Gamete Donation Research Articles

Reconceptualising the Interest in Knowing One's Origins: A Case for Mandatory Disclosure.

The aim of this article is to make a case for mandatory disclosure in assisted reproduction. This refers to a system whereby those who are born through gamete donation and/or surrogacy would be notified about the manner of their birth and the availability of information about their genetic and/or gestational origins. The article argues that, to date, the law has interpreted an individual's interest in knowing their origins as being predominately about identity. However, the central importance of the principle of autonomy in the conceptualisation of this interest has been overlooked. A reconceptualisation of the interest in knowing one's origins as being concerned predominantly with autonomy provides a justification for mandatory disclosure. It is argued that the interest of individuals born through assisted reproduction in having autonomous choice regarding the significance of information about their origins should be prioritised over the autonomous choices of parents not to disclose to their offspring the manner of their birth.

Does personalized embryo transfer based on era improve the outcomes in patients with thin endometrium and Rif in Self Versus Donor Programme?

This study was designed to explore the influence of personalized Embryo Transfer (pET) with the guidance of endometrial receptivity array (ERA) on reproductive outcomes in patients with Recurrent Implantation Failure (RIF) and thin endometrium, and to determine its efficacy in self versus donor gamete programme.

New columnar apple hybrdids of VNIISPK breeding

Within the framework of updating import substitution in agriculture, the issue of creating adaptive, competitive and suitable for intensive gardening apple cultivars is acute. VNIISPK conducts selection for the creation of columnar apple cultivars that meet the requirements of modern market. As a result of purposeful crosses of columnar cultivars of scab immunity donors and diploid gamete donors, a series of hybrids was obtained. 9 analyzed families have 595 seedlings, of which 299 have columnar habitus (50.3%). Among columnar seedlings, 38 seedlings are diploid (2x) and have immunity to scab (Vf), 47 seedlings are triploids (3x), but have only field resistance to scab, 98 seedlings combine in their genotype a triple set of chromosomes and immunity to scab (Vf). Preliminary data on the study of economically valuable features of columnar seedlings by employees of the Apple breeding laboratory of VNIISPK were allocated to select forms of 8 hybrids: from families [Vostorg x 25-37-45 (4x) (Orlovskaya Girlyanda x Wealthy tetraploid - 3 seedlings, [Poezia x 30-47-88 (4x) (Liberty x 13-6-106 (S. Suvorovetz)]- 4 seedlings, [(22-26-124 (Wealthy x OR38T17) x Poezia] - 1 seedling.

Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors?

The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks. National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence. Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available. These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.

Outcomes of pregnancies using donor sperm compared with those using partner sperm: systematic review and meta-analysis.

