Natural In Vitro Fertilization Research Articles

Overnight maturation of a metaphase I oocyte retrieved from a natural cycle using human tubular fluid: a case report

Since the first successful pregnancy and live birth was achieved through natural cycle in vitro fertilization (IVF) in 1978 [1], there have been many technological advancements and refinements of protocols and techniques through the years [2]. Ovarian hyperstimulation was favored over unstimulated cycles, due to the increased number of embryos available for transfer and hence increased success rate. However, stimulated IVF is also associated with side effects such as ovarian hyperstimulation syndrome [3] and it is costly [4]. For patients who have failed to conceive after repeated stimulated IVF cycles, natural cycle IVF may be a cost-saving alternative [5, 6] which allows patients to avoid further exposure to the side effects associated with stimulated IVF cycles [7, 8]. However, one of the drawbacks of pure natural cycle IVF is its higher cancellations rates (28.9 % per cycle) and lower pregnancy rate (0 to 12.5 % per cycle) [5]. The main reasons for cancellation are premature ovulation before oocyte retrieval, failure to retrieve oocytes and retrieval of immature oocytes. The stage of maturation of the oocyte cannot be determined before retrieval as well. When an immature oocyte is retrieved, it is usually discarded and the cycle is cancelled. To maximize the utilization of the immature oocytes collected from unstimulated cycles, our centre evaluated our protocol and started incubating the immature oocytes overnight in human tubular fluid (HTF) (Irvine Scientific, USA) instead of discarding them. Standard IVF culture media has been shown to be as efficacious as specialized IVM media in ‘rescuing’ immature oocytes retrieved from standard stimulated IVF cycles [9]. When fully matured, the oocytes are fertilized, allowed to develop into embryos in culture and eventually transferred. We report the first case of a successful implantation and pregnancy achieved from this ‘rescue’ protocol in a natural IVF cycle.

Embryo deaths in reproduction and embryo research: a reply to Murphy's double effect argument

The majority of embryos created in natural reproduction die spontaneously within a few weeks of conception. Some have argued that, therefore, if one believes the embryo is a person (in...

Individualised controlled ovarian stimulation (iCOS): maximising success rates for assisted reproductive technology patients

BackgroundIn the last two decades, pregnancy rates for patients undergoing in-vitro fertilisation (IVF) have significantly increased. Some of the major advances responsible for this improvement were the introduction of controlled ovarian stimulation (COS) for the induction of multiple follicle development, and the utilisation of mid-luteal gonadotropin-releasing hormone agonists to achieve pituitary down-regulation and full control of the cycle. As a result, a combination of a gonadotropin-releasing hormone agonist with high doses (150-450 IU/day) of recombinant follicle-stimulating hormone has become the current standard approach for ovarian stimulation. However, given the heterogeneity of patients embarking on IVF, and the fact that many different drugs can be used alone or in different combinations (generating multiple potential protocols of controlled ovarian stimulation), we consider the need to identify special populations of patients and adapt treatment protocols accordingly, and to implement a more individualised approach to COS.DiscussionStudies on mild, minimal and natural IVF cycles have yielded promising results, but have focused on fresh embryo transfers and included relatively young patient populations who generally have the potential for more favourable outcomes. The efficacy of these protocols in patients with a poorer prognosis remains to be tested. When comparing protocols for COS, it is important to think beyond current primary endpoints, and to consider the ideal quality and quantity of oocytes and embryos being produced per stimulated patient, in order to achieve a pregnancy. We should also focus on the cumulative pregnancy rate, which is based on outcomes from fresh and frozen embryos from the same cycle of stimulation. Individualised COS (iCOS) determined by the use of biomarkers to test ovarian reserve has the potential to optimise outcomes and reduce safety issues by adapting treatment protocols according to each patient's specific characteristics. As new objective endocrine, paracrine, functional and/or genetic biomarkers of response are developed, iCOS can be refined further still, and this will be a significant step towards a personalised approach for IVF.ConclusionsA variety of COS protocols have been adopted, with mixed success, but no single approach is appropriate for all patients within a given population. We suggest that treatment protocols should be adapted for individual patients through iCOS; this approach promises to be one of the first steps towards implementing personalised medicine in reproductive science.

Natural-cycle in vitro fertilization in poor responder patients: a survey of 500 consecutive cycles

To determine the role of the natural cycle for in vitro fertilization (IVF) in poor responder patients. Retrospective survey. Private center for assisted reproduction. 294 women who were poor responders in a previous IVF cycle. Analysis of 500 consecutive natural cycles IVF. Number of cycles with oocytes, pregnancy rate per cycle, per transfer, and implantation rate. Oocytes were found in 391 cases (78.1%), and cleaving embryos suitable for transfer were obtained in 285 cycles (57.0%). Pregnancy was observed in 49 cases, with a pregnancy rate of 9.8% per cycle, 17.1% per transfer, and 16.7% per patient. The patients were subdivided arbitrarily by the women's age into three groups. Patients 35 years old or younger showed a pregnancy rate of 18.1% per cycle, 29.2% per transfer, and 31.7% per patient. Women aged between 36 and 39 years showed a pregnancy rate of 11.7% per cycle, 20.6% per transfer, and 20.3% per patient. Women 40 years old or older showed a pregnancy rate of 5.8% per cycle, 10.5% per transfer, and 9.7% per patient. No differences were found for any of the evaluated parameters, independent of which cycle was the first, the second, third, fourth, or fifth, or further consecutive cycle. In poor responder patients, natural-cycle IVF is an effective treatment, especially in younger women.

