Gamete Intrafallopian Transfer Research Articles

Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.

Differences in medically assisted reproduction use by sexual identity and partnership: a prospective cohort of cisgender women.

Long-Term Effects of ART on the Health of the Offspring.

Assisted reproductive technologies (ART) significantly increase the chance of successful pregnancy and live birth in infertile couples. The different procedures for ART, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), and gamete intrafallopian tube transfer (GIFT), are widely used to overcome infertility-related problems. In spite of its inarguable usefulness, concerns about the health consequences of ART-conceived babies have been raised. There are reports about the association of ART with birth defects and health complications, e.g., malignancies, high blood pressure, generalized vascular functional disorders, asthma and metabolic disorders in later life. It has been suggested that hormonal treatment of the mother, and the artificial environment during the manipulation of gametes and embryos may cause genomic and epigenetic alterations and subsequent complications in the health status of ART-conceived babies. In the current study, we aimed to review the possible long-term consequences of different ART procedures on the subsequent health status of ART-conceived offspring, considering the confounding factors that might account for/contribute to the long-term consequences.

Racial/ethnic disparities in infertility treatment utilization in the US, 2011–2019

With delayed child-bearing age, there has been an increase in infertility rates globally and in the United States (US). Unsurprisingly, there has been a concomitant substantial increase in the number of individuals seeking infertility treatments over the last decade. This study aimed to examine the relationship between race/ethnicity and the utilization of different infertility treatments over the previous decade. We conducted this retrospective cohort study using the United States (US) Birth data files 2011–2019. We calculated the rates of infertility treatment and its subtypes over the study period. Descriptive statistics were utilized to examine the sociodemographic and birth characteristics for overall births and those associated with any infertility treatment and each of its subtypes. We calculated the level of association between race/ethnicity and utilization of infertility treatment and the subtypes using adjusted logistic regression models. We found that the rate of infertility treatments for all subtypes considered, had steadily increased by 63.7% within the past decade. In contrast, fertility enhancing drugs or Intrauterine Insemination (IUI) increased by 134%, and in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) treatments increased by 40% over the 9-year study period. Non-Hispanic (NH) Asian women had the highest rate of any infertility treatment with a rate of 25 per 1000 births whereas Hispanic women had the lowest rate of any infertility treatment at 5.8 per 1000 births. When compared with NH-White women, NH-Asian women had a modest 7% lower likelihood (OR = 0.93, 95% CI = 0.92–0.94) of receiving any infertility treatment while NH-Black and Hispanic women had about 70% lower likelihood of receiving any infertility treatment. Our report of increased assisted reproductive technology (ART) utilization rates, and marked racial/ethnic differences in ART utilization highlight the importance of expanding knowledge of inequities that continue to impact marginalized groups, a critical step for informing actionable strategy formulations (i.e., advocacy, policy change, patient education, provider training) to address these inequities.

Perceived Causes of Infertility Among Married Adults in Kwara State, Nigeria

Infertility is one of the major causes of marital discord with damaging condition that exposes couple to emotional, physical and financial stress. Therefore, this study aimed at investigating the perceived causes of infertility of married adults in Kwara State. The research design adopted for this study is descriptive survey method. The population of this study is all married adults in Kwara State while the target population comprised married adults in the seven selected Local Governments Areas from the three senatorial districts of Kwara State. 420 respondents were selected as the sample for the study. Proportional and simple random sampling techniques were employed by the authors to select the sample for this study. The instrument (questionnaire) used for this study was designed by the authors. Content validity of the instrument was ascertained, and the reliability of the instrument was established using test-retest method. The correlation of the two sets of scores using Pearson’s Product Moment Correlation yielded a co-efficient R=0.81. The data collected was analysed using t-test and Analysis of Variance at 0.05 level of significance. The findings revealed that there were no significant differences on the perceived causes of infertility among married adults in Kwara state on the basis of age and gender. This study, therefore, recommended that Modern and assisted methods of conception such as intra-uterine insemination (IUT), Invitro fertilisation and embryo transfer (IVF/ET), gamete intra fallopian transfer (GIFT) should be encouraged by medical personnel and implemented by couples suffering from infertility. Counselling services should be organised regularly for couples to alleviate the impacts of infertility on the well-being of the couple.

