Medically Assisted Procreation Research Articles

Access to medically-assisted procreation: the withdrawal of paternal consent in the maze of law n. 40/2004.

The law (No.40/2004) stipulates that consent to Medically Assisted Procreation (MAP) remains irrevocable post ovum fertilization. Cryo-preservation introduces complexities, enabling embryo implantation requests after a couple's separation and the dissolution of the original parenthood plan. Constitutional Court Ruling No.161 in 2023 affirmed that the prohibition of revoking consent to MAP aligns with the Italian Constitution and the jurisprudence of the European Court of Human Rights. This delicate equilibrium of conflicting interests upholds human freedom, allowing consent revocation prior to ovocyte fertilization. Permitting revocation until implantation could inflict more significant harm: the infertile woman can in fact miss the opportunity to become a mother, impacting her psychophysical well-being and freedom of self-determination. Moreover, the embryo loses the chance to live, remaining in cryopreservation, which violates its dignity. Addressing this issue requires thorough communication by medical profession-als to inform couples about the limitations on consent revocation. An element of objectivity in terms of standards and evidence-based guidelines, from which norms must originate, is of utmost importance. Relying on broadly shared rules, especially at the international level, is vital in light of the unremitting scientific advances in MAP, as in other areas of medicine, which will open up new opportunities for which current legal/regulatory frameworks are inadequate.

Chapitre 14. Le nouveau droit de l’assistance médicale à la procréation. Entre démédicalisation et stigmatisation : les tâtonnements du principe d’égalité

The law of bioethics of 2 August 2021 is readily presented as enforcing the “medically-assisted procreation (MAP) for everyone”. It is true that opening up the MAP to female couples and single women made the law depart from the former legal framework which was based on a strong medicalization of this assisted procreation. This shift seems to be justified by the legislator’s intent to ensure equal rights when it comes to parental projects. Nevertheless, this “new” MAP right keeps facing differences in the treatment of applicants based on their gender or sexual orientation.

Medically assisted procreation: A new legal framework to overcome infertility in Morocco in the context of energy optimization

After more than a quarter of a century of the practice of medically assisted procreation (MAP) in Morocco in the absence of a legal framework, the Moroccan legislator passed Law 47-14, in April 2019, to make up for the considerable delay in the field of medically assisted procreation. Through this research work, we aim to explore the field of application of this law and demonstrate its contributions to the lives of couples aspiring to motherhood and fatherhood in order to achieve their parenthood project within the couple. From a methodological point of view, this research is based on the qualitative analysis of semi-directive interviews conducted with infertile couples having recourse to (AMP) and practitioners of this medical technique. One of the key findings of this work is that there are major differences between the provision of medically assisted reproduction services in the public and private sectors, and between insured and uninsured couples.

COVID-19 and female fertility: the flaws of Italian Law 40/2004 on assisted procreation in pandemic times.

SARS-CoV-2 has infected over 614 million people worldwide, killing more than 6.5 million. COVID-19 impact on fertility may have far-reaching ramifications, considering that only in Italy, over 20 million people have been infected, many more considering unconfirmed cases. The authors aimed to outline the repercussions of COVID-19 on female reproductive capabilities, through an analysis of underlying mechanisms and dynamics liable to cause long-term COVID-19 complications and sequelae, including direct virus-induced tissue damage. The entry receptor for SARS-CoV-2, Angiotensin-converting enzyme 2 (ACE2) can be found in several tissues and organs within the human body, including ovaries, oocytes and placenta. In order to assess the fertility-damaging potential of the disease, it is necessary to clarify highly complex mechanisms such as the ovarian renin-angiotensin system (OVRAS) affecting ovarian physiology and dysfunction. COVID-19 and its potential to undermine the fertility prospects of millions cannot be underestimated. It is therefore essential for lawmakers to solve inconsistencies such as those in Italy's Law 40/2004, which has been all but dismantled by Constitutional Court and European Court of Human Rights rulings, and cannot therefore offer a sufficient degree of certainty and reliability. When crafting novel, updated standards, norms and regulations to govern access to medically-assisted procreation, national leaders need to take into account the grave threat to fertility in a country such as Italy, which already has one of the world's lowest birth rates, posed by COVID-19 in light of currently available research findings outlining its impact on reproductive capacity.

