Reproductive Procedures Research Articles

How Not to Argue for Selective Reproductive Procedures.

Many bioethicists try to secure a moral requirement to select against disability, while wishing to avoid denigrating disabled people. Dan Brock's arguments are representative of this attempt. Brock argues that the harm of giving birth to a disabled child when an able child could be had in its stead is a "nonperson-affecting harm." The harm is creating a world with less opportunity and more diminishment of opportunity. I argue that the presumptions that a life with disability is ceteris paribus a worse life, and that there is an inherent badness in living with a disability are contestable and fail to provide an argument that avoids the objections that disability scholars have voiced to reproductive selection against disability.

Impact of the Z potential technique on reducing the sperm DNA fragmentation index, fertilization rate and embryo development.

BackgroundIn assisted reproduction procedures, we need to develop and enhance new protocols to optimize sperm selection. The aim of this study is to evaluate the ability of the Z potential technique to select sperm with intact DNA in non-normospermic patients and evaluate the impact of this selection on embryonic development.MethodsWe analyzed a total of 174 human seminal samples with at least one altered parameter. We measured basal, post density gradients, and post density gradients + Z potential DNA fragmentation index. To evaluate the impact of this technique on embryo development, 54 cases were selected. The embryo development parameters evaluated were fertilization rate, cleavage rate, top quality embryos at the third day and blastocysts rate.ResultsWe found significant differences in the study groups when we compared the sperm fragmentation index by adding the Z potential technique to density gradient selection vs. density gradients alone. Furthermore, there was no significant difference in the embryo development parameters between the low sperm fragmentation index group vs. the moderate and high sperm fragmentation index groups, when selecting sperms with this new technique.ConclusionsThe Z potential technique is a very useful tool for sperm selection; it significantly reduces the DNA fragmentation index and improves the parameters of embryo development. This technique could be considered routine for its simplicity and low cost.

Oncofertility program implementation increases access to fertility preservation options and assisted reproductive procedures for breast cancer patients.

Breast cancer treatment can cause premature ovarian failure, yet the majority of young cancer patients do not receive adequate education about treatment effects before initiating chemotherapy. We studied the impact of an oncofertility program on access to fertility preservation. An oncofertility program was initiated to foster collaboration between oncologists and reproductive endocrinologists, and to help increase access to fertility preservation. Documented conversations about fertility concerns, specialist referrals, appointments, and fertility preservation procedures were compared between breast cancer patients from 2004 to 2006, before oncofertility program initiation, and 2007-2012, after program initiation. The study included women <45, stages 0-III, diagnosed before (n = 278) and after (n = 515) program initiation. Demographics for the cohorts were similar. Fertility discussions (P < 0.0001), patients interested in maintaining fertility at diagnosis (P = 0.0041), referrals to reproductive endocrinologists (P < 0.0001), appointments (P < 0.0001), and fertility preservation procedures (P < 0.0183) increased significantly after programmatic implementation. An oncofertility program increased discussions about fertility preservation and access to assisted reproductive procedures. This program positively impacted compliance with national guidelines advising reproductive-age cancer patients to be offered fertility preservation counseling as an initial component of the multidisciplinary care plan. J. Surg. Oncol. 2017;115:116-121. © 2016 Wiley Periodicals, Inc.

Traitement des séquelles de traumatismes de la main ou des doigts par lipofilling

Background Lipofilling was studied in the treatment of Duputren's contracture and cosmetic surgery. The aim of this study was to analyse objective and subjective results of patients who have undergone autologous fat grafting by lipofilling procedure to treat functional sequelae of hand or finger traumatic injuries. Methods Six patients (1 female, 5 males) with a mean age of 48 suffering from dystrophic scar and neuropathic pain due to finger or hand multi-tissue injuries were treated by lipofilling. The mean delay between initial trauma and lipofilling was 24 months. Clinical and subjective assessments were performed during follow-up. Results At a mean follow-up of 8 months, subjective and functional results were considered as good or excellent. Aesthetic results were considered as average or good. Pain on visual analogic scale was divided by 3. No complication occurred. Conclusion Lipofilling is a simple, reproductive, minimally invasive and low cost procedure which can be used to treat cutaneous and neuropathic pain sequelae of complex hand or finger traumatic injuries.