Anaesthesia for assisted reproductive technology (ART): A narrative review

Assisted reproductive technology (ART) is used primarily to address the treatment of infertility which includes medical procedures such as in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), gamete intra-fallopian transfer (GIFT) or zygote intra-fallopian transfer (ZIFT). IVF has revolutionised infertility treatment and is nowadays widely accepted all over the world. The IVF is carried out as a daycare procedure and many anaesthetic regimens have been studied, tried and tested so far. An anaesthesiologist's role mainly comes into play during trans- vaginal oocyte retrieval and embryo transfer (ET) process of IVF. Various techniques of anaesthesia are practised which include general or regional anaesthesia, conscious sedation or monitored anaesthesia care, patient-controlled analgesia, acupuncture and transcutaneous electrical nerve stimulation (TENS). The anaesthetic management needs careful consideration of the effect of drugs on the maturation of oocytes or embryonic development, fertilisation and pregnancy rates. In view of the Coronavirus disease-19 (COVID-19) pandemic, ART clinics have been affected and due to the ambiguity of its effects on the reproductive outcome, anaesthesiologists need to be vigilant and cautious with anaesthetic management during pandemic times. This review includes a discussion of various anaesthetic options and agents along with their advantages or disadvantages if any. The literature sources for this review were obtained via PubMed, Medline, Cochrane Library and Google Scholar. The results of 82 out of 110 articles discussing different methods of anaesthesia for ART procedures over 25 years were compiled.

Uterus transplant and controversial assisted reproductive technologies: can the right to parenthood clash with ethical precepts?

Fast-developing assisted reproductive techniques based on innova- tive technologies have given rise to incredibly consequential ethical challenges of unprecedented scope. The development of innovative assisted reproductive technologies (ARTs) has steadily risen since the late 1970s. Until just over 20 years ago, those who sought to become parents had no way to overcome their infertility or sterility issues, but can now achieve parenthood and have children with at least a partial genetic and/or biological relationship. Treatments aimed at ovarian stimulation, artificial insemination, either by using the sperm of a husband or of an unrelated donor, in vitro fertilization with embryo transfer, gamete and zygote intrafallopian transfers, and intracyto- plasmic sperm injection are among the options currently available. A major ethical quandary linked to ARTs is the one arising from unused embryos, i.e. supernumerary embryos which were not implanted. Still, aside from ethical concerns stemming from embryo rights, in such a fast-evolving field, a solid ethical foundation is absolutely necessary to provide guidance for regulations and legislation. This is especially true considering how assisted reproductive practices such as surrogacy and uterus transplant (UTx) are even more controversial, hence the need to rely on a broadly acknowledged and shared set of principles for their regulation, by virtue of their unique distinctive traits which challenge our ethical and moral compass at its very core.

O-073 Perinatal outcomes of infants conceived using partner versus donor sperm - An analysis of singleton and twin pregnancies from the UK national dataset