Registry data from the Human Fertilisation and Embryology Authority (HFEA) show an increase of 40% in IUI and 377% in IVF cases using donor sperm between 2006 and 2016. The objective of this study was to establish whether pregnancies conceived using donor sperm are at higher risk of obstetric and perinatal complications than those conceived with partner sperm. As more treatments are being carried out using donor sperm, attention is being given to obstetric and perinatal outcomes, as events in utero and at delivery have implications for long-term health. There is a need to know if there is any difference in the outcomes of pregnancies between those conceived using donor versus partner sperm in order to adequately inform and counsel couples. We performed a systematic review and meta-analysis of the outcomes of pregnancies conceived using donor sperm compared with partner sperm. Searches were performed in the OVID MEDLINE, OVID Embase, CENTRAL and CINAHL databases, including all studies published before 11 February 2019. The search strategy involved search terms for pregnancy, infant, donor sperm, heterologous artificial insemination, donor gametes, pregnancy outcomes and perinatal outcomes. Studies were included if they assessed pregnancies conceived by any method using, or infants born from, donor sperm compared with partner sperm and described early pregnancy, obstetric or perinatal outcomes. The Downs and Black tool was used for quality and bias assessment of studies. Of 3391 studies identified from the search, 37 studies were included in the review and 36 were included in the meta-analysis. For pregnancies conceived with donor sperm, versus partner sperm, there was an increase in the relative risk (RR) (95% CI) of combined hypertensive disorders of pregnancy: 1.44 (1.17-1.78), pre-eclampsia: 1.49 (1.05-2.09) and small for gestational age (SGA): 1.42 (1.17-1.79) but a reduced risk of ectopic pregnancy: 0.69 (0.48-0.98). There was no difference in the overall RR (95% CI) of miscarriage: 0.94 (0.80-1.11), gestational diabetes: 1.49 (0.62-3.59), pregnancy-induced hypertension (PIH): 1.24 (0.87-1.76), placental abruption: 0.65 (0.04-10.37), placenta praevia: 1.19 (0.64-2.21), preterm birth: 0.98 (0.88-1.08), low birth weight: 0.97 (0.82-1.15), high birthweight: 1.28 (0.94-1.73): large for gestational age (LGA): 1.01 (0.84-1.22), stillbirth: 1.23 (0.97-1.57), neonatal death: 0.79 (0.36-1.73) and congenital anomaly: 1.15 (0.86-1.53). The majority of our findings are reassuring, except for the mild increased risk of hypertensive disorders of pregnancy and SGA in pregnancies resulting from donor sperm. However, the evidence for this is limited and should be interpreted with caution because the evidence was based on observational studies which varied in their quality and risk of bias. Further high-quality population-based studies reporting obstetric outcomes in detail are required to confirm these findings.

The Scope of Donor-Conceived Person’s Right to Access Information about the Gamete Donor in Europe – A Comparative Review

Legal regulations concerning infertility treatment differ among European jurisdictions. Broadly speaking, three types of gamete donation are distinguished – anonymous donation, identifiable donation, and known donation. However, using only these terms during a debate on international standard of gamete donation is a significant simplification. Even in those jurisdictions in which the same model of gamete donation occurs, the scope of information about a donor that is accessible for a child differs. Moreover, in some jurisdictions, the law permits donors and recipients to choose between two or more types of gamete donation. This paper therefore analyses the extent to which the donor’s data is accessible to a donor-conceived person within these different regimes. It argues that a balanced international standard for data exchange concerning gamete donation could be acceptable for all European countries. This paper concludes that it would be a positive first step to harmonise legal framework of gamete donation in Europe to reach a position that would be acceptable for countries in which donor’s anonymity is protected, as well as in countries in which the donor’s identity is always open for a donor conceived-person.