Association between ambient particulate matter exposure and semen quality in Wuhan, China

BackgroundHealth effects of exposure to particulate matter (PM) on male reproductive health remain unclear. Only a limited number of studies have investigated the effects of PM2.5 or PM10 exposure on semen quality, and the results were largely inconsistent. ObjectivesTo quantitatively assess the exposure-response association between PM exposure and semen quality in Chinese men who were exposed to a wide concentration range of PM. MethodsWe investigated 1759 men from Wuhan, China, who were partners of women undergoing assisted reproductive technology procedures, and had semen examined at least once between 2013 and 2015. Individual PM2.5 and PM10 exposures during 0–90, 0–9, 10–14 and 70–90days before each semen examination (corresponding to the entire and three key periods of sperm development, respectively) were retrospectively estimated by inverse distance weighting interpolation. Linear mixed models were used to assess exposure-response relations of PM exposure with sperm concentration, count and motility. ResultsPM2.5 exposure during 0–90 lag days ranged from 27.3 to 172.4μg/m3. It was linearly and inversely associated with sperm concentration (β: −0.20; 95% CI: −0.34, −0.07) and count (−0.22; −0.35, −0.08). For the three key exposure periods, only PM2.5 exposure during the 70–90 lag days was significantly associated with sperm concentration (−0.12; −0.22, −0.03) and count (−0.12; −0.21, −0.02). Sensitivity analyses for a subgroup (n=1146) excluding subjects with abnormal sperm concentration, count or motility yielded similar results. Compared with PM2.5, we found generally similar associations for PM10 exposure in relation to sperm concentration and count, except that the associations appeared to be nonlinear with inverted J-shaped relationships. Neither PM2.5 nor PM10 exposure was significantly associated with sperm motility (all p>0.05). ConclusionsOur results suggest that ambient PM exposure during sperm development adversely affects semen quality, in particular sperm concentration and count.

Identification of Reproductive Education Needs of Infertile Clients Undergoing Assisted Reproduction Treatment Using Assessments of Their Knowledge and Attitude.

In order to empower infertile individuals and provide high quality patient-centered infertility care, it is necessary to recognize and meet infertile individuals' educational needs. This study aims to examine infertility patients' knowledge and subsequently their education needs given their attitudinal approach to infertility education in terms of patients who undergo assisted reproduction treatment. This descriptive study enrolled 150 subjects by conveni- ence sampling of all patients who received their first assisted reproductive treatment between July and September 2015 at a referral fertility clinic, Royan Institute, Tehran, Iran. We used a questionnaire that measured fertility and infertility information (8 questions) as well as attitude toward education on the causes and treatment of infertility (5 questions). Chi-square, independent sample t test, and one way ANOVA analyses were conducted to examine differences by sex. P<0.05 was considered statistically significant. Total mean knowledge was 3.08 ± 0.99. Clients' responses indicated that the highest mean knowledge scores related to knowledge of factors that affected pregnancy (3.97 ± 1.11) and infertility treatment (3.97 ± 1.16). The lowest mean knowledge scores related to knowledge of the natural reproductive cycle (2.96 ± 1.12) and anatomy of the genital organs (2.94 ± 1.16). Most females (92.1%) and males (83.3%) were of the opinion that infertility education programs should include causes of infertility and types of treatment associated with diagnostic and laboratory procedures. No statistically significant difference existed between male and female participants (P=0.245). Most participants in this study expressed awareness of factors that affect pregnancy and infertility treatment. It is imperative to educate and empower infertile individuals who seek reproduction treatment in terms of infertility causes and types of treatment, as well as diagnostic and laboratory procedures to enable them to make informed decisions about their assisted reproductive procedures.

Reexamining the Prohibition of Gestational Surrogacy in Sunni Islam.

