Receiving Fertility Treatment Research Articles

Parental Infertility and Semen Quality in Male Offspring: A Follow-up Study

Jensen et al. (Am J Epidemiol 2007;165:583-90) reported for the first time that men whose mothers had received fertility treatment had poor semen quality. This result could be confounded by the mothers' body mass index. Obesity is a strong predictor of fecundity and could have a programming effect on semen quality through hormonal factors or links to fetal growth. The authors of the current study tried to replicate the finding of Jensen et al. after controlling for maternal body mass index and other covariates using data from a recently conducted, population-based, Danish follow-up study on the association between maternal smoking during pregnancy in 1984-1987 and sons' semen quality, in which the participants were sampled according to levels of maternal smoking during pregnancy. After adjustment, sons of mothers who reported that they had been examined or treated for childlessness (n = 30) had a lower sperm concentration and total sperm count and fewer motile and morphologically normal spermatozoa in comparison with sons of mothers who had not been examined or treated for childlessness (n = 295). None of the differences (except for semen concentration) between the groups reached statistical significance, but the study has limited power. The findings were in the same direction as those reported by Jensen et al. and do not indicate that their results are confounded by maternal body mass index.

Pregnancy Outcome of Patients with Known Celiac Disease

Celiac disease is a permanent condition characterized by gluten intolerance, which probably has an autoimmune basis. Previous studies seeking an association between this condition and pregnancy outcomes have given mixed results. The present trial was a retrospective population-based study comparing women with and those without celiac disease who delivered infants in the years 1988-2002. During this period there were 48 deliveries of women having celiac disease and 143,663 control pregnancies. Just over 10% of the affected women had two deliveries during the years under review. The celiac disease and control groups did not differ significantly with regard to birth order, maternal age, gestational age, birth weight, or infant gender. Intrauterine growth retardation (IUGR) was more frequent in women with celiac disease, but there were no recurrent abortions and none of the affected women had received fertility treatment. Labor was induced more often in the study group, but there were no significant group differences in low Apgar scores, congenital malformations, or perinatal mortality. When multivariable logistic regression analysis was carried out to control for maternal age and gestational age, a nearly significant association was apparent between celiac disease and IUGR. These findings suggest that adverse pregnancy outcomes are not associated with diagnosed celiac sprue. The risk of IUGR may, however, be increased in parturients having this condition. Those affected should continue eating a gluten-free diet throughout pregnancy.

Different skeletal phenotypes in a mother and two daughters with short stature homeobox-containing haploinsufficiency.

Haploinsufficiency of the short stature homeobox-containing (SHOX) gene causes Turner skeletal features such as short metacarpals, cubitus valgus, and Madelung deformity. We report the clinical findings of a Japanese family consisting of two daughters with SHOX haploinsufficiency (46, X, del(X) (p.22.3)) and their mother with 45,X [9]/ 46, X, del(X) (p22.3) [11] karyotype. Physical and auxological examinations revealed a mesomelic appearance, cubitus valgus, a short neck and short stature in the daughters, but on the other hand, only a short neck and short stature in the mother. Radiological studies indicated markedly curved radii in the daughters, but only mild curvature of the radii in the mother. Regular menstruation had taken place since the age of 12 yr in the elder daughter, but the mother had irregular menstruation and she had received fertility treatment for pregnancy. The different skeletal phenotypes of the mother and her daughters with SHOX haploinsufficiency might be due to the mild gonadal estrogen deficiency found in the mother, which was caused by mosaic Turner syndrome, and the phenotypic variability of SHOX haploinsufficiency.

Fertility Treatment and Reproductive Health of Male Offspring: A Study of 1,925 Young Men from the General Population

Little is known the about the reproductive health of offspring after fertility treatment. In 2001-2005, the authors approached young Danish men attending a compulsory physical examination to determine their fitness for military service. A total of 1,925 men volunteered, delivered a semen sample, had a physical examination performed and a blood sample drawn, and responded to a questionnaire. Their mothers were questioned about whether they had received fertility treatment in order to conceive their sons. Forty-seven mothers reported having received fertility treatment to conceive the index subject. After control for confounders, men whose mothers had received fertility treatment to conceive them had a 46% lower sperm concentration (95% confidence interval (CI): -63, -20) and a 45% lower total sperm count (95% CI: -64, -16). They had a smaller testis size (-0.9 ml, 95% CI: -2.2, 0.4), fewer motile sperm (-4.0%, 95% CI: -8.0, -0.1), and fewer morphologically normal spermatozoa (-2.0%, 95% CI: -4.1, 0.0). They also had a lower serum testosterone level and free androgen index (results not statistically significant). These findings should be viewed in light of the increasing use of fertility treatments. Although the cause of these findings is unknown, they raise concern about possible late effects of fertility treatment. Larger-scale studies of children born after fertility treatment should be performed.