Jurisprudence-Legal Consideration of Single-Status Childbearing

Background: Among the achievements of modern fertility technologies available to contemporary humans, we could mention the freezing technique to fertility preservation, and subsequently, unmarried childbearing. The only way for having children was having sexual intercourse with the opposite gender in the past years; however, with the advent of this technology, even without such a relationship, it is possible to have a child. This process could be termed unmarried childbearing or single-status fertilities. This is one of the resent subjects in medical fertility; however, there is no research in this field, in Iran.
 Methods: This was an applied and theoretical research in the theology field; thus, no research material was implemented. The main method of this research was the bookcase approach.
 Result: In countries such as the USA, UK, and Australia, where there are more coherent laws about employing modern fertility techniques, this issue is addressed and specific laws exist in this regard. However, despite widespread use of this technique in Iran, we have no law in this respect except for the Fetal Donation Act of 2003, which only covers the general issues. In other words, the social fertility mandate has remained silent given permission, prohibition, and its conditions and effects on the child lineage in Iran's laws.
 Freezing gametes is practiced in our country for a wide range. Besides, single-status fertility is occurring worldwide. Accordingly, this seems to be among the problems facing our society, and may also be illegally conducted in some cases, in Iran. In Islamic law, the permissible instances of reproductive rights include births through marriage, not otherwise, as well as births employing reproductive aids in terms of meeting the Islamic law. On the other hand, some individuals believe that this case can be regarded as some kind of inoculation with the involvement of a donor agency, and some jurists have voted to allow it. Therefore, these jurists explicitly accepted the use of donor gamete in the form of marital relations. The legislature of the Islamic Republic of Iran also emphasizes on donation to lawful couples in the law of donation approach. Therefore, using donated gametes for childbearing is excluded in singles. Additionally, Judaism and all branches of Christianity, except for the liberal protestant denomination prohibit unmarried childbearing.
 While the approach to the issue differs from one country to another, the USA Supreme Court has recognized and protected free relationships, family formation, and decisions on births, as freedom rights. The UK law has subjected the provision of services to single women to the welfare of children resulting from the process. However, in France, the provision of infertility treatment services to single individuals is prohibited. According to Australia law, any single or heterosexual individual without receiving medically-assessed services, i.e., referred to as ‘‘clinically infertile’’ cannot use this technology for having children.
 Conclusion: In some countries, like the USA, bearing a child at a single status is legal; however, in some other regions, like the UK and Australia, it is permitted under special conditions. In some countries, like France, this action is prohibited. There is no law about this matter in Iran. The 167 article of the constitution addresses considering the Islamic verses and narrations on preserving the destination of the generation or acquiring the benefits and disposing of the corruption. In conclusion, the only way to have a child and to realize the principle of reproduction is permitted in the framework of religious marriage; thus, bearing a child at a single status is illegal and prohibited, in Iran.

‘Two countries-two labs’: the transnational gamete donation (TGD) programme to support egg donation

PurposeTo evaluate the effectiveness, efficiency, and safety of a transnational gamete donation (TGD) programme based on the shipping of vitrified donor oocytes.MethodsA retro-prospective observational study was conducted in the Assisted Reproductive Technology Center of the University Hospital of Florence, Italy. The study population included 622 consecutive donor oocyte cycles. A mean number of 6 vitrified oocytes per couple were shipped from two Spanish biobanks. In the receiving centre, gametes were warmed and inseminated and the subsequent embryo transfer (ET) was performed. The main outcome measurement was LBR. Secondary outcomes included oocyte survival rate, ICSI damage rate, normal fertilization, cleavage, and implantation rate (IR) in both ‘fresh’ and cryotransfer cycles.ResultsA total number of 3536 mature oocytes were warmed with 81.4% surviving oocytes. 2PN oocytes were 1941 with an ICSI normal fertilization rate of 70.4% and a cleavage rate of 93.4%; 857 day-3 embryos were transferred in 498 women, 63 blastocysts in 44. Couples with at least one vitrified embryo were 181 (32.3%). IR was 25.1% and 33.1% for day-3 ET and blastocyst stage respectively. Crude pregnancy rate and LBR after the first ET were 35.5% and 27% correspondingly with a conservative cumulative LBR of 34% and an optimal LBR of 51.4%.ConclusionImported vitrified donor oocytes retain their competence and are capable of resulting in ongoing pregnancies and healthy babies in a proportion comparable to other existing systems as egg donation with vitrification/warming in the same laboratory and transnational fresh oocyte donation.

Reimagining disability: the screening of donor gametes and embryos in IVF.

ABSTRACTIn this article, we examine how disability is figured in the imaginaries that are given shape by the reproductive projects and parental desires facilitated by the bio-medical techniques and practices of assisted reproductive technologies (ARTs) that involve selection and screening for disability. We investigate how some users of ARTs understand and deploy these imaginaries in ways that are both concordant with and resistant to the understanding of disability embedded within the broader sociotechnical and social imaginaries. It is through users’ deliberations, choices, responses, and expectations that we come to understand how these imaginaries are perpetuated and resisted, and how maintaining them is also dependent upon the individual actions and actors who have internalized them. Our examination is grounded in a close analysis of a small selection of interviews drawn from data gathered during a 4-year project funded by the Australian Research Council exploring the Australian experience of cross border reproductive treatment, looking particularly at surrogacy, and gamete and embryo donation. Our interviewees were individuals or couples who used gamete or embryo donation, coupled at times with surrogacy in attempting to have a child. Participants discussed their views on testing, screening, and future disability.

