not a guaranteed solution to an ageing woman's fertility. New Zealand University students, like other cohorts, overestimated the chances of a woman getting pregnant and predicted the fertility decline to occur much later than it does in reality.

Infertility, in vitro fertilization and congenital tuberculosis

Congenital tuberculosis (CTB) due to maternal genitourinary (GU) TB infection is a rare occurrence, as infection of the genital tract in women generally leads to infertility. Increasing availability of assisted reproductive technology creates the potential for CTB to emerge as a significant problem. We describe five infants (two sets of twins and a singleton birth) conceived by in vitro fertilization who developed CTB. All five infants were born to mothers who had immigrated to the United States from India and none had GU TB diagnosed before the birth of their infected infants.

Breast Cancer and Fertility

The increased availability of assisted reproductive technologies (ART) allows women with fertility issues to increase their chances of a successful pregnancy with the use of medications that, in some cases, increase circulating estrogens. There has been significant concern that the use of these medications will increase the risk of hormone-sensitive cancers such as breast, ovarian and uterine malignancies. Additionally, for those women who are diagnosed with a breast cancer during their reproductive years, this diagnosis can be particularly difficult as future fertility is a major concern for many young breast cancer survivors. With the current available data, there does not appear to be a statistically significant increase in the risk of developing breast cancer with ART, although several series suggest a potential possible related increase in borderline ovarian and uterine cancers. For breast cancer survivors, there does not appear to be an increased risk of death associated with subsequent pregnancies when compared with breast cancer patients who did not have subsequent pregnancies, although waiting at least 2years after the diagnosis of breast cancer potentially may convey a protective effect. Therefore, when systemic therapy for breast cancer is recommended, early counseling and referral to a reproductive endocrinologist is warranted to provide optimal fertility preservation options. Further safety and outcomes studies are warranted for children.

Identification of the second CFTR mutation in patients with congenital bilateral absence of vas deferens undergoing ART protocols

Congenital bilateral absence of vas deferens (CBAVD) is a manifestation of the mildest form of cystic fibrosis (CF) and is characterized by obstructive azoospermia in otherwise healthy patients. Owing to the availability of assisted reproductive technology, CBAVD patients can father children. These fathers are at risk of transmitting a mutated allele of the CF transmembrane conductance regulator (CFTR) gene, responsible for CF, to their offspring. The identification of mutations in both CFTR alleles in CBAVD patients is a crucial requirement for calculating the risk of producing a child with full-blown CF if the female partner is a healthy CF carrier. However, in the majority of CBAVD patients, conventional mutation screening is not able to detect mutations in both CFTR alleles, and this difficulty hampers the execution of correct genetic counselling. To obtain information about the most represented CFTR mutations in CBAVD patients, we analysed 23 CBAVD patients, 15 of whom had a single CFTR mutation after screening for 36 mutations and the 5T allele. The search for the second CFTR mutation in these cases was performed by using a triplex approach: (i) first, a reverse dot-blot analysis was performed to detect mutations with regional impact; (ii) next, multiple ligation-dependent probe amplification assays were conducted to search for large rearrangements; and (iii) finally, denaturing high-performance liquid chromatography was used to search for point mutations in the entire coding region. Using these approaches, the second CFTR mutation was detected in six patients, which increased the final detection rate to 60.8%.

Preimplantation Genetic Diagnosis and Selection

The availability of assisted reproductive technologies and advances in molecular biology gave rise to preimplantation genetic diagnosis (PGD). PGD is an early form of prenatal diagnosis and determines the genotype of an embryo before implantation takes place to avoid the implantation of diseased embryos. This requires couples to adhere to a strict family planning and effective contraceptive strategy, and undergo in vitro fertilization (IVF) treatment. During IVF, sampling of the cells can be performed at different developmental stages from polar body biopsy to trophectoderm cells from the blastocysts. It is indicated in couples with a family history of monogenic autosomal or X-linked recessive or dominant disorders and in detecting chromosomal aberrations of the embryos. The genetic diagnosis is performed using appropriate molecular testing which might include polymerase chain reaction, fluorescent in situ hybridization, comparative genomic hybridization or microarrays. PGD is now a well-established procedure and offers an alternative reproductive choice for couples who are at risk of an affected child. In this review, the past, present and future aspect of PGD will be covered.

Diagnosing twins in early pregnancy

Multiple pregnancy has increased in frequency as a result of the ageing maternal population as well as the advent and wider availability of assisted reproductive technologies. Higher-order pregnancies are associated with increased morbidity and mortality for both the foetuses and mother. The introduction of transvaginal ultrasound has made accurate diagnosis of twin pregnancy, determination of chorionicity and subsequent planning of these high-risk pregnancies a common part of obstetric care. In this article, we critically evaluate the role of transvaginal ultrasound in the diagnosis of twin pregnancies.

A survey of the attitudes of infertile and parous women towards the availability of assisted reproductive technology

The aim of the study was to assess differences in attitudes towards aspects of assisted reproduction technology between infertile and parous women. Case-control study. University-based tertiary care clinic. Three hundred and ninety-two women with fertility problems and 200 parous controls. A questionnaire was sent out to 392 the members of Childless Support Association and 200 parous women who had at least three infants and had given birth at Kuopio University Hospital. The questionnaire consisted of 46 questions: demographic information, fertility history, different aspects of assisted reproduction technology and prioritisation issues. Attitudes towards assisted reproduction technology. The overall response rate was 46%. Infertile women were highly educated (P < 0.01) and had lower parity (mean 0.83 vs 4.76, P < 0.01) than parous women. We recorded four major differences in attitudes between the two groups (OR >2 or <0.5) including provision of infertility treatment to lesbian (46.9% vs 16.7%) and homosexual couples (28.4% vs 11.4%), the opportunity for homosexual couples to use surrogate mothers (30.6% vs 15.2%) and limitations in the number of infertility treatment cycles (28.4% vs 61.4%). For 11 questions, we recorded minor, but statistically significant, differences. In the prioritisation questions, the women set the order according to their own interests, probably because the women were at fertile age and they had or would like to have a child. Maternity services and screening for cancer in women (Papanicolaou's test and mammography) were at the top of the list. These results reflect a split attitude that was influenced by the wish of infertile women to help childless couples and to be able to recruit suitable sperm/oocyte donors. Parous women were motivated by their concern for children's rights.