scholarly journals Age-discriminated IVF Access and Evidence-based Ageism: Is There a Better Way?

2021 ◽  
pp. 016224392110219
Author(s):  
Giulia Cavaliere ◽  
James Rupert Fletcher
Keyword(s):  
Evidence Base ◽  
Fertility Treatment ◽  
Potential Candidate ◽  
Vitro Fertilization ◽  
Scarce Resources ◽  
Fertility Treatments ◽  
Age Related ◽  
The Uk

Access to state-funded fertility treatments is age-restricted in many countries based on epidemiological evidence showing age-associated fertility decline and aimed at administering scarce resources. In this article, we consider whether age-related restrictions can be considered ageist and what this entails for a normative appraisal of access criteria. We use the UK as a case study due to the state-funded and centrally regulated nature of in vitro fertilization (IVF) provision. We begin by reviewing concepts of ageism and age discrimination in gerontological scholarship and contend that it is analytically useful to differentiate between them when considering age-restricted health services. We then argue that criteria to access IVF could be considered indirectly ageist so far as they rely on an age-related evidence base that manifests ageist categorizations of persons. Lastly, we examine whether there could be more normatively desirable alternatives to devise criteria to access fertility treatment, considering “lifestyle” as a potential candidate. We conclude, however, that lifestyle-based discrimination is problematic because, unlike age-based discrimination, it risks exacerbating existing socioeconomic and ethnic inequalities.

How Does the Inclusion of Twins Conceived via Fertility Treatments Influence the Results of Twin Studies?

2012 ◽  
Vol 15 (6) ◽  
pp. 746-752 ◽  
Author(s):  
S. Alexandra Burt ◽  
Kelly L. Klump
Keyword(s):  
Twin Studies ◽  
The United States ◽  
Fertility Treatment ◽  
State University ◽  
Behavioral Differences ◽  
Vitro Fertilization ◽  
Fertility Treatments ◽  
Control And Prevention ◽  
Twin Families

Rates of twinning have risen dramatically over the last 30 years, from 1 in 53 births in 1980 to 1 in 30 births in 2009 (Martin et al. (January 2012). Three decades of twin births in the United States, 1980–2009. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics). This increase is largely attributable to increases in the use of fertility treatments (i.e., ovulation induction and in vitro fertilization) combined with delays in parenthood. Although this increase means that more twins are available for recruitment into twin studies, it also has potential consequences for the heritability estimates obtained in these studies. This study sought to evaluate this possibility, making use of the ongoing Michigan Twins Project (N = 7,261 families with twins aged 3–17 years), an arm of the Michigan State University Twin Registry. Results revealed that, on average, twins conceived via fertility treatments had lower rates of behavior problems than those conceived naturally, although these behavioral differences could be explained largely by demographic and socio-economic differences across the two types of twin families. Twin similarity did not meaningfully differ across fertility treatment status. We thus conclude that estimates of genetic and environmental influences obtained from twin studies over the last 10–15 years are more or less unaffected by the inclusion of twins conceived via fertility treatments in their samples.

scholarly journals The Octo Mom Meets Constitutional Law: Testing the Constitutionality of Restricting Fertility Treatments

2011 ◽  
Vol 5 ◽  
Author(s):  
Theresa Miller-Sporrer
Keyword(s):  
In Vitro Fertilization ◽  
Constitutional Law ◽  
Fertility Treatment ◽  
Multiple Pregnancies ◽  
Financial Situation ◽  
Vitro Fertilization ◽  
The Public ◽  
Fertility Treatments

On 26 January 2009, Nadya Suleman gave birth to eight children. 1 The public outpouring of support quickly turned into widespread condemnation as more information about Ms. Suleman’s multiple pregnancies and financial situation was released.2 Once the public learned not only that Ms. Suleman had six other children but also that all fourteen children had been conceived using in vitro fertilization, the public began to question both her judgment and the judgment of her doctor.3 The public apparently was willing to accept the birth if it was the non-deliberate product of a hormone-based fertility treatment but was less willing to accept the birth if it was the result of a deliberate choice on the part of Ms. Suleman and her physician.