Le don de gamètes dans la prise en charge de l’infertilité du couple: connaissances, attitudes et perception des étudiants en médecine de la Faculté des Sciences de la Santé de Cotonou-Bénin

Introductionde nos jours l´infertilité est un réel problème de santé publique. Parmi les solutions proposées il y a l´assistance médicale à la procréation (AMP) avec le don de gamètes. Au Benin, malgré un cadre législatif bien défini (code des enfants), le don de gamètes en vue d´une AMP, n´a pas fait l´objet d´une étude. Nous nous proposons d´étudier des connaissances, attitudes et perceptions des étudiants en médecine de la FSS de Cotonou par rapport au don de gamètes.Méthodesune étude transversale et descriptive a été réalisée auprès des étudiants du 2e et 3e cycle en médecine à la Faculté des Sciences de la Santé (FSS) de Cotonou au Bénin.Résultatsau total 236 étudiants dont 54% (n=127) d´homme et 46% (n= 109) de femme. L´âge moyen était de 23 ans. La connaissance du traitement par l´AMP avec recours au don de gamètes est de 90,6%, (n=214). La possibilité de ce traitement au Bénin est connue de 55,6% (n=131). Un peu plus de quatre vingt-huit pour cent (n=209) des enquêtés ignorent l´existence d´une législation en vigueur depuis 2015 sur la question. Plus, de soixante-neuf pour cent (n=69%) (n=164) refusent de faire don des gamètes. La raison éthique était principalement évoquée.Conclusionla connaissance des étudiants sur l´AMP par le don de gamètes est correcte et leur refus de faire don de leurs gamètes est estimée importante avec comme raison dominante de refus l´éthique.

Female obesity and infertility: outcomes and regulatory guidance.

Obesity has been associated with reduced fertility, although the dynamics and mechanisms which link excess weight to reduced fertility are not yet fully clarified. Obese women, especially those with central obesity, are less likely to conceive per cycle. Obese women suffer from perturbations of the hypothalamus-pituitary-ovary axis, disturbances of the menstrual cycle and are up to three times more likely to suffer from oligo/anovulation. A delicate hormonal balance regulates follicular development and the maturation of oocytes and it has been observed that obesity can alter the hormonal environment: adipocytes, in fact, are responsible for the production of a hormone called leptin (present in high quantities in obese women) which has been associated with reduced fecundity. In addition to compromising ovulation, obesity negatively affects the development and implantation of the endometrium. The expression of polycystic ovary syndrome (PCOS) is regulated, in part, by weight, so obese women with PCOS often have a more severe phenotype and higher subfertility rates. Furthermore, obesity impairs women’s response to medically assisted procreation (MAP) treatments. The authors have set out to delineate a broad-ranging overview of obesity’s impact on female fertility, by drawing upon sources spanning the 1994-2022 period. Assisted reproductive technology (ART) procedures are also discussed as they relate to obese patients. In addition the dynamics by which maternal obesity reportedly affects fetal, neonatal and child development have also been briefly enunciated. (www.actabiomedica.it)

'Wherever you are, my son, wait for me.' study on medically assisted reproduction

Abstract Introduction In Italy the use of Medically Assisted Procreation (MAP) is increasingly frequent also because the mean age at which Italian women have their first child has increased in recent decades (31.8 years in 2017) and it is more difficult to have a child for an older woman. The aim of this study was evaluate the maternal and neonatal outcomes of MAP and compare them with those of natural pregnancies. Methods The cross-sectional study was performed during the period January 2015-June 2019. All women that gave birth in the Hospital of Siena were included. The sample was divided in two groups (Natural pregnancy/MAP Pregnancy). The outcome variables were: maternal age, number of foetus, type of childbirth, timing of the birth, Apgar Index and necessity of hospitalization in neonatal intensive therapy unit (NITU) or resuscitation. The statistical analysis was performed with Stata 12. Results In total 5066 females were included (4.5% MAP pregnancy). The average age (±SD) of females was 32,9±5,56 (min 14-max 61). The mean age (±SD) of women with PMA was significantly higher 38.7 ± 5.7 vs. 32.6± 5.4 of those who had natural pregnancy. In PMA Pregnancy there was a higher probability of multiple pregnancy (OR = 16.13; 95% CI 10.38-25.07; p < 0.001), Caesarean Section (OR:4,54; 95% CI 3.28-6.31; p < 0,001) and preterm birth (OR 3.79; 95% IC 2.80-5.14; p < 0.001). Apgar index at the first minute was significantly lower in children born from pregnancies from MAP (8,6 ±1,4 vs, 9 ±1,4 p < 0.01), the difference was significant even in the 5th minute (9,6 ±0,7 vs. 9,8 ±0,6 p < 0.01). Children born by MAP Pregnancy had higher probability of hospitalization in Neonatal Intensive Care (OR = 3.12; 95% CI 2.12-4.59; p < 0.001). Conclusions In our sample we found that MAP is used by women with older average age and it is associated with less favourable maternal and neonatal outcomes than those from natural conception. Key messages In Italy the use of Medically Assisted Procreation (MAP) is increasingly frequent because it is more difficult to have a child for an older woman. In our sample we found that MAP is used by women with older average age and it is associated with less favourable maternal and neonatal outcomes than those from natural conception.

