Type Of Assisted Reproductive Technology Research Articles

Neurodevelopmental Disorders in Offspring Conceived via In Vitro Fertilization vs Intracytoplasmic Sperm Injection

Intracytoplasmic sperm injection (ICSI), the most common type of assisted reproductive technology (ART), might damage the sperm or embryo. The implications of male infertility and ICSI for the neurodevelopmental health of offspring remain unknown. To analyze the risks of neurodevelopmental disorders in offspring of couples with male or female infertility with or without ICSI use. This cohort study was conducted in Taiwan and used information collected from the national population registry data set, national birth data set, and national ART data set for all live singleton births from January 1, 2008, to December 31, 2016. The follow-up period started from the date of birth until the diagnosis of a disorder or December 31, 2018, whichever occurred first. Data were analyzed from July 1, 2021, to August 1, 2022. Male or female infertility with or without ICSI. The outcome was the incidence of autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and developmental delay in offspring with ART conception. Taiwan's national population registry data set was used to identify ASD, ADHD, and developmental delay diagnosed in outpatient clinic and hospitalization records. The study included 1 575 971 singleton births (mean [SD] age, 5.87 [2.60] years; 819 389 boys [52.0%]), of whom 1 568 257 (99.5%) had natural conception, 2111 (0.1%) had ART conception with male infertility, and 5603 (0.4%) had ART conception with female infertility. The risks of ASD (adjusted hazard ratio, 2.49; 95% CI, 1.61-3.84; P < .001) and developmental delay (adjusted hazard ratio, 1.92; 95% CI, 1.54-2.39; P < .001) in offspring with ART conception and ICSI use were significantly higher than those in offspring with natural conception. The same results were found in offspring of couples with either male or female infertility and ICSI intervention. Results of this study suggest that male infertility was not associated with an increased risk of neurodevelopmental disorders in offspring. In both male and female infertility groups, ICSI had unfavorable implications for the neurodevelopmental health of offspring in terms of increased risks of ASD and developmental delay.

Stress Associated with In Vitro Fertilization (IVF) in Women

Millions of people around the world affect infertility in their reproductive age. Infertility has a major impact on the couples’ families and communities in which they live. Around 10% to 15% of couples are infertile in a general population. IVF is one of the option when we think to cure the infertility to those couple in which either of them has been diagnosed with problem of having a baby. In vitro fertilization IVF is one of the most promised types of assisted reproductive technology (ART). The latest report, from 2018, shows that 50% of women ages 35 gone through IVF procedures and resulted in a live birth of baby. 3.9% of the egg transfers done women ages 42 and older and it resulted in a live birth. If a woman is under childlessness, she was experiencing years of the stress from the beginning onwards from where the couple is incapable of having a baby. At that time, she gets to know that she needs to undergo in vitro fertilization, feeling of stress will magnify. IVF is a series of intense medical procedure so when a women passes through the treatment if she felt emotional stress is which is not unusual. Success rate of IVF treatment varies depending on several factors, so if unfortunately the treatment fails it will definitely cause a dramatic emotional distress in the couple especially in case of females. The objective of our study is to analysis the stress of women when she preparing for, during the procedure and after the treatment. In short it is concluded that before during and after the procedure of IVF women generally faces stress in its various degrees. In wide spectrum, marital, social, physical, emotional, financial, and religious status causes stress in women.