A case of germline mosaicism for a 7q32.1q33 deletion in a sperm donor: consequences on pregnancy follow-up and recommendations

BackgroundGermline mosaicism is considered to be a rare event. However, its occurrence is underestimated due to the limited availability of germ cells. The genomic variations that underlie this phenomenon comprise single nucleotide polymorphism (SNPs), copy number variations (CNVs) and aneuploidies. In the case of CNVs, deletions are more frequent in the paternal germline while duplications are more commonly maternal in origin. Germline mosaicism increases with paternal age as the risk of SNPs increase with the number of germ cell divisions. We here report a case of germline mosaicism in the spermatozoa of a donor that resulted in one pathological pregnancy.ResultsStraws from the same sperm donor were provided to seven recipient couples, resulting in four pregnancies. Second trimester ultrasound analysis revealed bilateral talipes equinovarus associated with growth retardation in one of these pregnancies. Array-comparative genomic hybridization (CGH) carried out after amniocentesis revealed a 4 Mb deletion in the 7q32.1q33 region. The blood karyotypes and array-CGHs were normal in the mother, as well as in the donor. However, the microsatellite profile indicated a paternal origin. Fluorescent in situ hybridization (FISH) analysis of the donor’s spermatozoa revealed the same chromosomal rearrangements in 12% of the spermatozoa population. Due to the documented risk of mental retardation associated with genomic rearrangements in the same region, the couple decided to terminate the pregnancy. Amniocentesis was performed in the other couples, which yielded normal FISH analysis results.ConclusionsSeveral cases of germline mosaicism have been reported to date, but their frequency is probably underestimated. Moreover, it is important to note that germline mosaicism cannot be ruled out by conventional cytogenetic screening of blood cells. This case highlights the need for close follow-up of every pregnancy obtained through gamete donation, given that the occurrence of germline mosaicism may have major consequences when multiple pregnancies are obtained concomitantly.

Methods of experimental polyploidization and their use in apple breeding

The article presents methods of experimental polyploidy of fruit, berry and ornamental plants. The purpose of this review is to highlight the problems and prospects of polyploidization of plants in the open ground and in vitro culture and the possibility of their application for apple trees. For the purpose of obtaining apple tetraploids as donors of diploid gametes, seed seedlings were treated with a solution of colchicine in concentrations of 0.1-0.4 % for 24 and 48 hours. Colchicine concentrations of 0.3 % and 0.4 % at 48 hours of treatment had a detrimental eff ect on their development. As a result, tetraploids and chimeras were obtained from seeds from free pollination of the varieties Orlik, Svezhest, Kandil Orlovsky, as well as from seeds obtained from crossing the varieties Svezhest×Bolotovskoe, Moskovskoe Оzherel’e×Imrus, Girlyanda×Venyaminovskoe. The optimal concentration of colchicine was 0.1 %. Methods of colchicine treatment have been studied: 1) adding to the nutrient medium, colchicine concentration: 0.01%, 0.02%, exposure time 24h-19 days; 2) applying amitotic solution to the growth point, colchicine concentration: 0.1 %, 0.2 %, exposure time 24h-7 days. To increase the penetration of colchicine through the cell walls, a 0.1 % dimexide solution was used. Studies have shown that high concentrations and prolonged exposure to colchicine reduce the viability of explants.