When childbirth turns red: the post-partum hemorrhagic emergency

Abstract Background WHO affirms that post-partum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity worldwide. The first step to recognize, prevent and diagnose this complication is to define it. The aim of this work is to identify risk factors for PPH. Methods A case-control study was conducted at the Hospital of Siena (Italy), including all females who have given birth from 2016 to 2018. In relation to presence of PPH (blood loss of ≥ 500 ml), the sample was divided into two groups. Analyzed variables were: age, parity, use of epidural, stimulation of labour with oxytocin or prostaglandins, episiotomy, manual removal of the retained placenta, medically assisted procreation (MAP), fetal weight, pre-pregnancy BMI (body mass index), placental localization and gestational age (GA). Statistical analysis was carried out using Stata 14. Results The sample was composed of 1490 women: 56% nulliparas, 18% had epidural, 34% had broken membranes, 22.6% had stimulation of labour, 1.5% had MAP. 8% older than 40 years, 32% of babies were ≥3500g; 5.1% had BMI ≥30; 11.2% had episiotomy; 2% had manual removal of the retained placenta, 3% had lateral placenta, 47.5% had GA ≥ 40th weeks. PPH occured in 15%; mostly in nulliparas (17.7% vs.12.4% p < 0.01), those that used epidural (20% vs. 14.5%¸ p < 0.05), MAP (32% vs.15.2%; p < 0.05), those had manual removal placenta (71.9% vs.14.4%, p < 0.05)in mothers of babies ≥3500g (21% vs. 13%; p < 0.05), in those with BMI ≥30 (27% vs. 15%; p < 0.05), those with lateral placenta (26% vs. 12.3%; p < 0.05), and GA ≥ 40th weeks (17.3% vs. 13.6%; p < 0.05). Conclusions PPH is one of the most studied obstetric emergencies being the leading cause of maternal mortality in the world. It is important to closely monitor during labour and childbirth to modify risk factors where possible. Key messages Postpartum bleeding is an obstetric emergency that causes mortality and morbidity in pregnant women. There are no effective treatments yet, so it is important to recognise the associated risk factors and prevent them.

Recent Judgement of the Italian Judiciary about medical assisted procreation (MAP): is informed consent valid after parents separation?

Law No 40/2004 regulates in Italy the matter of medically assisted procreation (MAP). Recently, the Tribunal of Capua Vetere expressed its position on the subject of informed consent in a case of MAP. In the specific case, a couple entered the preliminary stages of the PMA procedures, carrying out the fertilization of the ovum and the embryo production. Afterwards, the couple separated and the man denied consent to the continuation of the MAP. The woman, willing to proceed with the implantation, the woman made an urgent judicial appeal, obtaining the judge's permission to transfer the embryo to the uterus. This paper analyses the different bioethical positions on MAP's informed consent. In fact, on the one hand, the paper highlight what is set out in Law 219/2017 which provides for the possibility of the patient to revoke at any time the consent to the treatment given. On the other hand, it should be noted that Law 40/2004, willing to protect the embryo, establishes the irrevocability of the position of parental consent after fertilization. The judgment in question seems to favour this latter position, placing itself in the protection of the cryopreserved embryo and recall-ing the principle of entrustment following the fertilization of the egg. Nevertheless, the matter is controversial a consistent amount of legal developments are expected to arise in the next future.

Eating disorders and sexuality: A quantitative study in a French medically assisted procreation course.