Legal nature of the agreement on surrogate motherhood

The article analyzes the legal relationship in the field of surrogacy through the prism of contract law in order to establish differences with the composition of the crime under Article 149 of the Criminal Code of Ukraine “Trafficking in Human Beings”. We also found that the basis for the emergence of legal relations between the subjects of this type of assisted reproductive technologies is the agreement on surrogacy.&#x0D; Analyzing the legal nature of this agreement in view of its subject, we found that the surrogacy agreement is a contract for the provision of medical services, which concerns the place of such a contract in the system of contracts - the contract for the provision of actual medical services. In addition, we have established and investigated the subject of the surrogacy agreement. Thus, the subject of this agreement is directly the actions of the surrogate mother, her voluntary consent to bear and give birth to a child for parents who are deprived of such an opportunity on medical grounds to do so independently, for monetary compensation or without. Because surrogacy is a type of assisted reproductive technology, we have found that this method is one of the medical indications for the treatment of infertility. It follows that the actions of a surrogate mother are medical services.&#x0D; In our articles, we investigated the nature of the crime of “Trafficking in Human Beings” and conducted a comparative analysis of this crime with the surrogacy agreement to identify differences between them. We have also identified a key feature that distinguishes the above-mentioned concepts: the lack of a genetic link between a child born as a result of a surrogacy program and a surrogate mother. In addition, we highlight the main features that do not include the crime of “trafficking in human beings” by participants in the surrogacy program.&#x0D; In this article, we have analyzed the case law, which has made it possible to demonstrate more practically when a person’s actions constitute a crime of “Trafficking in Human Beings”, which is different from the legal nature of the surrogacy agreement.

Effect Analysis of Degranulated Cell in Early Fertilization on FET Outcome and Offspring Safety with Data Mining.

In vitro fertilization and embryo transfer is one type of assisted reproductive technology, although the technology is now more mature. Many factors, however, will have an impact on oocyte fertilization, embryo growth, pregnancy outcome, and child safety due to the journey from clinical to the laboratory. The influence of degranulated cells early in fertilization on frozen embryo transfer (FET) results is investigated in this study. This article analyzes 255 patients who underwent in vitro fertilization (IVF) and FET transplantation at the author's central unit from January 1, 2015, to June 30, 2021. Among them, IVF-assisted conception is the early degranulation of homologous oocyte fertilization. Correlation analysis is performed by observing the embryonic outcome of the early degranulation group and the overnight fertilization group and the clinical outcome after FET. Through data mining analysis, the results show that the polyfertilization rate and 0PN rate for the early degranulation group are significantly higher than the overnight fertilization group (9.87% vs. 8.24% and 3.14% vs. 1.69%). In terms of normal fertilization rate, there is no significant difference between D3 high-quality embryo rate and D5 high-quality blastocyst rate (64.07% vs. 65.15%, 27.5% vs. 26.5%, and 15.97% vs. 17.35%). There is no significant difference in the complete recovery rate of embryos after thawing (93.24% vs. 93.46%), and the implantation rate, clinical pregnancy rate, abortion rate, and live birth rate are not significantly different between the two groups after FET. The offspring outcomes of singletons do not differ significantly between the two groups; however, twins born early degranulate have much greater rates of ultralow birth weight and ultrapreterm children than twins born overnight fertilization (14.29% vs. 0). Therefore, it can be concluded that degranulation of cells early in fertilization is a desirable method to prevent fertilization disorders. However, under the premise of ensuring that no fertilization disorder occurs, it is not appropriate to degranulate all the oocytes of the patient at the early stage of fertilization.

Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy.

Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments. Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART. Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI). Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000). This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.

Illusory palinopsias induced by in vitro fertilization treatment: a case report

BackgroundIn the current era, in vitro fertilization, a type of assisted reproductive technology, has been commonly used for infertility management and gestational surrogacy. The techniques that are routinely used in in vitro fertilization include ovarian hyperstimulation to generate multiple eggs, preparation of the ova and sperm, and culture and selection of resultant embryos before transfer into a uterus. These steps increase the chances of successful pregnancy following in vitro fertilization treatment many-fold, especially in young women. Complications reported with in vitro fertilization treatment include multiple gestations, ovarian hyperstimulation syndrome, and birth defects while ocular side effects reported include retinal detachment and progression of keratoconus. We report a case of visual illusory palinopsia following in vitro fertilization treatment in a patient with unexplained infertility.Case presentationA 31-year-old Asian woman was administered in vitro fertilization treatment for her unexplained infertility. She complained of visually disturbing flashes in her peripheral vision during her pregnancy. She described these flashes as occurring usually in the morning hours or while walking, coming in sets of three to four, occurring five–six times a day and lasting for less than 5–10 minutes. Her flashes were not accompanied by other ocular symptoms such as pain, redness, photophobia, or decrease in vision. Her ocular examination was normal. Neuroimaging with magnetic resonance imaging revealed no pathology. A diagnosis of visual illusory palinopsia secondary to in vitro fertilization treatment was made.ConclusionDisturbing visual palinopsia and afterimages can occur following in vitro fertilization treatment for infertility due to increased estrogen levels. This rare ocular side effect caused by in vitro fertilization treatment is not reported in the literature to the best of our knowledge. Gynecologists and/or infertility experts should educate their patients regarding these possible ocular symptoms. Even ophthalmologists should be aware of this rare cause for visual palinopsia.