Thromboprophylaxis In Women with Recurrent Pregnancy Loss and Thrombophilia Undergoing Fertility Treatments: An Observational Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4396-4396
Author(s):  
Liana Makarian ◽  
Daniel Stein ◽  
Martin Keltz ◽  
Mala Varma
Keyword(s):  
Pregnant Women ◽  
Assisted Reproduction ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Fertility Treatment ◽  
Limited Data ◽  
Vitro Fertilization ◽  
Fertility Treatments ◽  
Pai 1

Abstract Abstract 4396 Thromboprophylaxis in women with recurrent pregnancy loss and thrombophilia undergoing fertility treatments: an observational study. Background Several phase II studies have suggested a benefit of thromboprophylaxis in pregnant women with histories of recurrent pregnancy loss (RPL) with and without thrombophilia. Two recent phase III studies (ALIFE, SPIN) showed no benefit of thromboprophylaxis in women with RPL, but they were not designed to study women with thrombophilia or with 3 or more miscarriages. In addition, plasminogen activator inhibitor-1 (PAI-1) has been linked to RPL, but there are limited data on the use of thromboprophylaxis in pregnant women with PAI-1 and RPL. A mechanism of unexplained RPL is thought to be placental thrombosis. The patients with thrombophilia who undergo assisted reproduction procedures might be at an increased risk of thrombosis due to multiple gestations, ovarian hyperstimulation and hyperestrogenemia. These could contribute to fetal loss via placental thrombosis. There are limited data on the outcome of pregnant women with histories of RPL treated with assisted reproduction and thromboprophylaxis. Methods We performed a retrospective review of 31 cases of women of age 20 to 42 that were referred to the Hematology Department at Roosevelt Hospital over the period of five years (between April 2005 and March 2010) for an evaluation prior to undergoing fertility treatment. Aspirin 81 mg daily prior to in vitro fertilization and enoxaparin 40 mg daily upon confirmation of pregnancy or following embryo transfer was recommended for the majority of patients. Aspirin and enoxaparin were recommended for 21 patients; aspirin alone for 5; enoxaparin alone for 4; and no therapy for 1. Baseline Characteristics of the Patients Results Fifteen out of 31 patients took aspirin and enoxaparin; 9, aspirin alone; 4, enoxaparin alone; and 3, no treatment. Sixteen patients had assisted reproduction with in vitro fertilization or intrauterine insemination; 4 received ovulation induction medications; 7 had natural pregnancies; 2 patients had pregnancies by unknown means. Twenty-five patients (81%) conceived; 13 (42%) had term deliveries; and 1(<1%) had a pre-term delivery at 31 weeks. Five patients (16%) were pregnant at last follow-up. Seven patients (22%) miscarried. Six patients (19%) did not conceive. Conclusion Thromboprophylaxis was associated with a high pregnancy rate and a high live birth rate in women with RPL, many with thrombophilia including PAI-1, presenting for fertility treatment. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Age-related decline in the expression of GDF9 and BMP15 genes in follicle fluid and granulosa cells derived from poor ovarian responders

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Yan Gong ◽  
Jesse Li-Ling ◽  
Dongsheng Xiong ◽  
Jiajing Wei ◽  
Taiqing Zhong ◽  
...  
Keyword(s):  
Granulosa Cells ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mrna Levels ◽  
Clinical Trial Registry ◽  
Altered Expression ◽  
Vitro Fertilization ◽  
Age Related ◽  
Tertiary Teaching ◽  
Poor Ovarian Responders

Abstract Background Growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15) genes play important roles in folliculogenesis. Altered expression of the two have been found among patients with poor ovarian response (POR). In this prospective cohort study, we have determined the expression of the GDF9 and BMP15 genes in follicle fluid (FF) and granulosa cells (GCs) derived from poor ovarian responders grouped by age, and explored its correlation with the outcome of in vitro fertilization and embryo transfer (IVF-ET) treatment. Methods A total of 196 patients with POR were enrolled from a tertiary teaching hospital. The patients were diagnosed by the Bologna criteria and sub-divided into group A (< 35 year old), group B (35–40 year old), and group C (> 40 year old). A GnRH antagonist protocol was conducted for all patients, and FF and GCs were collected after oocyte retrieval. Expression of the GDF9 and BMP15 genes in the FF and GCs was determined with enzyme-linked immunosorbent assay (ELISA), quantitative real-time polymerase chain reaction (qRT-PCR) and Western blotting. Results Compared with group C, groups A and B had significantly more two pronuclei (2PN) oocytes and transplantable embryos, in addition with higher rates of implantation and clinical pregnancy (P <  0.05). The expression level of GDF9 and BMP15 genes in the FF and GCs differed significantly among the three groups (P <  0.05), showing a trend of decline along with age. The ratio of GDF9/BMP15 mRNA levels were similar among the three groups (P > 0.05). The relative levels of GDF9 and BMP15 proteins in GCs have correlated with the relative mRNA levels in GCs and protein concentrations in FF (P <  0.05). Conclusions For poor ovarian responders, in particular those over 40, the expression of GDF9 and BMP15 is declined along with increased age and in accompany with poorer oocyte quality and IVF outcome, whilst the ratio of GDF9/BMP15 mRNA levels remained relatively constant. Trial registration Chinese Clinical Trial Registry Center (ChiCTR1800016107). Registered on 11 May 2018.