British South Asian communities and infertility services

This paper presents key findings from the first major study of the provision of infertility services to South Asian communities in the UK. The research aimed to explore the social meanings of infertility and to examine the experiences of couples receiving fertility treatment. Focus groups with people from Pakistani, Bangladeshi and Indian communities (n = 93) revealed a strongly pro-natalist ideology and a relatively limited knowledge of infertility and treatments. Interviews with 50 participants from the same communities revealed a general satisfaction with secondary level infertility services. However, a minority felt inadequately informed about their condition, tests undertaken and treatment options; only one-third were given any written information about treatment; many were concerned about delays and waiting times; a minority felt that staff could be more sympathetic in their response to ‘failed’ treatment and several couples suggested that additional emotional support would be helpful. No information or resources were available in any South Asian language and the arrangements for communication support for non-English speakers were generally less than adequate. There was little evidence of the use of data on ethnic or religious background in infertility clinics. Recommendations for policy and practice are proposed.

A high DFI score does not preclude patients from achieving a pregnancy with ICSI

The Sperm Chromatin Structure Assay (SCSA), a newly available diagnostic tool for IVF practitioners, measures the percentage of sperm with high levels of DNA fragmentation − DNA Fragmentation Index (% DFI). The results are used to ascertain the fertility potential of patients receiving fertility treatment. The objective of this study was to evaluate the correlation between DFI and outcome in patients receiving ICSI treatment.

Confidentiality. 7: Human fertilization and embryology issues.

A woman who was having in-vitro fertilization (IVF) treatment was involved in a road accident. Her sister, a nurse, who was with her at the time, knew the drugs which she was taking as part of the IVF treatment and passed this information on to those caring for her in the accident and emergency department. Subsequently, the patient complained that this information should not have been passed on. She did not want anyone else to know that she was receiving fertility treatment. What is the law?

Fertility treatment and risk of breast cancer

The relationship between fertility treatment and breast cancer was investigated in a multicentric case-control study conducted in Italy on 2569 women with incident, histologically confirmed breast cancer and 2588 control women admitted to hospitals for acute, non-neoplastic, non-hormonal or gynaecological conditions, unrelated to fertility problems. The odds ratio of breast cancer was 1.08 (95% confidence interval 0.8-1.5) in those reporting fertility treatment compared with those who did not receive fertility treatment. Similarly, the odds ratio was 0.60 for women with tubal occlusion, 0.99 for those reporting hormonal imbalances and 1.32 for other/unspecified reasons. There was no consistent pattern of risk according to age at treatment and time since treatment. Women reporting fertility treatment with drug use had an odds ratio of 1.43, while those who did not report drug therapy had an odds ratio of 0.85. None of these odds ratio estimates was significant. Likewise, there was no heterogeneity among strata of parity, menopausal status, education and family history of breast cancer. Thus, our study, while providing reassuring evidence on the relationship between fertility treatment and breast cancer risk, cannot exclude the possibility that the use of specific drugs may be related to breast carcinogenesis.

Attitudes about infertility interventions among fertile and infertile couples.

There has been marked progress in the development of infertility interventions. This paper reports attitudes about 11 interventions for infertility. Face-to-face interviews were conducted with each member of 185 infertile and 90 presumed fertile couples in southeastern Michigan. Seven of these interventions were generally viewed favorably and four were generally viewed negatively, regardless of the couple's fertility status. Infertile couples viewed all interventions, except for adoption, more favorably than did fertile couples. Multidimensional scaling was used to cluster the interventions according to similarity in endorsement. These clusters form a continuum from interventions that allow only one member of the couple to be a biological parent to the most noninvasive techniques. All clusters remain roughly equidistant from adoption, in which neither member of the couple is a biological parent. Interventions that produce a child who is biologically related to only one member of the couple were viewed most negatively. Members of couples who were receiving fertility treatment made finer discriminations among infertility interventions than did individuals who had not received treatment.