Assisted Reproductive Technology and the Reproductive Behavior of Urban Youth (Experience of a Pilot Study)

Introduction. The use of assisted reproductive technology in a situation of a demographic crisis can contribute to an increase in the birth rate among childless parents. The paper is of relevance as there is a need for a sociological analysis of the youth’s attitudes towards the use of assisted reproductive technology. The purpose of the article is to reveal significant factors affecting the youth’s attitudes towards assisted reproductive technology and its application, based on the results of a case study conducted among young people residing in the city of Saransk. Materials and Methods. The study used the methods of analysis, comparison and correlation. The data of a pilot survey conducted among young people residing in the city of Saransk and statistics were used as the empirical base of the study. The data were collected on the basis of the methodology developed by the authors according to quota sampling (by sex, age and place of residence). Results. The study has revealed the correlation between the respondents’ awareness of assisted reproductive technology and their level of education, age and marital status. It has been established that those respondents who took advantage of assisted reproductive technology, more often used such methods as in vitro fertilization, intracytoplasmic sperm injection and surrogacy. The authors have formulated proposals on the need for the state to increase funding for the assisted reproductive technology programs, when it concerns reproductive health, to allocate quotas, ensuring the availability of the technology for the enforcement of the reproductive rights in society, as well as to inform the public about new types of assisted reproductive technology. Discussion and Conclusion. The results of the study can be used by the authorities, staff of reproductive health centers and in vitro fertilization clinics to develop and plan assisted reproductive technology programs, for conducting monitoring studies on the use of assisted reproductive technology. Prospects for the study are associated with conducting further in-depth qualitative research on parents using assisted reproductive technology.

Assisted reproductive technology: prevalence and associated factors in Southern Brazil.

ABSTRACTOBJECTIVE:To assess the prevalence of successful assisted reproductive technology and to identify the associated factors.METHODS:This population-based birth cohort study was carried out with 4,333 pregnant women expected to deliver in 2015 in the urban area of Pelotas, Southern Brazil. Use of an assisted reproductive technology procedure, type of assisted reproductive technology [in vitro fertilization or intracytoplasmic sperm injection or artificial insemination], number of embryos transferred, success of embryo transfer, number of attempts, and reported reasons for seeking assisted reproductive technology were the main outcomes measured. Use of an assisted reproductive technology procedure was analyzed according to sociodemographic, nutritional, reproductive history, and behavioral characteristics. Unadjusted and adjusted analyses were performed by logistic regression.RESULTS:Among the 4,275 newborns enrolled in the Pelotas 2015 Birth Cohort Study, 18 births (0.4%) were conceived by assisted reproductive technology. Most cases of assisted reproductive technology were by in vitro fertilization (70.6%). All cycles were performed in private clinics under direct out-of-pocket payment. Even after controlling for confounders, maternal age > 35 years, nulliparity and high family monthly income were strongly associated with assisted reproductive technology.CONCLUSIONS:The use of assisted reproductive technology services was reported by only a few women in the Pelotas 2015 Birth Cohort Study. Our study highlights sociodemographic factors associated to assisted reproductive technology procedures. To better understand the patterns and barriers in overall use of assisted reproductive technology services over time, national-level trend studies in assisted reproductive technology treatments and outcomes, as well as studies exploring the characteristics of women who have sought this kind of treatment are needed in low-middle income countries.