Abstract Study question Are perinatal outcomes different in pregnancies conceived using donor sperm compared with those with partner sperm? Summary answer The perinatal outcomes of singleton and twin pregnancies conceived with donor sperm are better when compared to those conceived with partner sperm What is known already There has been a substantial increase in the use of donor sperm in the last 15 years across the world. A recent systematic review and meta-analysis has suggested that there is an increased risk of hypertensive disorders of pregnancy and small for gestational age babies from ART treatment using donor sperm compared to partner`s sperm. This meta-analysis was limited due to poor quality of primary studies often with small sample sizes. Study design, size, duration This is a retrospective cohort study on 196,293 singleton and 46,275 twin pregnancies from the Human Fertilisation and Embryology Authority (HFEA) anonymised dataset including all live births from 1991 to 2016. Outcomes were preterm birth ( < 37 weeks); very preterm birth ( < 32 weeks); very low, low, high and very high birth weight ( < 1500g, < 2500g, >4000g and >4500g respectively); congenital anomaly and healthy baby (term live birth with appropriate weight and no congenital anomaly). Participants/materials, setting, methods All pregnancies resulting in singleton or twin livebirth were included. Any cycle involving donor oocytes, PGD, gamete intra-fallopian transfer, ectopic pregnancy, miscarriage, stillbirth, or termination was excluded. Logistic regression and generalised estimating equations were used for analysis of singletons and twins, respectively. Odds ratios (aOR) with 95% confidence intervals (CI) for donor versus partner sperm were adjusted for maternal age, previous pregnancy, cause of infertility and year for all outcomes plus gestational age for birthweight. Main results and the role of chance Baseline characteristics for donor and partner sperm pregnancies were assessed for singleton and twin livebirths separately. In both analyses there were significant differences between donor and partner sperm pregnancies in terms of maternal age, previous pregnancy status and cause of infertility. Analysis of singleton births demonstrated an increased odds (aOR, 95% CI) of having a healthy baby (1.09, 1.05 - 1.12) and reduced odds of congenital anomaly (0.34, 0.29 - 0.39), very preterm birth (0.66, 0.58-0.75), preterm birth (0.81, 0.76-0.86), low birthweight 0.89 (0.83 - 0.96) in singleton births using donor sperm compared with those using partner sperm. There was, however, an increased odds of high birthweight (1.10, 1.05 - 1.16) and very high birthweight (1.16, 1.05-1.29) with donor sperm pregnancies. Analysis of twin births conceived with donor sperm also showed higher odds of having a healthy baby (1.07, 1.01 - 1.15) and lower odds of congenital anomaly (0.52, 0.39 - 0.68) compared with partner sperm. There were no statistically significant differences between the birthweight or birth gestation outcomes for twin pregnancies. Sensitivity analysis of only cases with complete outcome data showed no significant differences when compared to the primary analysis. Limitations, reasons for caution This is a retrospective study of a single nation’s routinely collected data. We could not adjust for confounders such as smoking, BMI and pregnancy complications such as pre-eclampsia, as they are not recorded in HFEA’s dataset. Wider implications of the findings Patients and clinicians can be reassured that donor sperm pregnancies are not at higher risk of adverse perinatal outcomes. In fact, they are more likely to result in a healthy baby. Worldwide registries should consider including maternal data to enable a better assessment of outcomes. Trial registration number Not applicable

Sperm DNA Integrity and Male Fertility in Farm Animals: A Review.

The accurate prediction of male fertility is of major economic importance in the animal breeding industry. However, the results of conventional semen analysis do not always correlate with field fertility outcomes. There is evidence to indicate that mammalian fertilization and subsequent embryo development depend, in part, on the inherent integrity of the sperm DNA. Understanding the complex packaging of mammalian sperm chromatin and assessment of DNA integrity could potentially provide a benchmark in clinical infertility. In the era of assisted reproduction, especially when in-vitro fertilization or gamete intrafallopian transfer or intracytoplasmic sperm injection is used, assessment of sperm DNA integrity is important because spermatozoa are not subjected to the selection process occurring naturally in the female reproductive tract. Although sperm DNA integrity testing measures a significant biological parameter, its precise role in the infertility evaluation in farm animals remains unclear. In this review, the earlier findings on sperm DNA integrity in relation to male fertility are compiled and analyzed. Furthermore, the causes and consequences of sperm DNA damage are described, together with a review of advances in methods for detection of sperm DNA damage, and the prognostic value of sperm DNA quality on male fertility.