Myths and Controversies in Assisted Reproductive Techniques: Gynecologist's Perspective

<p><strong>Background and Objective:</strong> Globally infertility affects between 60 million and 168 million all over the world. Regardless of the fact that Pakistan being currently among the most overpopulated nations of the globe and a populace development pace of around 2%, confronts with the higher pace infertility (21.9%); 3.5%primary and 18.4% secondary. The aim of the study was to assess the understanding of gynecologist of Pakistan regarding Assisted Reproductive Techniques (ART).<br /><strong>Methods:</strong> It was a descriptive study, conducted only for gynecologists who attended the “Asia Pacific Initiative on Reproduction” (ASPIRE) conference held in Lahore, Pakistan, from 29th Nov to 1st December2019. Data was collected from the n = 252 gynecologist who were attending the conference.<br /><strong>Results:</strong> Out of n = 252 doctors, 82.9% participants considered test tube baby a social norm and acceptable option while 55.6% participants were in the opinion of basically a stigma attached to society. According to 77.8% participants, socially and legally involvement of 3rd party like donor eggs, sperms and gametes cannot justify.<br /><strong>Conclusion:</strong> Pakistan, gynecologists are the mainstream dealing with infertility. Apart from general population, there are certain myths and controversies among the gynecologist as well. So that gynecologists’ knowledge and perception is the most important point regarding infertility and ART. </p>

Intrafamilial Surrogacy: Motivations, Imaginary and Current Reality

In some countries it happens that a person or a couple making use of medically assisted reproductive technology prefers (if possible) to use as gamete donor or a surrogate woman a person from within their own family, whether this person offers their services spontaneously or is asked to help: sisters who donate eggs to their sisters, brothers who donate sperm to their brothers, mothers who carry their future grandchildren in their own womb or vice versa. The aim of this article is to investigate the issue of intrafamilial donation, with particular focus on intrafamilial surrogacy. Our analysis will be based on the results of a survey conducted on the wider topic of the social imaginary associated with medically assisted procration.

GAMETE DONATION. ETHICAL AND LEGAL ASPECTS

This world literature review tries to determine the significance of the gamete donation in the field of assisted reproductive technologies as well as the availability of treatment methods using donation in in vitro fertilization programs.
 Gamete donation is regulated by every country's national legislation system, and quite often the laws vary between the states. There are practically no universal standards and/or rules in this area, which, in turn, leads to an ambivalent reaction towards reproductive practices.

HEALTHCARE PROVIDER PREFERENCES RELATED TO DISTRIBUTION OF GAMETE DONOR MEDICAL HISTORY UPDATES

Personal and family medical history is collected from gamete donors during their initial eligibility assessment for participation in a donor program. This medical information captures only a short period of time given that donors are required to be young and healthy at the time of donation. New diagnoses in a gamete donor, a family member or a donor-conceived individual could significantly impact the health management of other donor-conceived offspring. Thus, the ASRM Ethics Committee recently published recommendations for donor programs (1) to encourage donors and recipients to provide medical updates and (2) to develop policies which outline the mechanisms for collecting and distributing updates.

National survey on the opinions of French specialists in assisted reproductive technologies about social issues impacting the future revision of the French Bioethics laws

IntroductionFrance is known for its conservative and unique position in assisted reproductive technologies (ARTs). At the eve of the future revision of French Bioethics laws, we decided to conduct a national survey to examine the opinions of French specialists in ARTs about social issues. Material and methodsDescriptive study conducted in May 2017 in a university teaching hospital using an anonymous online questionnaire on current issues in ARTs. The questionnaire was sent by email to 650 French ARTs specialists, both clinicians and embryologists. ResultsAfter 3 reminders, 408 responses were collected resulting in a participation rate of 62.7% (408/650). Concerning pre-implantation genetic testing, 80% of the physicians were in favor of expanding the indications, which in France are presently limited to incurable genetic diseases. Authorizing elective Fertility Preservation was supported by 93.4% of the specialists, but without social coverage for 86.3% of them. Concerning gamete donation, 77.4% of the French ARTs specialists were in favor of giving a financial compensation to donors, 92% promoted preserving their anonymity and 80.9% were against a directed donation. ARTs for single heterosexual women were supported by 63.4% of the French specialists and by 72.5% for lesbian couples. The legalization of surrogacy was requested by 55.2%. DiscussionPending the revision of the French Bioethics laws, this survey provides an overview of the opinion of the specialists in ARTs on expanding ARTs for various social indications.Because of the evolution of social values, a more liberal and inclusive ART program is desired by the majority of ART specialists in France.