Legal regulation of surrogacy in Ukraine and the United States of America

In this article, the authors investigated the regulatory acts and laws governing surrogacy in Ukraine. The concept of “surrogacy” was also considered and the absence of fixing of this term at the legislative level was established. In addition, it was determined that the necessary condition for the implementation of the method of surrogacy is the genetic link of the spouse or one of the couples with an unborn child. It follows that the surrogate mother should not be genetically related to the child. However, the legislator doesn’t prohibit bearing the pregnancy of close relatives of future parents (sister, mother, aunt, cousin, etc.). This work also focuses on the definition of the legal nature of the contract concluded between the surrogate mother and the infertile couple for artificial insemination by the method of surrogacy. As a result, this agreement is similar to the civil service agreement. The publication also analyzes the state registration procedure for a newborn baby that was born using the method of surrogacy. The peculiarity of the procedure for registering a newborn baby conceived in this way is the presence of a certificate and statement. The certificate proves the genetic link of the baby with the couple. The statement is given by the surrogate mother to recognize the spouse as the child’s parents. Much attention is paid to the experience of regulating surrogacy in the United States. The country does not have a single codified law on artificial insemination by surrogacy. Each state decides in what manner, in what order, and under what conditions it is possible to resort to this type of assisted reproductive technology. The conclusions provide suggestions for resolving problems that may arise while using the method of surrogacy. Also the possibility of improving current legislation on the legal regulation of this procedure by borrowing from foreign experience. Keywords: surrogacy, legal regulation, surrogate mother, assisted reproductive technologies, married couple, contract.

Congenital Heart Defects in IVF/ICSI Pregnancy: Systematic Review and Meta-analysis

Objective There is no consensus in current practice guidelines on whether conception by in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) techniques is an indication for performing a fetal echocardiogram. The aim of the study was to assess whether congenital heart defects (CHD) occur more often in pregnancies conceived after IVF/ICSI as compared with those conceived spontaneously. Methods A systematic search for studies was conducted of PubMed/MEDLINE, EMBASE and Scopus from inception to September 2017. The search included the following medical subject heading (MeSH) terms alone or in different combinations: ‘IVF’, ‘IVF/ICSI’, ‘ART pregnancy’, ‘assisted conception’, ‘birth defect’, ‘congenital heart defects’ and ‘congenital malformation or abnormalities’. Studies comparing neonatal incidence of CHD in pregnancies conceived after IVF/ICSI and those conceived spontaneously were included. Studies reporting on other types of assisted reproductive technology (ART) or lacking information concerning termination of pregnancy were excluded. Chromosomal abnormalities were excluded in all analyzed studies. A meta-analysis of selected cohort studies was conducted to estimate the pooled odds ratio (OR) with 95% CI using a random-effects model. Statistical heterogeneity among the studies was evaluated with the I2 statistic and Q-test. Results Forty-one studies were identified for review including six case–control and 35 cohort studies. Data of eight selected cohort studies were used for meta-analysis. A total of 25 856 children conceived from IVF/ICSI techniques and 287 995 children conceived spontaneously, involving both singleton and multiple gestations, were included in the analysis. Total CHD events were 337/25 856 (1.30%) and 1952/287 995 (0.68%) in the IVF/ICSI and spontaneous conception groups, respectively. The risk of CHD was significantly increased in the IVF/ICSI group as compared with the spontaneous conception group (pooled OR, 1.45; 95% CI, 1.20–1.76; P = 0.0001; I2 = 44%; P = 0.08). In the subgroup of singleton IVF pregnancies, a significant difference was also obtained (OR, 1.55; 95% CI, 1.21–1.99; P = 0.0005; I2 = 36%; P = 0.18) and also multiple confounding factors adjusted ORs showed statistical significance (pooled OR, 1.29; 95% CI, 1.03–1.60; P = 0.02; I2 = 0%; P = 0.43). Conclusion Fetuses conceived with IVF/ICSI methods are at an increased risk of developing CHD compared with those conceived spontaneously. However, this finding deserves further investigation due to heterogeneity of both ART procedures and cardiac defects. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Molecular mechanisms of embryonic implantation in mammals: Lessons from the gene manipulation of mice.