A Baby at All Costs? Exploring the Use and Provision of Unproven Adjuvant Treatments in the Context of IVF

2021 ◽  
Author(s):  
Georgina L. Jones ◽  
Victoria Lang ◽  
Nicky Hudson
Keyword(s):  
Reproductive Technologies ◽  
Patient Survey ◽  
Fertility Treatment ◽  
Vitro Fertilization ◽  
The Past ◽  
The United Kingdom ◽  
Wide Range ◽  
National Patient ◽  
Psychosocial Perspective

AbstractThe year 2018 marked 40 years since the birth of Louise Brown, the first baby born as a result of pioneering in vitro fertilization (IVF) treatment. Since then, advances have seen a wide range of reproductive technologies emerge into clinical practice, including adjuvant treatments often referred to as IVF “add-ons.” However, these “optional extras” have faced growing criticism, especially when they have often come at additional financial cost to the patient and have little evidence supporting their efficacy to improve pregnancy or birth rates. Despite this, according to the latest national patient survey by the Human Fertilisation and Embryology Authority, three quarters of patients who had fertility treatment in the United Kingdom in the past two years had at least one type of treatment add-on highlighting the growing demand for these interventions. This article uses a psychosocial perspective to consider the motivations behind patient and clinician behavior along with the wider societal and economic factors that may be impacting upon the increase in the use of adjuvant treatments in fertility clinics more widely. It suggests the reasons fertility patients use unproven “optional extras” are complex, with interpersonal, psychological, and social factors intertwining to generate an increase in the use of IVF add-ons.

Fertility Treatments and the Risk of Preterm Birth Among Women with Subfertility: A Linked-Data Retrospective Cohort Study

2021 ◽  
Author(s):  
Jessica N Sanders ◽  
Sara E Simonsen ◽  
Christina A Porucznik ◽  
Ahmad O Hammoud ◽  
Ken Smith ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Birth ◽  
In Vitro Fertilization ◽  
Retrospective Cohort ◽  
Fetal Death ◽  
Perinatal Outcomes ◽  
Birth Certificates ◽  
Vitro Fertilization ◽  
Fertility Treatments

Abstract Background: In vitro fertilization (IVF) births contribute to a considerable proportion of preterm birth (PTB) each year. However, there is no formal surveillance of adverse perinatal outcomes for less invasive fertility treatments. The study objective was to determine the effect of fertility treatment (in vitro fertilization, intrauterine insemination, usually with ovulation drugs (IUI), or ovulation drugs alone) on preterm birth, compared to no treatment in subfertile women.Methods: The Fertility Experiences Study (FES) is a retrospective cohort study conducted at the University of Utah between April 2010 and September 2012. Women with a history of primary subfertility self-reported treatment data via survey and interviews. Participant data were linked to birth certificates and fetal death records to asses for perinatal outcomes, particularly preterm birth.Results: A total 487 birth certificates and 3 fetal death records were linked as first births for study participants who completed questionnaires. Among linked births, 19% had a PTB. After adjustment for maternal age, paternal age, maternal education, annual income, religious affiliation, female or male fertility diagnosis, and duration of subfertility, the odds ratios and 95% confidence intervals (CI) for PTB were 2.17 (CI: 0.99, 4.75) for births conceived using ovulation drugs, 3.17 (CI: 1.4, 7.19) for neonates conceived using IUI and 4.24 (CI: 2.05, 8.77) for neonates conceived by IVF, compared to women with subfertility who used no treatment during the month of conception. A reported diagnosis of female factor infertility increased the adjusted odds of having a PTB 2.99 (CI: 1.5, 5.97). Duration of pregnancy attempt was not independently associated with PTB. In restricting analyses to singleton gestation, odds ratios remained elevated but were not significant for any type of treatment.Conclusion: IVF, IUI, and ovulation drugs were all associated with a higher incidence of preterm birth and low birth weight, predominantly related to multiple gestation births.