ObjectiveAmong medically assisted procreation (MAP) patients, the prevalence of eating disorders (ED), clinical or subclinical, current or past, is considerable. In addition to metabolic repercussions, the literature suggests that these patients present with more sexual dysfunction, leading to anxiety.This quantitative research on a population of women consulting a MAP department for unexplained or ovulatory infertility proposed to study the sexuality of this population by comparing the sexuality of patients suffering from or having suffered from an ED to the sexuality of the non‐ED group.MethodPatients (n = 61) filled out the Eating Disorder Examination Questionnaire (EDE‐Q), the Brief Index of Sexual Functioning for Women (BISF‐W), the ED Whole Life Research Questionnaire, the Hospital Anxiety and Depression Scale (HADS) and the Kansas Marital Satisfaction Scale (KMSS).ResultsWe found a prevalence of 54% of ED, current or past. Even though these patients reported the same prevalence of sexual intercourse, they had significantly more physical problems (e.g., anorgasmia, vaginismus, headache) affecting their sexuality (p = .01) than the non‐ED group, after adjusting for depression. Approximately 10% of the study population reported no intravaginal intercourse during the last month.DiscussionThis study provides evidence for the existence of more sexual dysfunction in patients who have a fertility disorder and have ED or a history of ED. Future research should evaluate the results of psychological or sexological care that may be more suitable for the infertility of these patients.

Is there anything left of the Italian law governing medically-assisted procreation?

Medically-assisted-procreation via in vitro fertilization, an integral part of of the so-called "reproductive revolution", is a valuable option for couples with sterility or fertility issues. That has however brought about three relevant results: the rift between procreation and sexual intercourse, the opportunity to use heterologous fertilization through donated gametes, and the ensuing increase in the number of "reproductive contributors" (male and/or female gamete donors, surrogate mothers). In Italy, Law n. 40 has put in place several restrictions, stricter than in most other European countries. Before being declared partly unconstitutional, Law 40 used to impose an array of bans and restrictions other than the ones still currently in force, such as the still unchanged prohibition to use human embryos for experimentation purposes and the ban on surrogacy. For same-sex couples who travel abroad to get around the Italian ban on heterologous fertilization, surrogacy, and MAP for homosexual couples. The authors have attempted to lay out a short analysis of how Italian courts have attempted to uphold the best interests of children born abroad in homosexual families, by taking into account the latest decisions on the subject.

Situations d’assistance médicale à la procréation en pédopsychiatrie : une clinique particulière ?

BackgroundIn daily practice, the clinical impression suggests an over-representation of children from medically assisted procreation (MAP) in the population consulting in child psychiatry. This raises the question of the reality of this over-representation and the impact of the MAP on the psychic child's development. Based on the different reflections that have been carried out in the case of adoption, the study presented here attempts to provide a reflection on the current state of families and how the MAP comes to upset our representations. MethodsThis is a non-interventional descriptive cross-sectional study including a population of 262 families whose children are followed at the Alfred Binet Center, a child psychiatry consulting center in Paris. The main outcome measure is the over-representation of children from MAP in the Alfred Binet Center active queue. The secondary judgment criteria is: whether or not the consulting physicians know the MAP birth status of their patients. This criterion was measured by evaluating a difference between the two methods of collecting information (consulting physicians vs questionnaires) as well as by describing the population of children from Alfred Binet Center MAP, by comparing it to the population of children of ordinary conception. ResultsChildren from MPA were significantly more represented in the Alfred Binet Center population between 1997 and 2015 (p<0.05) and between 2006 and 2015 (p<0.0001). There are other significant differences between MAP patients and naturally conceived children with a higher rate of prematurity respectively (43.7% vs 3.7%), a younger average age (4.8 years vs 9.76 years) and an over-representation of single-parent families (25% vs 6.1%). The results of this study are important but have certain limitations. Firstly, it is a unicentric study. Secondly, the cofactors identified are insufficient to explain the real impact of the MPA on the child's psychic development. ConclusionThere is an overrepresentation of children from MAP in the population of the Alfred Binet Center. However, these results do not explain a specific psychic development. Additional multicentric, quantitative and qualitative studies are necessary to support these results. In this perspective, research is underway at the Alfred Binet Center on the development and the future of children born from MAP.

Surrogacy and "Procreative Tourism". What Does the Future Hold from the Ethical and Legal Perspectives?