Development of assisted reproductive technology services in Thailand between 2008 and 2014 before the new law: Results generated from the National ART Registry, Royal Thai College of Obstetricians and Gynecologists

Abstract Background While the assisted reproductive technology (ART) relieves the burden of infertility in many couples, it presents significant public health challenges due to the substantial risk for multiple birth delivery and preterm birth, which are associated with poor maternal and fetal health outcomes. For this reason, it is important to monitor the development and effectiveness of ART services in Thailand. Objective To analyze the trends of ART services in Thailand between 2008 and 2014. Methods ART clinics in Thailand are required to submit data to the Royal Thai College of Obstetricians and Gynecologists via the National Reporting System. The data from 2008 to 2014 were collected and analyzed. Results The number of ART centers was increased from 35 to 47. The total fresh ART cycles were also increased from 3,723 to 6,516. The percentage values of intracytoplasmic sperm injection (ICSI), in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer cycles were changed from 77.87 to 95.59, 21.43 to 4.31, 0.21 to 0.09, and 0.45 to 0.05, respectively. The clinical pregnancy rates were 28.79–33.19, 22.84–51.34, 14.29–42.86, and 0.00–26.67, respectively. The clinical pregnancy rates in fresh vs. frozen-thawed cycles were 31.01–36.33 vs. 31.54–37.34 (P < 0.05). The clinical pregnancy rates in female age <35 vs. 35–39 vs. ≥40 years were 36.97–40.70 vs. 32.74–33.42 vs. 21.08–31.34, respectively (P < 0.001), and the percentage values of multifetal pregnancy rate were 18.75 vs. 13.30 and 13.69, respectively (P < 0.001). There were increasing preimplantation genetic screening (PGS) cycles, with the percentage of the clinical pregnancy rate (25.90–42.63, P < 0.05). The clinical pregnancy rates in medium-sized ART centers (100–300 cycles per year) vs. in small and large centers were 30.79–41.14 vs. 28.01–34.04 and 8.70–40.35, respectively (P < 0.001). Trends of increasing percentage of ART birth rate to total birth rate ratio were 0.24–0.34 (P < 0.05). Conclusions There were higher clinical pregnancy rates in frozen-thawed cycles. Higher multifetal pregnancy rate and clinical pregnancy rate were also found in younger females. There were increasing uses of ICSI and PGS. A trend toward increasing ART birth to total birth ratio was observed.

A Clinical study on the efficacy of Udvartana and Nasya on Ovulatory functions w.s.r. to Female infertility in Moderate Obese (Sthula) individuals

Childlessness and infertility are rising dramatically in cities. The increase may be due to many reasons like the way of living, coping with stress, job pressure, obesity, postponing parenthood, galloping urbanization, sexually transmitted infections and many others. Hence treating infertility is the challenging job for the doctors in present era. The failure to ovulate is the major problem in approximately 40% cases of female infertility. This can be anovulation or severe oligo ovulation. In the latter case even though the ovulation does occur, its relative infrequency decreases the womanand#39;s chance of pregnancy. Hence the infertility and especially ovarian factor induced female infertility needs an immediate attention from alternative medicines. Over last decades, fertility therapy has expanded more than any other field of medicine. Hormonal therapy, In vitro Fertilization (IVF), Embryo Transfer (ET), Gamete Intra Fallopian Transfer (GIFT) etc., all these have a minimal success rate. Additionally these procedures are associated with adverse effects andamp; are not affordable to all. Ayurveda may give a promising hand to cure this condition with the various treatment modalities mentioned in the classics. For the present clinical study, an effort was made to study the efficacy of Udvartana and Nasya followed by Shamanaushadhis in reversing the pathology of this disease and giving a “Never-Ending Joy” of parenthood to the couples through the Ayurvedic treatment.

Ian Craft: fertility pioneer responsible for the UK’s first IVF twins

Credit: Simon Craft On 29 April 1982, Europe’s first set of twins conceived by in vitro fertilisation (IVF) were born at London’s Royal Free Hospital. They represented the culmination of...