Cyclic QDE peptide increases fertilization rates and provides healthy pups in mouse

To evaluate the effects of cyclic QDE peptide (cQDE), derived from sperm fertilin beta (ADAM2), in mouse in vitro fertilization (IVF) and its harmlessness on pups after embryo transfer. Prospective in vivo and in vitro study in mice. Murine model in an academic research environment in France. Normal B6CBF1 mice. Indirect immunofluorescence was used to evaluate cQDE binding to oolemma. The IVF assays were run in presence of the species-specific tripeptide (cQDE at 100 microM), and embryos were transferred in pseudopregnant mice. Controls were obtained by natural mating and IVF in regular medium followed by embryo transfer. Evaluation of fertilization, litter size, pup fertility and health. Biotinylated cQDE peptide binds to oocyte plasma membrane and increases gamete fusion in cumulus-intact IVF assay. Litter size as well as pup development after embryo transfer showed no statistically significant differences compared with controls. Pups born from embryos that were incubated with the peptide were as healthy and normally fertile as control mice over at least three generations. Cyclic QDE is harmless and improves mouse IVF pregnancy rates. A randomized prospective clinical trial to evaluate the beneficial effect of cyclic FEE on human IVF is required before its clinical use.

Laterality in five‐year‐olds conceived by intracytoplasmic sperm injection, standard in vitro fertilisation and natural conception: a European study

To assess laterality in a group of European children conceived with the help of assisted reproductive therapy, or naturally conceived. Prospective cohort study. Five European countries. A total of 1525 five-year-old children divided into three groups according to conception status: naturally conceived; intracytoplasmic sperm injection (ICSI); in vitro fertilisation (IVF) group. All children were assessed using the McCarthy Scale of Children's Abilities (Motor Scale) with additional items using a comb, a spoon and an indirect measure was made of the parental handedness scores, using a questionnaire. Child handedness for drawing and writing. Observed handedness did not differ significantly between natural conception, IVF and ICSI in girls or boys, except for ICSI-conceived girls, fewer of whom were left-handed than the naturally conceived controls, 7.0%versus 12.4% (P < 0.05), however, this was close to the population norm of 8%. The degree of parental handedness did not significantly vary in the three groups. Laterality, as assessed by handedness, may be marginally less common in girls conceived with assisted reproductive therapies than with children conceived naturally.

Natural In Vitro Fertilization Cycles

Although the first in vitro fertilization (IVF) baby was born after a natural IVF cycle, very soon this procedure was almost abandoned mainly because of the very high cancellation rates, and controlled pharmacological ovarian hyperstimulation became the standard treatment in IVF cycles of normoresponder patients. However, in poor-responder patients, where only very few follicles can be recruited and very few oocytes, if any, can be retrieved after controlled ovarian hyperstimulation, natural IVF cycles may offer a comparable number of follicles, reduced costs, and less discomfort for the patients. In this group of patients, natural IVF cycle is a cost-effective approach.

Maternal serum levels of placental proteins after in vitro fertilisation and their implications for prenatal screening.

To determine whether the serum levels of pregnancy-associated plasma protein A (PAPP-A), pregnancy-specific beta(1)-glycoprotein (SP1), placental lactogen (hPL) and human chorionic gonadotrophin (hCG) are different in pregnancies obtained after in vitro fertilisation (IVF) and embryo transfer (ET) in comparison to spontaneous pregnancies. Assessment of the need to establish normal medians for biochemical trisomy screening in IVF pregnancies. The population comprised 96 IVF-ET pregnancies, of which 79 came from fresh gonadotrophin-stimulated cycles and 17 from embryo transfers without gonadotrophin stimulation (natural cycle IVF, frozen embryo transfers), and 156 spontaneous pregnancies. A single blood sample was obtained between 7 + 0 and 16 + 3 weeks. PAPP-A, SP1, hPL and hCG were quantified and the levels compared between gonadotrophin-stimulated IVF, steroid-only- or non-stimulated IVF, and controls with respect to gestational age using non-parametric statistical analysis. PAPP-A and hPL levels were reduced after stimulated IVF in early gestation (before 10 pregnancy weeks); SP1 followed the same trend without reaching statistical significance. hCG tended to be increased after IVF treatment including non-gonadotrophin-stimulation cycles, and also beyond 10 pregnancy weeks. Reduced PAPP-A with increased hCG yields an increased risk in screening for foetal trisomy 21. We confirm recently published observations but do not recommend the establishment of normal medians for IVF pregnancies since the extent of the deviations is varying according to the different stimulation protocols and dosages of gonadotrophins used.

With or against nature? IVF, gender and reproductive agency in Athens, Greece

Based on ethnographic research in Athens, this paper argues that in vitro fertilization (IVF) in urban Greece does not so much make explicit the social construction of nature, as has been argued of the US and UK, but is accommodated into a prior understanding of “nature” as socially realized. Calling upon an ethic of maternal sacrifice, Athenian women see themselves taking charge of a natural process, often correcting damage done to them by nature. A sense that adults should produce children in order to realize their natures and be completed as women and men also poses particular, and gendered, ethical questions of fertility technologies: is this a proper way of realizing nature? While those who successfully use IVF depict assisted conception as “a natural” and “proper way of reproduction,” some fear that others will view their child as abnormal. Contests over “normal” reproduction are articulated to a tradition/modernity dichotomy which Athenians discuss through an idiom of maturity. Believing that Greek society is not always mature enough to understand how natural IVF really is, couples turning to IVF follow one of the two strategies: to educate others or to completely hide it. Both groups want to guard against a view of IVF—in the terms of this volume—as a kind of “reproduction gone awry.”