BackgroundHuman infertility has become a serious and social issue all over the world, especially in developed countries. Numerous types of assisted reproductive technology have been developed and are widely used to treat infertility. However, pregnancy outcomes require further improvement. It is essential to understand the cross‐talk between the uterus (mother) and the embryo (fetus) in pregnancy, which is a very complicated event.MethodsThe mammalian uterus requires many physiological and morphological changes for pregnancy‐associated events, including implantation, decidualization, placentation, and parturition, to occur. Here is discussed recent advances in the knowledge of the molecular mechanisms underlying these reproductive events — in particular, embryonic implantation and decidualization — based on original and review articles.Main findings (Results)In mice, embryonic implantation and decidualization are regulated by two steroid hormones: estrogen and progesterone. Along with these hormones, cytokines, cell‐cycle regulators, growth factors, and transcription factors have essential roles in implantation and decidualization in mice.ConclusionRecent studies using the gene manipulation of mice have given considerable insight into the molecular mechanisms underlying embryonic implantation and decidualization. However, as most of the findings are based on mice, comparative research using different mammalian species will be useful for a better understanding of the species‐dependent differences that are associated with reproductive events, including embryonic implantation.

999: The Impact of Gestational Diabetes in Twin Pregnancies on Maternal and Neonatal Outcomes

Studies of gestational diabetes (GDM) in twin pregnancies are limited by small sample size and unknown chorionicity. We sought to determine how rates of GDM vary by chorionicity and determine the impact of GDM on maternal and neonatal outcomes in a large cohort of well-characterized twin pregnancies. This is a retrospective cohort study of all twin deliveries from Magee-Womens Hospital, University of Pittsburgh between 1998 and 2013. Monochorionic monoamniotic twins were excluded. Maternal and neonatal data were collected using a perinatal database, chart abstraction, and placental review. Large and small for gestational age (LGA/SGA) were defined as less than 10% using the NICHD growth study. Given the limited number of monochorionic diamniotic (mono/di) twins with GDM, univariate and multivariable logistic regression were used to interrogate the association between GDM and perinatal outcomes among dichorionic twins. Given GDM is a maternal exposure, analysis was done at the maternal level and outcomes reported are for either baby. Prepregnancy body mass index, race, parity, maternal age and type of assisted reproductive technology were included as potential confounders. 2927 twin pregnancies were included in the cohort: 79.4% (n=2323) were dichorionic and 20.6% (n=604) were mono/di. The median gestational age at delivery was 36 weeks (IQR: 33.4,37.5). 23.6% of women were obese, 468 (16%) conceived with in vitro fertilization and the average age was 30 years (+/-5.8y). The overall rate of GDM was 6.4% (n=188) and there was no difference in rate of GDM by chorionicity with 154 (6.6%) cases in di/di twins and 34 (5.6%) cases in mono/di twins (p=0.47). Among dichorionic twins, GDM was associated with an increased risk of preeclampsia with an OR = 2.0 (CI: 1.4, 2.8; p<0.001). After adjusting for confounders, this remained significant with an aOR = 1.6 (CI:1.1, 2.3, p=0.02). Among dichorionic twins, GDM was not associated with an increased risk of cesarean delivery, LGA, SGA, or admission to the NICU for either twin (Table 1). The rate of GDM in this cohort was similar to rates in singleton pregnancies. Dichorionic twin pregnancies affected by GDM have an increased risk of preeclampsia compared to twin pregnancies without GDM. Neonatal outcomes were not different. Future studies to determine if glycemic control modifies these associations are needed.

Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis.