EFFECTS OF SPERM AGE ON EMBRYO PLOIDY IN PGT-A

PGT-A is routinely offered to patients undergoing IVF. Advanced maternal age (AMA), defined as ≥35 years, has a known significant effect on embryo ploidy status. The effects of advanced paternal age (APA), defined as ≥40 years, on ploidy have been studied less. This study assesses euploid and mosaic rates of embryos created with donor sperm (DS), non-APA sperm, and APA sperm, stratified by use of donor egg (DE), non-AMA eggs, and AMA eggs. Retrospective analysis. All samples received 5/2018 - 5/2020 were included, except for those sent for PGT-SR or with suspected rearrangements. Samples created with known donor gametes were categorized with their respective age groups. Whole-genome amplification, next generation sequencing, and data analysis was performed using the Ion ReproSeqTM PGS Kit and Ion ReporterTM software (Thermo Fisher Scientific). Results were reported as 1) no abnormal cells detected, 2) abnormal cells detected (with percentages if mosaicism was identified), or 3) did not pass quality control (QC) metrics, leading to embryo categories euploid, aneuploid, mosaic, and QC failure. Results were tallied and chi square analyses were performed to compare euploid and mosaic rates between DS samples and non-APA and APA sperm samples. A total of 23,239 samples from 4,691 cycles were included. Table 1 displays ploidy rates for each group and corresponding chi square p-values. Our data shows that sperm age can have an effect on embryos’ ploidy status, as shown by a significantly higher euploid rate in embryos created with DE and DS compared to those created using DE and either non-APA or APA sperm; this effect was noted even with a small sample size. Amongst embryos created with AMA eggs, DS has less of an effect, demonstrating that egg age is still the primary factor affecting embryo ploidy. Clinicians can use this information when counseling patients on the effects of AMA and APA on embryo ploidy.Tabled 1Table 1. Euploid & Mosaic Rates by GroupEmbryo Categories% Euploidχ2 p-value (Euploid)% Mosaicχ2 p-value (Mosaic)Average Egg Age (years)Average Sperm Age (years)DE + DS97/146-19/146-25.228.266.44%13.01%DE + S<401770/3146p = 0.015581/3146NS25.834.656.26%18.47%DE + S≥401478/2593p = 0.025456/2593NS264657.00%17.59%E<35 + DS265/494-99/494-31.626.353.64%20.04%E<35 + S<402662/4808NS757/4808p = 0.01331.833.755.37%15.74%E<35 + S≥40455/829NS129/829p = 0.03732.146.254.89%15.56%E≥35 + DS396/1145-129/1145-39.427.434.59%11.27%E≥35 + S<402122/5251p = 0.0003646/5251NS37.736.340.41%12.30%E≥35 + S≥401559/4827NS458/4827NS39.445.132.30%9.49%DE: donor egg; DS: donor sperm; S<40: non-APA sperm; S≥40: APA sperm; E<35: non-AMA egg; E≥35: AMA egg; NS: not significant Open table in a new tab

Acceptability of assisted reproductive technologies in Hong Kong, a very low fertility Asian city