Advances in reproductive medicine have provided new, and much needed, hope for millions of people struggling with infertility. Gestational surrogacy is one such development that has been gaining popularity with infertile couples, especially those unable to benefit from other reproductive procedures such as In Vitro Fertilization. For many Muslim couples, however, surrogacy remains a nonviable option. Islamic scholars have deemed the procedure incompatible with Islam and have prohibited its use. This paper examines the arguments presented for proscribing surrogacy arrangements in Sunni Islam in particular. These include preservation of lineage, exclusion of third parties in reproduction, upholding the rights of the child, and protection from the negative effects of surrogacy arrangements. The rationales for banning surrogacy are subsequently refuted utilizing Islamic law "Sharia", bioethics, and medical evidence. The paper also presents reasons for why surrogacy is not only consistent with Sunni Islamic teachings, but is also both ethically justified and medically necessary. Lastly, Islamic scholars are urged to take into account the arguments presented in this paper and reconsider their rulings on the permissibility of surrogacy.

Molecular cytogenetic analysis of early spontaneous abortions conceived from varying assisted reproductive technology procedures.

BackgroundSpontaneous abortion (SA) is the most common complication of pregnancy, and chromosome aberrations are the principal cause of the first trimester abortuses in natural conception (NC) The increasing use of assisted reproductive technology (ART) has raised concern about chromosome abnormalities in ART-initiated pregnancies. Up to date, the literature on the risk of aneuploidy in failed pregnancies among various ART factors remain limited and inconclusive. This study aimed to explore the genetic etiology of pregnancy loss conceived from varying ART procedures.ResultsA total of 560 cases of villus that were successfully collected and performed molecular karyotype analysis were enrolled in present research, including 92 cases of NC, 340 cases of in-vitro fertilization (IVF) and 128 cases of intracytoplasmic sperm injection (ICSI). There was no statistical difference in the distribution of karyotyping results and the aneuploidy rate of each individual chromosome among NC, IVF and ICSI group. Both the total chromosomal abnormality rate and the one chromosome aneuploidy rate were increased with maternal age. Compared with fresh ET abortion group, frozen-thawed embryo transfer (FET) abortion group had elder maternal age (34.68 ± 4.73 years vs. 33.41 ± 4.48 years, P = 0.003) but lower chromosomal aberration rate of abortus (58.33 % vs. 67.50 %, P = 0.040). A slightly higher incidence of chromosome segmental abnormalities was found in FET than in fresh ET abortion (5.26 % vs. 2.08 %, P = 0.066).ConclusionsChromosomal abnormality of fetus is the main cause of SA in the first trimester, no matter pregnancies are conceived through NC, IVF or ICSI. ART is a relatively safety treatment, and it does not enhance aneuploidy rate of abortus. The FET is bad for ongonging pregnancy and the aneuploidy rate were increased with maternal age.

Development of a peripheral nerve stimulator-guided technique for equine pudendal nerve blockade

The aim of this study was to develop and evaluate a procedure for equine pudendal nerve block using a peripheral nerve locator. In the first experiment, six ponies were used to determine the relationship between elicited muscle contractions (anal, perineal or both) and nerves serving the perineal region (pudendal, caudorectal and perineal nerves) when methylene blue dye was injected using the electrolocation technique. This experiment showed that the pudendal nerve was approached effectively when both anal and perineal twitch were elicited during electrolocation.In a second experiment, seven Thoroughbred horses were used to evaluate the appropriate volume of anaesthetic solution for the nerve block. Immediately after euthanasia, lidocaine/methylene blue solution was injected after positive electrolocation. A stained segment of 2 cm or more of the nerve was considered effective and this was evaluated after dissection. Both 10 and 20 mL per injection site resulted in effective nerve staining.Finally, pudendal nerve block was performed and evaluated in 27 horses admitted for selected reproductive surgical procedures including perineoplasty, urethroplasty, clitorectomy in mares and penile examination, phallectomy and urethrostomy in geldings. Surgical time varied from several minutes to 3 h. The choice between lidocaine, mepivacaine or bupivacaine was based on the duration of analgesia required. In mares and males, a volume of 20 mL and 10 mL, respectively, was injected per site. The use of a peripheral nerve stimulator-guided pudendal nerve block is a feasible, safe and reliable alternative for both epidural and general anaesthesia, to provide peri-operative analgesia in clinical equine patients undergoing specific reproductive surgeries.