Background and objectives: To explore the ethical and legal complexities arising from the controversial issue of surrogacy, particularly in terms of how they affect fundamental rights of children and parents. Surrogacy is a form of medically-assisted procreation (MAP) in which a woman “lends” her uterus to carry out a pregnancy on behalf of a third party. There are pathological conditions, such as uterine agenesis or hysterectomy outcomes, that may prevent prospective mothers from becoming pregnant or carry a pregnancy to term; such patients may consider finding a surrogate mother. Many issues relating to surrogacy remain unresolved, with significant disagreements and controversy within the scientific community and public opinion. There are several factors called into play and multiple parties and stakeholders whose objectives and interests need to somehow be reconciled. First and foremost, the authors contend, it is essential to prioritize and uphold the rights of children born through surrogacy and heterologous MAP. Materials and methods: To draw a parallel between Italy and the rest of the world, the legislation in force in twelve European countries was analyzed, eleven of which are part of the European Union (France, Germany, Italy, Spain, Greece, Netherlands, Belgium, Denmark, Lithuania, Czech Republic and Portugal) and three non-members of the same (United Kingdom, Ukraine and Russia), as well as that of twelve non-European countries considered exemplary (United States, Canada, Australia, India, China, Thailand, Israel, Nigeria and South Africa); in particular, legislative sources and legal databases were drawn upon, in order to draw a comparison with the Italian legislation currently in force and map out the evolution of the Italian case law on the basis of the judgments issued by Italian courts, including the Constitutional and Supreme Courts and the European Court of Human Rights (ECHR); search engines such as PubMed and Google Scholar were also used, by entering the keywords “surrogacy” and “surrogate motherhood”, to find scientific articles concerning assisted reproduction techniques with a close focus on surrogacy. Results: SM is a prohibited and sanctioned practice in Italy; on the other hand, it is allowed in other countries of the world, which leads Italian couples, or couples from other countries where it is banned, to often contact foreign centers in order to undertake a MAP pathway which includes surrogacy; in addition, challenges may arise from the legal status of children born through surrogacy abroad: to date, in most countries, there is no specific legislation aimed at regulating their legal registration and parental status. Conclusion: With reference to the Italian context, despite the scientific and legal evolution on the subject, a legislative intervention aimed at filling the regulatory gaps in terms of heterologous MAP and surrogacy has not yet come to fruition. Considering the possibility of “fertility tourism”, i.e., traveling to countries where the practice is legal, as indeed already happens in a relatively significant number of cases, the current legislation, although integrated by the legal interpretation, does not appear to be effective in avoiding the phenomenon of procreative tourism. Moreover, to overcome some contradictions currently present between law 40 and law 194, it would be appropriate to outline an organic and exhaustive framework of rules, which should take into account the multiplicity of interests at stake, in keeping with a fair and sustainable balance when regulating such practices.

Determinants of the Health Services Limited the Supply of Care Related to the Second Pillar of the Prevention of Mother-Child Transmission of HIV in the Region of Hauts Bassins, Burkina Faso

Intoduction This research assessed the determinants of the health services limited the supply of care related to the second pillar of the prevention of mother-child transmission of HIV (PMTCT) involving workers from the maternity units and the HIV active queues in the district hospitals and the Department of gynaecology, obstetrics and reproductive medicine (DGORM) of the National teaching hospital Souro Sanou (NTHSS) in the Region of Hauts Bassinsin the Region of Hauts Bassins, Burkina Faso. Materials and methods This was a cross-sectional study conducted from January 15 January to 30 July 2017. The study method used individual interview and the literature review (content analysis of national documents and activity reports on PMTCT). Results The main results included insufficient organization of services and low levels of the workers knowledge and activities related to the second pillar of PMTCT in the all health districts concerned. The second pillar of PMTCT has not been mentioned in any structure supervised. The definition of dual/double protection was only known by 9 (9.4%) participants. The knowledge of the strategies about the double protection was limited to a single strategy. The knowledge and activities on medically assisted procreation among people living with HIV were amost nil. The knowledge and practices on FP appropriate for People living wih HIV were poor. Conclusion For a successful PMTCT, it is important to implement its all four (04) pillars, taking into account the double/dual protection and the medically-assisted procreation.

Advances in Medically-assisted procreation technologies: can malpractice claims and "reproductive damage" be identified.