Abstract Background Although advances in medical technologies now allow greater reproductive options, the social acceptance of assisted reproductive technologies (ART) has not been examined in East Asian countries which currently have the lowest fertility rates in the world and highly prohibitive regulations. Methods A cross-sectional telephone surveys interviewed 990 among Hong Kong Chinese adults (&amp;gt;18 years of age) in 2015 who were asked about their knowledge and attitudes towards various ART and their inclination to use ART. A focus group was conducted (n = 30) on physicians to examine the perceived barriers and benefits of integrating ART as routine offerings. Results Although nearly all adults (&amp;gt;92.0%) were familiar with ART procedures such as in vitro fertilization, sperm banking, and gestational surrogacy, attitudes supporting the use of these services and the inclination to use these services varied widely by socio-demographic attributes. Nearly one-third (31.5%) of women said that they would consider cryopreservation of their oocytes or embryos if they could afford it and 21.9% would encourage their female family members to do so. Although respondents considered sperm donation and embryo preservation to be well-accepted practices, support for these services was noticeably lower than in Western countries for unmarried individuals and homosexuals. Also, the vast majority of respondents were much more disinclined to use anonymous donor gametes than in Western countries. Among medical practitioners, the primary barriers to routine offering of these services to their clients was the perceived lack of cultural acceptance of these types of services. Conclusions Public support of assisted reproductive services for genetic offspring is well-accepted for heterosexual couples. Main Messages: Asian countries with sub-replacement fertility levels may consider integrating ART into their mainstream health services and updating their regulatory frameworks. Key messages Public support for assisted reproductive technologies is high for married couples only in Hong Kong. Given the sub-replacement fertility levels, cities in East Asia should consider updating regulatory frameworks to allow expansion of ART services.

RAISED SPERM DNA FRAGMENTATION – WILL INTERVENTION WITH SURGICAL RETRIEVAL OF TESTICULAR SPERMS OPTIMIZE REPRODUCTIVE AND PERI-NATAL OUTCOMES ?A DECADE’S OBSERVATIONAL STUDY FROM AN INDIAN CLINIC

For Individuals with Raised Sperm DNA Fragmentation (SDF), will intervention with Surgical Retrieval of Sperms (SRS) from testes optimize Reproductive and Peri-Natal outcomes in Assisted Reproductive Techniques (ART) cycles. This is a retrospective study at our private IVF clinic from 2010 to 2019. SAMPLE SIZE: Couples with history of at least one failed IVF cycle were offered testing for SDF by SCSA method. SDF >30% was considered high and such couples were offered SRS from testes and testicular sperms were used for ICSI (n= 342). Couples were counselled about the risks, benefits and experimental nature of this intervention. Written consent was obtained from the couple and taken through an ART cycle with SRS from tests. Women underwent controlled ovarian stimulation and oocyte retrieval as per our clinic’s standard operating protocol (SOP). Fertilized oocytes were cultured till blastocyst stage and freeze all policy was adopted. Two blastocysts were transferred in a frozen embryo replacement cycle. INCLUSION CRITERIA: Individuals who had successful SRS with self-gamete cycles were included in this study. Exclusion CRITERIA: Donor gamete cycles and individuals who had failed SRS were excluded from this study. Primary Outcomes: Implantation rate (IR), Live birth rates (LBR) and Perinatal outcomes (Gestation Diabetes (GDM), Pregnancy Induced Hypertension (PIH), Intra Uterine Growth Restriction (IUGR), mean Pre-Term Birth rate (PTB), Birth weight (BW Normal - >2.5kgs), Low Birth weight (LBW – 1.5-2.5kgs), Very LBW (VLBW - <1.5kgs) Secondary Outcomes: Fertilization rate (FR); blastocyst rate (BR), Clinical pregnancy rate (CPR); Miscarriage rate (MR) and Multiple Pregnancy rate (MPR) Mean of the outcomes were as follows: FR - 93.35%, BR - 35%, IR - 40.34%, CPR - 56.90 %, MR was 12.03 %, MPR – 17.2% , LBR - 35.23, GDM – 6.06%, PIH – 6.82%, No IUGR reported in the study group. 17.4% had PTB. Mean BW was 2.5 kg. Out of this Normal BW was 55.6 %, LBW was 36.7 % and VLBW was 13.3 %. Use of SRS in couples with raised SDF seems to offer optimal reproductive and perinatal outcomes. Couples seeking ART with raised SDF, SRS can be offered as an active intervention. Testicular sperm for Raised SDF seem to offer beneficial reproductive and perinatal outcomes in ART cycles. TESA can be offered as an active intervention.