1168 Physiological and management advances enhancing adoption of applied reproductive management procedures in beef cattle

1168 Physiological and management advances enhancing adoption of applied reproductive management procedures in beef cattle

1169 Physiological and management advances enhancing adoption of applied reproductive management procedures in dairy cattle

1169 Physiological and management advances enhancing adoption of applied reproductive management procedures in dairy cattle

PA-3 - Increased abstinence period results in improved semen volume, sperm concentration and total motile concentration in sperm banking patients

Objective: Semen quality is dependent on highly variable factors, including activity of accessory glands, size of the testes and time since the last sexual activity (WHO, 2010). The extent of these influences have been difficult to determine and are not routinely used in interpretation of the semen analysis. However, quality is of paramount importance when sperm are needed for fertility treatments. Design: Retrospective database analysis. Materials and Methods: The study group included all patients seeking sperm cryopreservation for medical or social reasons. A total of 1205 unique sperm banking patients, providing 1877 specimens were analyzed for 1/2004 through 12/2015. Specimens presenting with no sperm, or 0% motility were excluded. Specimens were collected by masturbation at the facility and days abstinence was self-reported. All specimens were evaluated 30 minutes after ejaculation by the same two technologists using quality-controlled Makler chambers. The patient groups were divided based on days abstained: <2, 2–3, 4–5, 6–7, >7. Data on patient age, days abstinence, volume, concentration, total count, total motile count, and % motility were analyzed using one-way ANOVA and Tukey post-hoc test. Significance was set at P < 0.05. Results: Semen volume, concentration, and total motile count were significantly improved with an increasing days abstinence up to 6–7 days, beyond which parameters showed some decrease. However, sperm concentration was highest at >7 days. There was no difference between initial % motility in the group with <2 days abstinence versus 4–5 and 6–7 days, however, > 7 days resulted in a significant decrease in motility. Conclusions: In this selected patient population, an increase in abstinence appeared to yield a significantly improved sperm count, sperm concentration, total motile count and semen volume. There was no significant change in motility with increased abstinence up to 6–7 days, beyond which motility significantly decreased. Our findings are similar to the results of Levitas E et al. (Fertil.Steril. 83:1680–6, 2005). The data suggest that the role of days abstinence, particularly for men before sperm banking or assisted reproduction procedures, is more important than previously considered. Furthermore, a recommended abstinence of 4–7 days may result in better quality sperm in these groups. Further study of the relationship between daysabstinence, sperm parameters and fertility potential is warranted. Disclosures: None. Funding: None.

Vascular endothelial growth factor (VEGFA) gene variation in polycystic ovary syndrome in a Tunisian women population.

BackgroundPolycystic ovary syndrome (PCOS) is characterized by the growth of a number of small cysts on the ovaries which leads to sex hormonal imbalance. Women who are affected by this syndrome suffer from irregular menstrual cycles, decline in their fertility, excessive hair growth, obesity, acne and most importantly cardiac function problems. The vascular endothelial growth factor (VEGF) plays a pivotal role in tissue vascularization in general and in the pathogenesis of many diseases. The PCOS was found to be associated with high expression levels of VEGF. In women who undergo assisted reproductive procedures (ART), VEGF was found to be a key mediator of other factors to control ovary angiogenesis. Here, we set out to examine the association of VEGFA gene polymorphism with PCOS and its components in a population of Tunisia women to enhance our understanding of the genetic background leading angiogenesis and vascularization abnormalities in PCOS.MethodsThe association of VEGFA gene with PCOS and its components was examined in a cohort of 268 women from Tunisia involving 118 PCOS patients and 150 controls. VEGFA gene variations were assessed through the analysis of the following SNPs rs699947 (A/C), rs833061 (C/T), rs1570360 (G/A), rs833068 (G/A), rs3025020 (C/T), and rs3025039 (C/T). The linkage disequilibrium between SNPs was assessed using HAPLOVIEW software while combination of SNPs into haplotypes in the population and the reconstruction of the cladogram were carried-out by PHASE and ARLEQUIN programs, respectively. Genetic association and genotype-phenotype correlations were calculated by logistic regression and non-parametric tests (Kruskall-Wallis and Mann–Whitney tests), respectively, using StatView program.ResultsWe observed 10 haplotypes in our studied cohort whereH1 (ACGG), H2 (ACAG), H7 (CTGG) and H8 (CTGA) were the most frequent. We observed the association of the genotype CT of the SNP rs30225039 with PCOS phenotype (P = 0.03; OR 95 % CI = 2.05 [1.07–3.90]) and a trend for correlation of the pair of haplotypes H2/H2 with prolactin levels in plasma (P = 0.077; 193.5 ± 94.3 vs 45.7 ± 7.2). These data are consistent with literature and highlight one more time the role of vascularization in the pathogeny of PCOS.ConclusionsLD pattern in VEGF locus showed a similar LD pattern between the Tunisian population and the CEU. More haplotypes in the Tunisian population than in CEU was observed (22 haplotypes vs 16 haplotypes) suggesting higher recombination rate in Tunisians. The study showed that there was any advantage of using haplotypes compared with SNPs taken alone.