Interferon-γ aids in protection against equine protozoal myeloencephalitis

Advanced reproductive technologies have been developed to enhance fertility in mares and stallions. Some of these technologies in mares include superovulation, embryo transfer (ET), intracytoplasmic sperm injection (ICSI), oocyte transfer (OT), gamete intrafallopian transfer (GIFT), and cloning. Superovulation can provide multiple oocytes for these techniques. This review will focus on how recombinant equine follicle-stimulating hormone (reFSH) and recombinant equine luteinizing hormone (reLH) are important for superovulation and ET and may be useful for ICSI, OT, GIFT, and cloning. Superovulation would increase pregnancy rates in normal and subfertile mares and enhance reproductive efficiency when using semen from subfertile stallions. Superovulation depends on a timely interaction of gonadotropins and gonadal feedback in the mare. Historically, several hormone protocols have been used to manipulate follicular waves to increase development and ovulations in cycling, anestrous, and transitional mares. Attempts to superovulate cyclic mares or induce the first ovulation of the year in anestrous or transitional mares using preparations of equine chorionic gonadotropin, gonadotropin-releasing hormone (GnRH), GnRH agonists, porcine FSH, domperidone, sulpiride, equine pituitary extracts, native equine FSH, human chorionic gonadotropin, progesterone, and immunization against inhibin have produced variable results. The use of recombinant technology has improved the ability to produce a reliable product in substantial quantities that is free of other hormones and possible contaminants. Several studies using reFSH and reLH that demonstrate their efficacy to superovulate the mare and induce the first ovulation of the year will be discussed in this review.

A preliminary investigation into the use of a “high altitude chamber” in racing Thoroughbreds

Advanced reproductive technologies have been developed to enhance fertility in mares and stallions. Some of these technologies in mares include superovulation, embryo transfer (ET), intracytoplasmic sperm injection (ICSI), oocyte transfer (OT), gamete intrafallopian transfer (GIFT), and cloning. Superovulation can provide multiple oocytes for these techniques. This review will focus on how recombinant equine follicle-stimulating hormone (reFSH) and recombinant equine luteinizing hormone (reLH) are important for superovulation and ET and may be useful for ICSI, OT, GIFT, and cloning. Superovulation would increase pregnancy rates in normal and subfertile mares and enhance reproductive efficiency when using semen from subfertile stallions. Superovulation depends on a timely interaction of gonadotropins and gonadal feedback in the mare. Historically, several hormone protocols have been used to manipulate follicular waves to increase development and ovulations in cycling, anestrous, and transitional mares. Attempts to superovulate cyclic mares or induce the first ovulation of the year in anestrous or transitional mares using preparations of equine chorionic gonadotropin, gonadotropin-releasing hormone (GnRH), GnRH agonists, porcine FSH, domperidone, sulpiride, equine pituitary extracts, native equine FSH, human chorionic gonadotropin, progesterone, and immunization against inhibin have produced variable results. The use of recombinant technology has improved the ability to produce a reliable product in substantial quantities that is free of other hormones and possible contaminants. Several studies using reFSH and reLH that demonstrate their efficacy to superovulate the mare and induce the first ovulation of the year will be discussed in this review.

Before Louise: the history of infertility.