There is no consensus in current practice guidelines on whether conception by in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) techniques is an indication for performing a fetal echocardiogram. The aim of the study was to assess whether congenital heart defects (CHD) occur more often in pregnancies conceived after IVF/ICSI as compared with those conceived spontaneously. A systematic search for studies was conducted of PubMed/MEDLINE, EMBASE and Scopus from inception to September 2017. The search included the following medical subject heading (MeSH) terms alone or in different combinations: 'IVF', 'IVF/ICSI', 'ART pregnancy', 'assisted conception', 'birth defect', 'congenital heart defects' and 'congenital malformation or abnormalities'. Studies comparing neonatal incidence of CHD in pregnancies conceived after IVF/ICSI and those conceived spontaneously were included. Studies reporting on other types of assisted reproductive technology (ART) or lacking information concerning termination of pregnancy were excluded. Chromosomal abnormalities were excluded in all analyzed studies. A meta-analysis of selected cohort studies was conducted to estimate the pooled odds ratio (OR) with 95% CI using a random-effects model. Statistical heterogeneity among the studies was evaluated with the I2 statistic and Q-test. Forty-one studies were identified for review including six case-control and 35 cohort studies. Data of eight selected cohort studies were used for meta-analysis. A total of 25 856 children conceived from IVF/ICSI techniques and 287 995 children conceived spontaneously, involving both singleton and multiple gestations, were included in the analysis. Total CHD events were 337/25 856 (1.30%) and 1952/287 995 (0.68%) in the IVF/ICSI and spontaneous conception groups, respectively. The risk of CHD was significantly increased in the IVF/ICSI group as compared with the spontaneous conception group (pooled OR, 1.45; 95% CI, 1.20-1.76; P = 0.0001; I2 = 44%; P = 0.08). In the subgroup of singleton IVF pregnancies, a significant difference was also obtained (OR, 1.55; 95% CI, 1.21-1.99; P = 0.0005; I2 = 36%; P = 0.18) and also multiple confounding factors adjusted ORs showed statistical significance (pooled OR, 1.29; 95% CI, 1.03-1.60; P = 0.02; I2 = 0%; P = 0.43). Fetuses conceived with IVF/ICSI methods are at an increased risk of developing CHD compared with those conceived spontaneously. However, this finding deserves further investigation due to heterogeneity of both ART procedures and cardiac defects. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Surrogacy: outcomes for surrogate mothers, children and the resulting families-a systematic review.

Surrogacy is a highly debated method mainly used for treating women with infertility caused by uterine factors. This systematic review summarizes current levels of knowledge of the obstetric, medical and psychological outcomes for the surrogate mothers, the intended parents and children born as a result of surrogacy. PubMed, Cochrane and Embase databases up to February 2015 were searched. Cohort studies and case series were included. Original studies published in English and the Scandinavian languages were included. In case of double publications, the latest study was included. Abstracts only and case reports were excluded. Studies with a control group and case series (more than three cases) were included. Cohort studies, but not case series, were assessed for methodological quality, in terms of risk of bias. We examined a variety of main outcomes for the surrogate mothers, children and intended mothers, including obstetric outcome, relationship between surrogate mother and intended couple, surrogate's experiences after relinquishing the child, preterm birth, low birthweight, birth defects, perinatal mortality, child psychological development, parent-child relationship, and disclosure to the child. The search returned 1795 articles of which 55 met the inclusion criteria. The medical outcome for the children was satisfactory and comparable to previous results for children conceived after fresh IVF and oocyte donation. The rate of multiple pregnancies was 2.6-75.0%. Preterm birth rate in singletons varied between 0 and 11.5% and low birthweight occurred in between 0 and 11.1% of cases. At the age of 10 years there were no major psychological differences between children born after surrogacy and children born after other types of assisted reproductive technology (ART) or after natural conception. The obstetric outcomes for the surrogate mothers were mainly reported from case series. Hypertensive disorders in pregnancy were reported in between 3.2 and 10% of cases and placenta praevia/placental abruption in 4.9%. Cases with hysterectomies have also been reported. Most surrogate mothers scored within the normal range on personality tests. Most psychosocial variables were satisfactory, although difficulties related to handing over the child did occur. The psychological well-being of children whose mother had been a surrogate mother between 5 and 15 years earlier was found to be good. No major differences in psychological state were found between intended mothers, mothers who conceived after other types of ART and mothers whose pregnancies were the result of natural conception. Most studies reporting on surrogacy have serious methodological limitations. According to these studies, most surrogacy arrangements are successfully implemented and most surrogate mothers are well-motivated and have little difficulty separating from the children born as a result of the arrangement. The perinatal outcome of the children is comparable to standard IVF and oocyte donation and there is no evidence of harm to the children born as a result of surrogacy. However, these conclusions should be interpreted with caution. To date, there are no studies on children born after cross-border surrogacy or growing up with gay fathers.