Medically assisted procreation and assisted reproductive techniques have made giant strides over the past decades, enabling countless couples to achieve parenthood. Still, the ethical and moral concerns that have come to the fore as a result of ART's rise pose a multi-faceted issue that lawmakers have struggled to keep up with; procedures such as heterologous fertilization are strictly regulated, and even banned, in several nations around the globe, among which Italy, where a controversial piece of legislation was passed in 2004; such a reform has been partly nullified by court decisions, among which the Italian Constitutional Court and even the European Court of Human Rights. Relevant scientific articles were identified from Medline, Cochrane Central, Scopus, Web of Science, Science Direct, EMBASE and Google Scholar, through February 2020, by using the following keywords: "assisted reproductive techniques", "heterologous fertilization", "European rulings on ART", "reproductive damages". The rise of ART has laid bare a shortage of adequate legal tools for the purpose of guaranteeing the exercise of reproductive rights for all. Hence, the harmonization of regulations, at least at the European level, is greatly needed in order to ensure equality of parental opportunities for all.

Emergency Contraception: are the rights to conscience and to reproductive freedom irreconcilable?

Emergency Contraception (EC) has been gaining attention for its controversial nature, from the ethical, moral and religious perspectives. Objecting health professionals feel that the implementation of certain procedures or the prescription of some drugs would engender a conflict of conscience. That is also true in the context of reproductive medicine and not only limited to EC, but including abortion and some medically-assisted procreation procedures; all such procedures have created a rift between sexuality and procreation that has substantial ethical complexities. Provided that respect for conscience is essential, and codified in many national and international statutes, any refusal to provide services or medication should be limited if it might negatively affect a patient's health, is based on scientific misinformation, or could bring about inequalities of any kind. First and foremost, any imposition of religious or moral beliefs on patients should not be countenanced. In fact, any form of conscientious objection that could harm patient well-being should be allowed only if the fundamental duty towards patients can be effectively discharged. The right to thorough and unbiased information is crucial so as to enable patients to make well-informed decisions. Moreover, as the WHO has remarked, access to safe and legal reproductive services should be fostered particularly in at-risk, resource-poor areas.

L’exploration par le dessin de famille ne permet pas de distinguer les enfants nés de père transgenre

BackgroundFor several years in France, children whose father is transgender (born female) are conceived through Medically assisted procreation (MAP). The development of these children is poorly known. Many interrogations have contributed to a controversy regarding this type of parenthood, including the very identity of the family constitution. MethodsIn order to assess whether there were noticeable differences in the gender identity representations for these children, we invited 47 children (74.5% of boys) aged between 3 and 14 years old to make a “drawing of a family” (Corman, 1964). 24 children whose father is transgender were compared to 23 children born of cisgender parents, conceived by sexual intercourse. The research was approved by the University of Paris V ethics committee. ResultsThe blind analyses of the different drawings did not allow us to distinguish any qualitative difference or particularity that would indicate in which group the child belongs. After the lifting of the blind, we were able to carry out a descriptive analysis of the drawings and observe that the gender markers in the drawings did evolve, in part and as expected, according to the age of the children but are not related to an effect of the home group. We have also been able to appreciate as expected from the previous researches that used the family drawing of the differences through certain qualitative elements related to the family representation, and this, in both groups. ConclusionThe children born with MAP from a cisgender mother and a transgender father projects internal states in the “drawing of a family” in all points close to those of children of the same age and of the same sex but born of cisgender parents and conceived by sexual intercourse. It would be relevant to reevaluate the cohort of the youngest children at the time of their adolescence when the sexual identity is reshaped by puberty.

D-Aspartic Acid in Vertebrate Reproduction: Animal Models and Experimental Designs‡.

This article reviews the animal models and experimental designs that have been used during the past twenty years to demonstrate the prominent role played by D-aspartate (D-Asp) in the reproduction of vertebrates, from amphibians to humans. We have tabulated the findings of in vivo and in vitro experiments that demonstrate the effects of D-Asp uptake on hormone production and gametogenesis in vertebrate animal models. The contribution of each animal model to the existing knowledge on the role of D-Asp in reproductive processes has been discussed. A critical analysis of experimental designs has also been carried out. Experiments performed on wild animal species suggest a role of D-Asp in the mechanisms that regulate the reproductive cycle. Several in vivo and in vitro studies carried out on mouse and rat models have facilitated an understanding of the molecular pathways activated by D-Asp in both steroidogenesis and spermatogenesis, with particular emphasis on testosterone biosynthesis. Some attempts using D-Asp for the improvement of reproductive activity in animals of commercial interest have yielded mixed results. The increased transcriptome activity of enzymes and receptors involved in the reproductive activity in D-Asp-treated broiler roosters revealed further details on the mechanism of action of D-Asp on the reproductive processes. The close relationship between D-Asp and reproductive activity has emerged, particularly in relation to its effects exerted on semen quality, proposing therapeutic applications of this amino acid in andrology and in medically-assisted procreation techniques.

