Research In Reproductive Medicine Research Articles

The scientific output of a Catholic university department of obstetrics and gynecology

The introduction of in-vitro fertilization (IVF) and prenatal diagnostics (PND) raised moral and ethical problems for Catholic universities. As expected, reproductive medicine research output was very low in departments that did not provide these facilities. It can be demonstrated that, by initiating IVF and PND under strong restrictions, a low scientific output in IVF and PND can be compensated for by increasing scientific output in new areas such as maternofetal physiology, primary prevention of birth defects and preconception care (folic acid and neural tube defects). This increase was mainly due to multidisciplinary efforts.

Are Catholic universities giving up reproductive medicine?

The Catholic Church has established a large number of universities worldwide. A dozen have schools of medicine and the impact of church doctrine on reproductive medicine appears widely disparate between some medical schools at Catholic universities in Europe and the rest of the world. The pressure of the Vatican on the Catholic universities in Belgium to abandon IVF is mounting. Comparison of the scientific performances by the Catholic universities with and without IVF shows that the absence of IVF is disastrous for research in reproductive medicine.

A survey of the practices and opinions of the domestic members of the American Society for Reproductive Medicine

To learn how the domestic members of the American Society for Reproductive Medicine (ASRM) use its services and to survey their opinions regarding clinical practices and research in reproductive medicine. A self-administered mail survey. Members of a professional organization. A total of 1,291 members responded. Of these, 80% were physicians, embryologists, or nurses. None. Demographics, use of ASRM services, and opinions. Eighty-five percent of the respondents provided some type of clinical care for individuals with fertility problems. Two thirds read the ASRM News, and more than half used ASRM Practice Committee statements, Ethics Committee opinions, and patient education materials. Eighty-three percent reported that they followed the Ethics Committee opinions. Whereas 78% did not support reproductive cloning, two thirds supported somatic cell nuclear transfer to produce stem cells for research. The majority opposed governmental regulation of assisted reproductive technologies. The domestic membership of the ASRM is diverse in terms of demographics, practices, and opinions. In addition, they find the services of the ASRM to be of value.

Regulation of assisted reproductive technologies in the United States

The regulation of any social activity is a complex activity, and perhaps this is no more so than in medicine where the interests of patients, profes sionals, society, and government can be in conflict. A special area of regula tory concern involves assisted reproductive technologies (ART), which are medical procedures involving the laboratory manipulation of gametes (sperm and eggs). In vitro fertilization (IVF) is the most commonly performed ART, whereas other technologies include intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis/screening (PGD/S) and assisted hatching (AH). The use of donor eggs (oocytes) and surrogates (gestational carrier, host uterus) are also considered ART procedures. Donor insemina tion (DI) by itself is generally not considered an ART procedure. Somatic cell nuclear transfer (SCNT) or "cloning" has been classified into thera peutic cloning or the use of SCNT to produce cells and tissues that can be used to treat disease, and is considered appropriate by many people, and reproductive cloning, the use of SCNT to create a genetically "identical" individual, which is considered an inappropriate use of technology by almost everyone. ART technologies are also used to create stem cells for both research and potential therapeutic purposes. Why should these technologies be regulated, what should be regulated, how should it be done, and who should be responsible? These are difficult questions that have been answered differently in many countries and by

ReproMED on the Internet today and tomorrow

ReproMED comprises a range of projects applying and researching the role of information technology to support clinical care, education and research in reproductive medicine. This article traces the development of ReproMED on the Internet and concludes by speculating on the future. The project started with a critical evaluation of the infertility information needs of general practitioners and the role of hypertext in meeting those needs, leading to the production of a ReproMED CD-Rom. However, as the project was under development in 1995, Microsoft launched its first web browser amid major expansions of the Internet, thus the project switched to a series of websites and played host to national bodies including the British Fertility Society and the British Andrology Society. After a critical evaluation of the role of the Internet in supporting postgraduate medical education in the southwest region, reproductive medicine training over the Internet was piloted. This pilot was followed by a series of similar training programmes for junior doctors, specialists and general practitioners, leading to the establishment of a formal MSc delivered principally over the Internet. In addition to professional education and research, the ReproMED websites provide patients with extensive interactive information. The future holds many exciting possibilities with rapid technological developments and ever-increasing information needs.

Crisis in Assisted Conception: The British Approach to an American Dilemma

Although British and American couples who are infertile have similar treatment options in their home countries, the British system for ensuring quality of care has striking advantages over the American status quo in reproductive medicine. The British system effectively addresses what continue to be serious problems on the American scene, such as the lack of any clear license or certification of infertility treatment centers to reassure consumers, the absence of a complete consumer-friendly account of success rates at various sites and by technique, and the continuing proportional increase in multiple births because of high numbers of embryos transferred in in vitro fertilization (IVF) and numbers of oocytes produced as a result of ovulation-stimulating drugs. In addition, the British system has clear compulsory guidelines in place that regulate what kinds of human embryo research can be performed, by whom, and where. In infertility practice, the British also have strict controls on the introduction of innovations, such as intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis (PGD). The British prohibition, for example, against cloning by nuclear replacement is already a matter of record, and there is no necessity (as is the case in the United States with cloning via nuclear transplantation) to invoke a public ban and hope that a private moratorium will be observed. Regardless of what one thinks about the clinical and research issues, the clarity and order that permeate practice and research in reproductive medicine in Great Britain have advantages that could serve as guideposts for necessary reforms in the United States.