The Evolving Landscape Of Donor Egg Treatment: Success, Women’s Choice And Anonymity

40K+ babies are born in the US annually from the use of donor gametes; ∼¼ are eggs (DE). Notably, in 2017, ∼¼ of the women > 40y that succeeded using ART did so with DE. DE is thus, common practice today as more women delay childbirth in lieu of professional/personal pursuits, causing them to “age-out” of traditional ART. DE has evolved from synching a recipient’s (REC) endometrium to a donor’s fresh retrieval (FRESH-O) + multi-embryo FRESH-ET to; (non-synchronized) frozen-embryo transfers (FROZ-ET) &/or the use of commercially-bought, frozen DE (COM-O) ± the use of PGT-A; all meant to optimize DE outcomes. We sought to examine trends over time re: psychology, cost, choice, genetics and ease. Retrospective analysis. From 1/2014-12/2019, we completed 462 DE transfers in 241 REC using a total of 163 donors (avg: 2-emb ET/REC). We analyzed donor characteristics & cycle repeats, &, over time, FRESH-O vs. COM-O, SOLE (1 REC) vs. SHARED (2 REC), FRESH-ET vs. FROZ-ET, PGT-A or not, single (SET) vs. double (DET) ET. Primary outcome was ongoing (> 8 wks) pregnancy + live birth rate (OP/LB). Stats: Chi Square was used. Of donors, 98 (60%) were FRESH-O; 65 (40%) were COM-O. 29 (30%) FRESH-O donated greater than once (REPEAT) with embryos transferred to a total of 108 REC. On average, REPEATs had 3 retrievals (range 2-6), went to 4 REC (range 2-9) & their donations resulted in 7 ETs (range 2-23) creating 84 OP/LB; 3 per donor (range 1-9). A total of 74 “genetic half-siblings” were born to 76 REC from 23 donors. Assessing oocyte & ET type, FRESH-ETs using FRESH-O compared to COM-O yielded a higher OP/LB rate (51% vs. 27% p=.0007). In FRESH-O, OP/LB rates were similar in FRESH-ET & FROZ-ET (50% vs 41%, p=.08). For all DE cycles, PGT-A use increased over time (2014-16: 0.2%, 2018-19: 13%) with no OP/LB improvement (p=.9). 2-ETs led to a higher OP/LB compared to SET (50% vs. 37%, p=.007) but had a 15% twin rate. The program trended from 2-ET to SET over 6y (2014-2019), decreasing from 42% to 19% (p<.05); SET continues to dominate. As years progressed, we trended toward SOLE over SHARED and less COM-O due to SOLE’s superior OP/LB per ET. Of note, 60/75 (80%) SOLE (17 eggs/REC) & 28/30 (93%) SHARED (10 eggs/REC) donors made at least 1 OP/LB. ART continues to evolve. As OP/LB successes have become universally acceptable, primary treatment emphasis has expanded from best-pregnancy-rate-only to include healthy baby (and mother) & meeting patient concerns: cost, timing, ease, non-family genetic siblings. Trends in practice require continuous reevaluation. Moving away from 2-ET in favor of SET is mandatory. PGT-A’s role in DE appears unnecessary except for carrier-state issues. The combo of SOLE, FRESH-O + readied REC continues to provide the best absolute OP/LB but COM-O and FROZ-ET add choice and convenience. Sharing donors, whether through FRESH-O or COM-O decreases cost & the # of supernumerary embryos but also increases the number of REC per donor, and therefore genetically-related offspring in the background of consumer testing unraveling anonymity. Donors and intended parents require full & appropriate counseling.