With gender equality and the ‘modern family’, the pace for advances in artificial reproductive technology is fast-moving. Louise Brown was the world's first ‘test tube baby’, born in 1978 (Steptoe & Edwards. Lancet 1978;2:366) (Figure 1). However, infertility and reproductive medicine have featured heavily in ancient mythology of many cultures, reflecting their long-standing value in human society. The Hippocratic Corpus from the 5th and 4th centuries BCE include three chapters on gynaecology and infertility, where infertility had become a medicalised concept and treatment options were proposed. Coxe's translation lists five causes of infertility: ‘the os uteri wrongly situated and firmly closed; the lubricity of the uterus preventing the retention of the seed; ulceration of the body of the uterus consequent to other diseases; retention of the menses; and too great laxity of the orifice of the uterus, precluding the retention of the seed’. Remedies for these afflictions included instrumentation of the stenosed cervical os, a multitude of pessaries containing herbal remedies, fumigation techniques, and specific instructions regarding the timing and method of intercourse (Coxe. The Writings of Hippocrates and Galen, Lindsay & Blakiston, Philadelphia, 306–7). There is also mention of ‘somatic’ or systemic causes, including what we now know as obesity (Flemming. Bull Hist Med 2013;87:565–90). The medicalisation of infertility improved understanding of anatomy and the advent of microscopy drove significant advancements during the 17th century. In 1672, Regnier de Graaf described the ovarian follicles now named after him, at the time believed to be the embryo that migrated to the uterus (Ankum et al. Hum Reprod Update 1996;2:365–9). Spermatozoa was first described in 1677 by microbiologist Anthoni van Leeuwenhoek, who hesitantly inspected his own semen. He wrote to the Royal Society of London stating, ‘If your Lordship should consider that these observations may disgust or scandalise the learned, I earnestly beg your Lordship to regard them as private and to publish or destroy them, as your Lordship sees fit’ (Philos Trans R Soc 1678;12:1040–3). William Smellie wrote on the concept of fertilisation in 1752, outlining the process of ovulation, transit of the ovum through the fallopian tube, and describing semen as ‘abounding with animalcula, that swim about in it like so many tadpoles’ (Smellie. A treatise on the theory and practice of midwifery, Balliere Tindall, London, 1974 reprint; 113–4). Spallanzani pioneered artificial insemination in 1784, achieving pregnancy in dogs, while Dr John Hunter performed the first successful artificial insemination in a human in 1790 for a man with hypospadias (Guttmacher. Ann NY Acad Sci 1962;97:623–31). Contrast this gradual development in reproductive medicine since Hippocrates with the 40 years since Louise Brown's birthday in 1978. The advances in reproductive technology – sperm and egg donors, intracytoplasmic sperm injection, frozen intravenous fertilisation cycles, surrogacy, gamete intrafallopian transfer and preimplantation genetic diagnosis – are remarkable. Improved take-home-baby rates, fewer multiple pregnancies, lower rates of ovarian hyperstimulation syndrome, and time-lapse embryology have followed. This rate of advancement likely reflects our societal drive to develop these technologies, with corresponding improvement in outcomes as described in this issue. The next 40 years are likely to be exciting. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Assisted Reproductive Technology in Iran: The First National Report on Centers, 2011.

Due to the worldwide increase in infertility, it is both necessary and important to have assisted reproductive technology (ART) registries. In Iran, donation and surrogacy programs are approved by decrees from religious scholars. ART has been used since 1984 in Iran and the first Iranian infant conceived by gamete intra-fallopian transfer (GIFT) was born in 1989. This report, however, is the first national report on Iranian ART centers. This cross-sectional study, conducted under the supervision of the Iranian Ministry of Health, presented a summary of the numbers and percentages of centers that provided infertility services in Iran, as well as the status of ART in Iran during 2011. A total of 52 centers reported treatment cycles and performed approximately 29000 intrauterine insemination (IUI), in addition to 35000 in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) cycles. Iran has considerable potential to provide IVF services for both Iranians as well as other nationalities throughout the region. This proves the need for a national center that will implement a registry system.

Oral Drugs for Unexplained Infertility.

Of the infertile couples unable to conceive without any identifiable cause, 30% are defined as having unexplained infertility. Management depends on duration of infertility and age of female partner. The treatment of unexplained infertility is empirical, and many different regimens have been used. Among these are expectant management, ovarian stimulation with clomiphene citrate, gonadotropins and aromatase inhibitors, fallopian tube sperm perfusion, tubal flushing, intrauterine insemination, gamete intrafallopian transfer, and IVF. The first approach to treatment of unexplained infertility generally is the use of drugs that stimulate oocyte production. For over four decades, the first-line treatment for ovarian stimulation in unexplained infertility has been clomiphene citrate. Multiple reports suggest that aromatase inhibitors may be effective alternative agents for ovarian stimulation in couples with unexplained infertility. Their administration is reported to be associated with monofollicular development in most cases, which may result in enhanced fertility and a reduced risk of ovarian hyperstimulation and multiple births, as compared to current standard therapies such as gonadotropin and clomiphene. Despite world evidence to the contrary, letrozole has been banned for use for infertility management in India since 2011.