Cord Blood Karyotyping: A Safe and Non-Invasive Method for Postnatal Testing of Assisted Reproductive Technology Children.

To verify the hypothesis that the incidence of chromosomal abnormalities increases in babies conceived by different assisted reproduction procedures. The availability of the umbilical cord blood encouraged us to study this hypothesis via this method. This is a descriptive study, umbilical cord blood samples of assisted reproductive technology (ART) children were analyzed with standard cytogenetic techniques (G banding). Karyotyping was possible in 109 cases. The number of abnormal cases was four (3.7%), among which, three cases (2.8%) were inherited and only 1 case (0.9%) was a de novo translocation. In total, the incidence of de novo chromosomal abnormalities was in the range observed in all live births in the general population (0.7-1%). No significant difference in the incidence of chromosomal abnormality was found between ART and naturally conceived babies. To date, several studies have examined the medical and developmental outcome of ART children and still have not reached a definite conclusion. Genetic counseling is recommended as an integral part of planning of treatment strategies for couples wishing to undergo ART.

Randomized double-blind clinical trial comparing two anesthetic techniques for ultrasound-guided transvaginal follicular puncture.

ABSTRACTObjective:To compare the anesthetic techniques using propofol and fentanyl versus midazolam and remifentanil associated with a paracervical block with lidocaine in performing ultrasound-guided transvaginal oocyte aspiration.Methods:A randomized double-blind clinical trial (#RBR-8kqqxh) performed in 61 women submitted to assisted reproductive treatment. The patients were divided into two groups: anesthetic induction with 1mcg/kg of fentanyl associated with 1.5mg/kg of propofol (FP Group, n=32), in comparison with anesthetic induction using 0.075mg/kg of midazolam associated with 0.25mcg/kg/min of remifentanil, and paracervical block with 3mL of 2% lidocaine (MRPB Group, n=29). Main outcome measures: human reproduction outcomes, modified Aldrete-Kroulik index, hemodynamic parameters, and salivary cortisol.Results:The results revealed a higher number of embryos formed in the FP Group (p50=2 versus 1; p=0.025), gestation rate two times higher in the FP Group (44.4% versus 22.2%; p=0.127), less time to reach AK=10 in the MRPB Group (p50=10 versus 2; p<0.001), and lower mean of hemodynamic parameters in the MRPB Group (p<0.05).Conclusion:Anesthesia with fentanyl and propofol as well as with midazolam, remifentanil, and paracervical block offered satisfactory anesthetic conditions when performing assisted reproduction procedures, providing comfort for the patient and physician.

Reproduction of solutions in the plane problem on motion of a free-boundary fluid

This study is devoted to finding exact solutions of the plane unsteady problem on the motion of an ideal incompressible free-boundary fluid. A certain procedure of reproduction making it possible to obtain a two-parametrical family of new exact solutions from one known solution is proposed.