Varicocele and Male Infertility: Current Issues in Management-A Review

Varicocele is the most common correctable cause of male factor infertility. The role of varicocele in the etiology of male infertility is still controversial regarding to whom varicocelectomy should be done and the selection should be meticulous. With the recent advances in biomolecular and development of novel sperm functional tests, it has been possible to better understand the mechanism involved in damage provoked by varicocele and therefore, propose ways to reverse them. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of assisted reproductive technology (ART) procedure required. This reveiw discusses current concepts on the mechanisms for varicocele induced testicular damage and efficacy of varicocelectomy for treatment of infertility. We also review the current guidelines and need for proper case selection before surgery.The authors critically reviewed the cost effectiveness of the surgical treatment of a varicocele compared with assisted reproductive techniques.

Collection, Isolation, and Culture of Somatic Cells from Avian Semen

Somatic cells in mammalian semen can be a potential source of nuclei for nuclear transfer to produce cloned animals. Somatic cells recovered from avian semen could also provide a source of cells for use in chimera formation or cloning of threatened and endangered birds. This type of assisted reproductive technology is especially important when a genetically unique animal has died and the only viable genetic material available is semen cryopreserved for artificial insemination and in vitro fertilization purposes. The usefulness of somatic cells obtained from fresh and frozen mammalian semen for nuclear transfer has already been evaluated, but still remains to be accomplished for avian semen. A non-invasive, or minimally invasive, technique to conserve avian genetic diversity via somatic cell collection from fresh avian semen, to our knowledge, has not been described. The present study investigated the use of fresh semen samples from domestic chickens ( Gallus domesticus) ( n = 7), i.e., white leghorn ( n = 4) and silkie chickens ( n = 3), as a source of somatic cells, specifically fibroblast-like cells and epithelial cells, for cytological analysis and somatic cell gene banking. Ultimately, somatic cell culture was successful for two of six selected samples (33.3%), with two of four white leghorn semen samples yielding cell cultures compared to 0 of 2 silkie chicken semen samples. Further research may include applying this technique to other avian species or address the effects of cryopreservation on the viability and DNA integrity of somatic cells derived in this manner.

Perinatal outcomes of intrauterine insemination/clomiphene pregnancies represent an intermediate risk group compared with in vitro fertilisation/intracytoplasmic sperm injection and naturally conceived pregnancies

To compare the pregnancy outcomes in terms of perinatal morbidities and mortality for different types of assisted reproductive technology (ART). A retrospective cohort study was conducted of all babies born by ART in Singapore General Hospital, between 1 November 2001 and 11 January 2012. Incidence of ART was 3.5% in our birth cohort. Pregnancies conceived by ART were more likely to be multiple pregnancies OR 43.50, and were more likely to be premature OR 5.51. Mortality OR was 3.93. IVF/ICSI contributed to an increased OR for multiple gestation of 48.26, an increased OR for prematurity of 5.95 and increased OR for low birthweight of 5.54. Mortality OR was 4.33. Intrauterine insemination (IUI)/clomiphene may represent a lower risk group compared with in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). Prematurity OR was only 2.35, and low birthweight OR was 2.38. These were less than half of IVF/ICSI. Fewer neonatal morbidities were found. Mortality was insignificant. Multiplicity had significant impact on perinatal outcomes in ART and IVF/ICSI but not in IUI/clomiphene conceptions, demonstrated by singleton subgroup analyses and by logistic regression using prematurity as outcome. IUI/clomiphene represented an intermediate risk group compared with the IVF/ICSI.

Gonadotropin stimulation contributes to an increased incidence of epimutations in ICSI-derived mice

We previously demonstrated that intracytoplasmic sperm injection (ICSI), a type of assisted reproductive technology (ART), can induce epimutations and/or epimutant phenotypes in somatic tissues of adult mice produced by this method. In the present study, we compared the occurrence of epimutations in mice produced by natural conception, ICSI and somatic cell nuclear transfer. Surprisingly, we observed the highest frequency of epimutations in somatic tissues from ICSI-derived mice. We also observed a delay in reprogramming of the maternal allele of the imprinted H19 gene in spermatogonia from juvenile ICSI-derived male mice. These observations led us to hypothesize that the exposure of the maternal gametic genome to exogenous gonadotropins during the endocrine stimulation of folliculogenesis (superovulation) may contribute to the disruption of the normal epigenetic programming of imprinted loci in somatic tissues and/or epigenetic reprogramming in the germ line of ensuing offspring. To test this hypothesis, we uncoupled superovulation from ICSI by subjecting female mice to gonadotropin stimulation and then allowing them to produce offspring by natural mating. We found that mice produced in this way also exhibited epimutations and/or epimutant phenotypes in somatic tissues and delayed epigenetic reprogramming in spermatogenic cells, providing evidence that gonadotropin stimulation contributes to the induction of epimutations during ART procedures. Our results suggest that gonadotropin stimulation protocols used in conjunction with ART procedures should be optimized to minimize the occurrence of epimutations in offspring produced by these methods.

Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used

To compare obstetric and perinatal outcomes of singleton pregnancies conceived with different types of assisted reproductive technology (ART) procedures with those of naturally conceived pregnancies. Retrospective cohort study. The perinatal database of the Japanese Society of Obstetrics and Gynecology. A total of 242,715 women with singleton pregnancies were examined as a base cohort. Three study groups were created according to the type of ART procedure used, namely ovulation stimulation medications (n = 4,111), IUI (n = 2,351), and IVF-ET (n = 4,570). Controls adjusted for multiple maternal characteristics were selected randomly for each study group. None. Obstetric and perinatal outcomes. Patients who conceived through the ART procedures were associated with an increased incidence of placenta previa, preterm delivery, and low birth weight infant and a decreased incidence of spontaneous cephalic delivery, regardless of the type of ART procedure. Among singleton pregnancies, patients conceived with ART procedures were at increased risk for several adverse obstetric and perinatal outcomes, regardless of the type of ART procedure used. These results suggest that maternal factors associated with infertility may contribute to the adverse outcomes rather than the ART procedures themselves.

Health of IVM children

In vitro maturation (IVM) is an emerging type of assisted reproductive technology (ART), in which immature as opposed to mature oocytes are collected from the ovaries and allowed to mature in vitro prior to fertilisation by either standard in vitro fertilisation (IVF) on intracytoplasmic sperm injection (ICSI). Since the first report of a human birth resulting from IVM in 1991 [1], it is estimated that over 1,300 babies have been born following the technique [2] (in contrast to an estimated 3 million babies conceived by standard IVF and ICSI over the last 30 years). IVM offers a number of potential benefits when compared to standard IVF, principally related to the avoidance of high doses of hormonal stimulation with gonadotrophins and GnRH analogues. In patients with polycystic ovary syndrome (PCOS) this avoids the risk of ovarian hyperstimulation syndrome (OHSS). The high costs of hormonal therapy also make IVM cheaper than conventional alternatives. Immature oocyte retrieval, without the need to wait for hormonal stimulation and in vivo maturation, offers the possibility of expedient oocyte cryopreservation for patients diagnosed with cancers without delaying cancer treatment. However, despite recent improvements, pregnancy rates with IVM remain lower than with conventional IVF, and higher miscarriage rates have been reported with IVM [2]. For these reasons IVM has yet to become widely used in the field of ART. Given that IVM is not yet a mainstream ART technique, it is not surprising that there is very limited follow-up data regarding the health of children conceived following its use. This is in contrast to a significant volume of high quality studies that have followed-up children conceived following standard IVF and ICSI. In this article we discuss hypothetical concerns regarding the health of IVM children, and review the few studies published in this area. Health of IVF & ICSI children High multiple pregnancy rates continue to be the single greatest factor adversely impacting upon the outcome of ART pregnancies [3, 4], with resulting increased risk of preterm delivery, low birth weight, and perinatal mortality. However, evidence regarding the health of ART singletons when compared to spontaneously conceived singletons is generally reassuring. The majority of studies investigating the risk of congenital malformations, neurodevelopmental outcome, physical health, growth, and psychosocial well-being in ART children are reassuring [5, 6]. Concerns have been raised that ART children may exhibit higher rates of cancer [7] and rare imprinting disorders [8] (such as Beckwith-Wiedemann Syndrome and Angelman Syndrome), however larger studies are required to confirm these associations. Risks of infertility and cardiovascular disease in later life remain unexplored areas of concern and require follow-up of cohorts of ART children to continue into adulthood.