Gamete Intra Fallopian Transfer（GIFT）法による糖尿病発症ミニブタの作出

Gamete Intra Fallopian Transfer（GIFT）法による糖尿病発症ミニブタの作出

Single Incision Laparoscopic management of a ruptured Heterotopic pregnancy presenting as an acute appendicitis: A case report

Heterotopic pregnancy, defined as the coexistence of an intrauterine pregnancy and an extrauterine pregnancy. It is a rare entity and theoretically occurs at an incidence of 1 in 30 000 pregnancies (2,3,12). The rise in the incidence of tubal and pelvic diseases has contributed to an increasing rate of heterotopic pregnancies. This rise can also be attributed to the increasing use of assisted reproductive technology such as In Vitro Fertilization (IVF) and Gamete intra-fallopian transfer (GIFT) (2,3,11,12). After assisted reproductive technology procedures, the incidence of heterotopic pregnancy is at a concerning 1 in 100 pregnancies (2,12).The treatment of heterotopic pregnancy aims to maintain the intrauterine pregnancy while removing the extrauterine pregnancy using a minimally invasive method (1). The treatment modalities for heterotopic pregnancy can be divided into surgical and non-surgical treatments. Non-surgical treatments involve the direct administration of drugs, such as potassium chloride, methotrexate, and hyperosmolar glucose to the extrauterine gestational sac under ultrasonographic or laparoscopic guidance (10,11). Systemic management of these agents is difficult because these treatments can result in termination of both the desirable intrauterine and unwanted extrauterine pregnancy (7). Surgical management, particularly laparoscopic surgery, has a shorter operating time, faster recovery, and less postoperative pain compared with those of laparotomy.As seen in our patient, heterotopic pregnancy is a difficult entity to diagnose, often leading to the late detection of an extrauterine sac (2). Our patient is a 36-year-old who has been trying to get pregnant for 2 years. Because of the information available a diagnosis of acute appendicitis in pregnancy was made. There were no clear signs of a ruptured ectopic pregnancy despite ultrasonography been done. An emergency laparoscopic procedure was done highlighting the underlining pathology.

In vitro fertilization in Japan - early days of in vitro fertilization and embryo transfer and future prospects for assisted reproductive technology.

Assisted reproductive technology (ART) such as in vitro fertilization (IVF) and embryo transfer (ET) has been essential in the treatment of infertility. The world’s first IVF-ET baby was born in 1978 based on the technique developed by Dr. Robert Edwards and Dr. Patrick Steptoe.1) In Japan, the first IVF-ET birth was reported in 1983 by Prof. Masakuni Suzuki at Tohoku University School of Medicine.2,3)IVF-ET is a procedure used to achieve pregnancy that consists of extracting oocytes from an infertile woman, fertilizing them in vitro, and transferring fertilized eggs into the patient’s uterine cavity (Fig. 1). Since the first report of successful IVF-ET, numerous techniques related to ART, such as cryopreservation of oocytes and embryos, gamete intrafallopian transfer (GIFT), and microinsemination, have been developed and refined (Table 1).Herein we describe the history of basic research in IVF-ET that led to human applications, how the birth of the first IVF-ET baby was achieved in Japan, the current status of ART in Japan, issues related to ART, and future prospects for ART.

Altering The Primal Environment: Health Effects Associated With Assisted Reproductive Technologies

When Darine El-Chaar began her residency in obstetrics and gynecology at the University of Ottawa five years ago, she grew curious about the potential health repercussions of assisted reproductive technologies (ART), the catchall term for procedures used to help couples artificially conceive a child. ART involves surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the womb.1 Women undergoing ART take “fertility drugs” such as clomiphene citrate and gonadotropins to stimulate the production of many eggs rather than the single egg that would normally grow during their monthly menstrual cycle.2 El-Chaar wondered about the influence that ART procedures, as well as the underlying infertility itself, might have on the health of children conceived. She is one of many researchers working to answer the fundamental question of whether introducing fertility drugs and manipulating eggs and sperm in a laboratory setting—in essence, altering the primal environment—sets the stage for adverse health effects in children. Artist’s rendering of intracytoplasmic sperm injection, in which a single sperm is inserted into an egg. Although some research indicates such a risk exists, there haven’t been enough large-scale studies to ascertain if the potential effects are severe enough over the long term to deter couples from seeking infertility treatments. Meanwhile, some findings are pointing the way toward possible refinements to improve health outcomes for ART babies.