La hormona antimülleriana como marcador de función ovárica

For many years, the clinical significance of the anti-Müllerian hormone (AMH) was limited to its critical role in foetal sexual development. However, in the last 20 years it has also emerged as a marker of ovarian function.AMH has specific functions as a regulator of follicular growth, playing its role as negative feedback signal. It may also play an important role in the regulation of the number of growing follicles (inhibiting the recruitment) as well as in their selection to be ovulated (inhibiting FSH).AMH is synthesised as a pre-pro-hormone. In the cytoplasm each monomer is cleaved, generating one N-terminal fragment: 110 KDa (pro region) and another C-terminal fragment: 25 KDa, non-covalently bound by two disulphide bridges. The C-terminal domain is bioactive, binding to the receptor, but requires the N-terminal fragment to trigger a biological response. A mixture of pro-AMH complex and C-terminal/N-terminal complex can be found in the bloodstream, which can be measured by the assays available.Several authors have shown that AMH is an early marker of the decrease and depletion of ovarian reserve. It shows a close correlation with follicular reserve and reproductive capacity more than FSH and oestradiol.This review leaves no doubt about the usefulness of AMH in the fertile phase. It has proven to be an excellent tool in characterising poor responders in assisted reproduction procedures, as an early alert in young women of a low ovarian reserve in relation to their chronological age, as well as in expressing a number of follicles in high growth, as in polycystic ovary syndrome, to avoid ovarian hyperstimulation. The growing number of patients who have decided to delay motherhood and the role of AMH in ovarian physiology has led it to an integral part of the assessment of women with impaired fertility.

On the equivalence of unidirectional rogue waves detected in periodic simulations and reproduced in numerical wave tanks

This paper deals with the reproduction of unidirectional extreme events in a numerical wave basin. From a rogue wave measurement at a given location, experiments or numerical simulations are conducted with the same wave profiles using reproduction procedures. Although it is recognized that many different physical mechanisms may be at play in freak wave formation, reproduction procedures generally use frequency focusing to generate these high waves. This paper intends to assess the validity of this approach. In particular, it will focus on the relationship between an accurate reproduction of the free surface elevation and the accuracy of the corresponding wave kinematics inside the fluid domain. A highly nonlinear model is used to compute the occurrence of unidirectional freak waves in large periodic domain, which are reproduced in a 2-D numerical wave tank and compared. The study presents an advanced reproduction procedure that deals with rogue waves embedded in an irregular sea state. It shows that, using the appropriate reproduction procedure, it is possible to accurately reproduce free surface elevation as well as kinematics induced by this extreme event.

AB008. Management of fertility post cancer

The successful treatment of males with cancer has led to increasing numbers of men and boys interested in life after cancer. One of the top priorities for many of these males is the opportunity to have a family. Most cancer treatments used for common malignancies in men and boys are associated with impaired fertility; for patients receiving alkylating agents or total body irradiation, severe fertility impairment occurs in most patients. While sperm banking for males, even those as young as 12, facing sterilizing cancer treatment can be effective, this approach requires subsequent use of reproductive procedures such as in vitro fertilization (IVF) or intrauterine insemination to achieve a pregnancy. Most males would prefer to restore their natural ability to father children and avoid these expensive and invasive approaches. No proven method for human male fertility restoration has yet been demonstrated; however, work in many mammalian species and recently in primates has demonstrated that autologous testicular cell transplant (TCT) can restore spermatogenesis after cancer treatment. Promising work in non-primate species has demonstrated the feasibility of in vitro development of mature sperm from neonatal testicular tissue. The safety and efficacy of either approach has not been established in humans. The objective of this lecture is to explore current and future fertility preservation and restoration techniques for males at risk of sterility from medical and surgical treatment.

Defining embryo donation: an Ethics Committee opinion

Building families through the adoption of children has been supported by human society throughout history. The ethical appropriateness of patients donating embryos to other patients for family building, or for research, is well established and is affirmed by this Committee. The use of the term ''adoption'' for embryos is inaccurate and should be avoided. This document replaces the ASRM Ethics Committee statement by the same name, last published in 2013 (Fertil Steril 2013;99:1846-7).