Research on reproductive medicine in the pharmaceutical industry

The selection of research projects in the pharmaceutical industry depends on different criteria from those used by academic researchers, who have more freedom to follow an intellectually exciting scientific topic even though it may have little immediate or obvious practical value. Fundamental, untargeted research is rarely carried out in industry except by collaboration with academic workers: such collaborations can offer advantage to both parties. The issues that are considered before research programmes are initiated in the pharmaceutical industry are: • medical need • commercial potential • scientific rationale • drug discovery feasibility • drug development feasibility • competitive position • ethical considerations Most pharmaceutical companies would not commit to a research programme unless the medical need was readily apparent and a drug with advantages over existing products would offer clear medical benefit. These prerequisites are strongly linked to commercial potential which is governed by market size and this, in turn, is related to the incidence of the disease, the extent of the existing need and the degree of differentiation that a new drug could achieve from existing therapies. However, even if the existing need was great but either the incidence of the disease was small, or it was largely confined to developing countries which would be unable to meet drug costs, research projects would be difficult to justify in a commercial environment. Therefore, it is imperative that national and international funding agencies concentrate resources on such diseases. In reproductive medicine, many pharmaceutical companies conclude that the contraceptive pill remains one of the most effective and well tolerated medicines available despite occasional criticisms. Improvement and increased safety in such efficacious drugs are difficult to achieve. It is not perceived that advancement is not possible, only that the chances of achieving improvement are far less than in other therapeutic areas, which makes research into contraception relatively unattractive except to pre-existing major players. The need for new approaches to male fertility control has been recognized, although it is appreciated that even if advances were made many women would still prefer to use contraceptive methods within their control. The scientific challenge to regulate male fertility is so much greater than that for female fertility, namely, to find an antifertility agent that preserves libido. As a consequence, many pharmaceutical companies have focused research in reproductive medicine on approaches to sex hormonedependent cancers and benign prostate and gynaecological diseases. The scientific rationale behind any drug discovery project is of paramount importance in ensuring eventual success. Issues of drug target, potency, selectivity, drug distribution and pharmacokinetics, and safety all need to be evaluated throughout any drug development programme and the project sponsor must be as confident as the research managers that a well differentiated and effective medicine can eventually be produced. It is not enough to have an original approach to disease therapy if redundancy in the factors driving the disease means that blocking the production or action of a single factor will have only a marginal or transient effect on the disease. Moreover, however effective a novel therapy may be, if it has serious side effects based on the mode of action of the drug it is unlikely to have a significant clinical impact. Even when there are feasible drug discovery approaches, it is important to consider the feasibility of demonstrating un

High fertilization and pregnancy rates after intracytoplasmic sperm injection in patients with disordered zona pellucida-induced acrosome reaction

Objective: To determine whether intracytoplasmic sperm injection (ICSI) is effective treatment for patients with disordered zona pellucida (ZP)-induced acrosome reaction (AR) who have failure of standard IVF-ET. Design: Tests of sperm-ZP binding and penetration and the ZP-induced AR were used to diagnose patients with disordered ZP-induced AR who then were treated with ICSI. Setting: Academic reproductive medicine research laboratory associated with a tertiary referral infertility clinic. Main Outcome Measure(s): Clinical features and results of previous IVF-ET, semen analysis and sperm-ZP interaction tests, and ICSI were analyzed. Result(s): The majority of patients had consistently normal sperm characteristics and all patients had normal sperm-ZP binding but failure of sperm-ZP penetration. The AR of sperm bound to the ZP was significantly lower in the patients (mean 6%, range 0% to 16%) than in the fertile men (mean 61%, range 27% to 96%). Intracytoplasmic sperm injection was performed on 34 patients and the normal fertilization rate averaged 73% per injected oocyte. Five ongoing and eight term pregnancies including two with twins were achieved after an average of two ET procedures per patient were performed. Two couples have second ongoing pregnancies from transfer of frozen embryos after successful first pregnancies. Overall, the implantation rate was 10.5% per embryo and the pregnancy rate 19% per ET and 38% per patient. Conclusion(s): Disordered ZP-induced AR is a cause of severe infertility and persistent failure of IVF-ET. Intracytoplasmic sperm injection is effective treatment for this condition. Patients with idiopathic infertility should be tested for this condition before commencing IVFET treatment.

The ISRA/R information system in gynecologic endocrinology

This paper presents an information system for the support of clinical research in reproductive medicine (ISRA/R). The system is established on a database approach--all data arising at our center is instantly recorded on-line into the database. Thus a mighty tool has been established to aid us considerably in our daily work as well as in clinical studies.