scholarly journals CH50 Activity and its Relationship to Antimüllerian Hormone in Patients with Infertility

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
José Manuel Lozano Sánchez
Keyword(s):  
Ovarian Reserve ◽  
Spearman Correlation ◽  
Complement Pathway ◽  
Cross Sectional ◽  
Vitro Fertilization ◽  
Tertiary Referral Center ◽  
Antimullerian Hormone ◽  
Age Related ◽  
Antimüllerian Hormone

Objective: To study the importance of immunological screening (CH50, C3, C4) to determine the correlation between the ovarian reserve and complement pathway. Design: A cross-sectional multivariate study. Setting: Single tertiary referral center. Patients: 40 Women with infertility diagnosis who underwent In Vitro Fertilization (IVF). Intervention(s): Basal blood samples collected to measure complement pathway and antimüllerian hormone. Main Outcome Measure(s): To correlate complement pathways (CH50 levels) with AMH. Results: The complement system and ovarian reserve were studied in 40 women aged from 28-48 years (mean=37.87 years), finding the values of CH50 65-268 CAE (mean=153.2 CAE), C3 13.9- 183mg/dl (mean=128.52mg/dl), C4 11.5-106mg/dl (mean=29.86mg/dl), AMH 0.10-3.9ng/dl (mean=1.32ng/dl). A multivariate analysis comparison was also conducted yielding significant results: negative correlation between AMH and age (Spearman correlation -0.6; P=0.001), as well as between AMH and CH50 (Spearman correlation -0.4; P=0.0129). Conclusion: High CH50 levels are correlated with an AMH decrease and it could be accordingly associated with age-related chronic inflammation. Capsule: High levels of CH50 are correlated with a decrease in AMH levels and could also be considered as a marker of poor response in IVF cycles.

Practice of in-vitro fertilization: A case study from Finland

1996 ◽  
Vol 42 (7) ◽  
pp. 975-983 ◽  
Author(s):  
Maili Malin Silverio ◽  
Elina Hemminki
Keyword(s):  
In Vitro Fertilization ◽  
Vitro Fertilization

Temporal changes in the expression of the insulin-like growth factor II gene associated with tissue maturation in the human fetus

Development ◽  
1989 ◽  
Vol 106 (3) ◽  
pp. 543-554 ◽  
Author(s):  
A.L. Brice ◽  
J.E. Cheetham ◽  
V.N. Bolton ◽  
N.C. Hill ◽  
P.N. Schofield
Keyword(s):  
Growth Factor ◽  
Cell Types ◽  
Specific Cell ◽  
Insulin Like Growth Factor ◽  
Vitro Fertilization ◽  
Age Related ◽  
Factor Ii ◽  
Metanephric Blastema

The insulin-like growth factors are broadly distributed in the human conceptus and are thought to play a role in the growth and differentiation of tissues during development. Using in situ hybridization we have shown that a wide variety of specific cell types within tissues express the gene for insulin-like growth factor II at times of development from 18 days to 14 weeks of gestation. Examination of blastocysts produced by in vitro fertilization showed no expression, thus bracketing the time of first accumulation of IGF-II mRNA to between 5 and 18 days postfertilization. The pattern of IGF-II expression shows specific age-related differences in different tissues. In the kidney, for example, expression is found in the cells of the metanephric blastema which is dramatically reduced as the blastema differentiates. The reverse is also seen, and we have noted an increase in expression of IGF-II in the cytotrophoblast layer of the placenta with gestational age. The sites of expression do not correlate with areas of either high mitotic activity or specific types of differentiation, but the observed pattern of expression in the kidney, adrenal glands and liver suggests an explanation for the abnormally high IGF-II mRNA expression in developmental tumours such as Wilms' tumour.

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