Postpartum hemorrhage: not only hypertensive disorders in oocyte donation pregnancies

The aim of the study is to compare the obstetric outcome between single pregnancies obtained by medically-assisted procreation using oocyte donors (MAP-E) versus homologous gametes (MAP-O) and single spontaneous conception pregnancies (SC). This is a retrospective case-control study on pregnancy outcome of consecutive singleton live birth pregnancies from MAP-E between January 2011 and August 2017 referred to Careggi University Hospital, Florence. The control group includes singleton pregnancies from MAP-O and pregnancies from spontaneous conceptions in the same period. The pregnancy outcomes considered were: postpartum hemorrhage (PPH), cesarean section (CS), gestational diabetes mellitus (GDM), hypertensive disorders including preeclampsia (HDP), preterm birth ≤34 weeks (PTB), and small-for-gestational-age (SGA) fetuses. The study group included 290 MAP-E pregnancies that were compared with 290 MAP-O and 870 singleton spontaneous conception pregnancies. The three groups did not show significant differences in maternal traits except for mean age (43.4±2.9 vs. 37.7±2.4 vs. 33.6±5.5, P<0.001), including a higher percentage of patients over 45 years (41.3% vs. 5% vs. 0.8%, P<0.001) and higher incidence of obesity (7.2% vs. 1.7%, P=0.02) in MAP-E than in MAP-O. The risk of HDP is increased in singleton pregnancies by oocyte donation with a significantly increased risk if compared to MAP-O (12% vs. 1%, P<0.001, OR=12.6). The risk of PPH in singleton pregnancies from oocyte donation is higher than in MAP-O (22% vs. 9% P<0.0001, OR=2.87). When we considered severe PPH (blood loss >1000 mL) the risk for MAP-E was higher if compared to MAP-O (OR=2.1, P=0.2) and mostly to SC (OR=14, P<0.005). Compared to SC, MAP-E pregnancies showed increased OR for all the outcomes: CS (78% vs. 30.8%, P<0.001, OR=7.91); GDM (26.1% vs. 10.8%, P<0.001, OR=2.92); HDP (12% vs. 2.2%, P<0.001, OR=5.99); PPH (22% vs. 8.5%, P<0.0001, OR=3.0); SGA (16% vs. 11%, P<0.05, OR=1.16); PTB ≤34 weeks (9.4% vs. 1%, P<0.001, OR=7.94). Most women who undergo MAP-E are in advanced age, representing a high-risk population for obstetric complications, like HPD and PPH, which stands as the main worldwide cause of maternal mortality.

The Desire for Children, the Children of one’s Desire. The Meaning of Medically Assisted Procreation and Technological Family Planning

The spread of medically assisted procreation (MAP) techniques promises to realise the previously denied human dream of planning and controlling one’s progeny. The new social imaginary features a disproportionately greater freedom of choice and decision-making powers for adults (parents), along with increased risks of genetic determination also given the extremely rapid developments in genetics. At the same time, this demand is fuelled by the presence of a booming private reproductive market which often employs commercial marketing techniques by promising couples and women not only that they can achieve their desire for a child but can make the ‘child of their desire’ – they can have the children that they want, when and how they want them. This article presents the results of an exploratory study conducted with a sample of 360 subjects aged between 25 and 45 who may or may not have not used MAP and examines their responses to a questionnaire. In particular, what lies behind the idea that technology and private fee-based services can supplant nature and public services in areas that they cannot reach? How widespread is the idea? What are the ethical, social and cultural implications at the root of the concept? How can this idea modify the sense and meaning of procreation? What level of freedom and rights should the baby be granted? The results of the research show that the sample is divided almost equally on the issue of MAP between those who acknowledge its potential but are aware of its associated social and cultural risks and those who highlight its potential by referring to rights-based reasons and money-based reasons.