Infertility and the excruciating pursuit of motherhood

Infertility Treatment ◽

In Vitro Fertilisation ◽

Natural Conception ◽

Graphic Description

What’s a Lemon Squeezer Doing in My Vagina? is a memoir of Rohini S Rajagopal’s excruciating five-year long fight with infertility and her journey to motherhood. After several failed attempts at natural conception and many negative home pregnancy tests, the author and her husband Ranjith visit a fertility centre in Bangalore. Rajagopal delivers a graphic description of the physical and emotional unpleasantness of her infertility treatment and also gives a vivid account of her experiences with the assisted reproductive technologies (ARTs) such as the intrauterine insemination (IUIs), in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Intrauterine Insemination (IUI) is facilitated by directly injecting a man’s sperm into the woman’s uterus around the time the eggs emerge from the ovaries.

May I have your uterus? The contribution of considering complexities preceding live uterus transplantation

Medical Humanities ◽

10.1136/medhum-2020-011864 ◽

2021 ◽

pp. medhum-2020-011864

Author(s):

Lisa Guntram

Keyword(s):

Medical Humanities ◽

In Vitro Fertilisation ◽

Medical Innovation ◽

Uterus Transplantation ◽

Ethical Debate ◽

Care And Support ◽

Different Dimensions

Uterus transplantation combined with in vitro fertilisation (IVF) (henceforth called UTx-IVF) as a treatment for infertility caused by an absence or malfunction of the uterus is advancing. About 50 transplantations have been conducted worldwide and at least 14 children have been born—9 of them by women taking part in a Swedish research project on UTx-IVF. The Swedish research protocol initially stated that the potential recipient must ‘have her own donor’ who is preferably related to the recipient. But what does it mean to ask someone for a uterus? What challenges does this question instigate? And what norms may it enact? In this article, I explore how 10 women—who have considered, and sometimes pursued, UTx-IVF—describe their experiences of searching for a donor. I aim to show how an analysis of such accounts can help us unpack some of the specific relational and gendered dimensions of UTx-IVF and by doing so enrich discussions of risks, benefits, care and support in UTx-IVF. Drawing on research in social sciences and medical humanities that has demonstrated how assisted reproductive technologies and organ donation can provoke social and familial conundrums, with respect to such topics as embodiment and identity, I present three patterns that describe different dimensions of the interviewees’ quest for a uterus donor. I discuss the negotiations that took place, how expectations unfolded and how entanglements were managed as the interviewees considered asking someone for a donation. Such an examination, I suggest, contributes to make care and support more attuned to the experiences and entanglements that UTx-IVF entails for those pursuing it. This will become increasingly important if (or when) UTx-IVF becomes part of general healthcare. To conclude, I problematise responsibilities and relational challenges in medical innovation, and in this way provide insights into how the ethical debate over UTx-IVF can broaden its scope.

Rare occurrence of Tetralogy of Fallot in dizygotic twins conceived via in vitro fertilisation

Cardiology in the Young ◽

10.1017/s1047951119002439 ◽

2019 ◽

Vol 29 (12) ◽

pp. 1541-1542

Author(s):

Jason W. Greenberg ◽

Chetana Reddy ◽

Charles B. Huddleston

Keyword(s):

Tetralogy Of Fallot ◽

In Vitro Fertilisation ◽

Rare Occurrence ◽

Dizygotic Twins

AbstractAn increased incidence of CHD has been noted in twin gestations and in infants conceived using assisted reproductive technologies. However, CHD in these populations remains understudied and the mechanisms underlying these phenomena remain unclear. We present the case of twins conceived via in vitro fertilisation both with Tetralogy of Fallot and additional cardiac and extracardiac malformations.

Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it?

Journal of Medical Ethics ◽

10.1136/medethics-2018-104983 ◽

2019 ◽

Vol 45 (5) ◽

pp. 346-350 ◽

Cited By ~ 4

Author(s):

Mila Stefanova Zemyarska

Keyword(s):

Cost Effective ◽

Conclusive Evidence ◽

Diagnostic Tools ◽

In Vitro Fertilisation ◽

Unborn Child ◽

Effective Adjunct ◽

Psychological Benefit

In vitro fertilisation (IVF) ‘add-ons’ are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical—namely, morally good and righteous, the question was considered in relation to three key values of medical ethics—autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child.

Foreword: A perspective on the role of emerging technologies for the propagation of companion animals, non-domestic and endangered species

Reproduction Fertility and Development ◽

10.1071/rd07091 ◽

2007 ◽

Vol 19 (6) ◽

pp. iii ◽

Cited By ~ 1

Author(s):

Monique C. J. Paris ◽

Gabriela F. Mastromonaco ◽

Damien B. B. P. Paris ◽

Rebecca L. Krisher

Keyword(s):

Endangered Species ◽

Emerging Technologies ◽

Companion Animals ◽

Reproductive Physiology ◽

In Vitro Fertilisation ◽

Genetic Management ◽

The Status

Assisted reproductive technologies (ART) have been used successfully in humans, domestic and laboratory species for many years. In contrast, our limited knowledge of basic reproductive physiology has restricted the application of ART in companion animal, non-domestic and endangered species (CANDES). Although there are numerous benefits, and in some cases a necessity, for applying ART for the reproductive and genetic management of CANDES, the challenges encountered with even the most basic procedures have limited the rate of progress. In this foreword we discuss the status of conventional ART, such as artificial insemination and in vitro fertilisation, as well as their benefits and inherent difficulties when applied to CANDES. It is upon these techniques, and ultimately our knowledge of basic reproductive physiology, that the success of emerging technologies, such as those described in this special issue, are dependent for success.

Use of an oncology sperm bank: a Canadian experience

Canadian Urological Association Journal ◽

10.5489/cuaj.1076 ◽

2013 ◽

Vol 3 (3) ◽

pp. 219 ◽

Cited By ~ 4

Author(s):

Amanda Selk ◽

Timea Belej-Rak ◽

Heather Shapiro ◽

Ellen Greenblatt

Keyword(s):

Tertiary Care ◽

Retrospective Chart Review ◽

Success Rates ◽

Oncology Patients ◽

Vitro Fertilization ◽

Sperm Bank

Background: We performed a retrospective chart review in 2006to review oncology patients’ use of banked semen samples infertility treatments at a tertiary care centre.Methods: From 2002 to 2005, 367 oncology patients bankedsemen. During the same period, 31 patients used banked samplesin 48 treatment cycles. Samples were used for intrauterine insemination(IUI) in 28 cycles and for in vitro fertilization (IVF) withor without intracytoplasmic sperm injection (ICSI) in 20 cycles.Results: Pregnancy rates per cycle were 21% for IUI and 50%for IVF with or without ICSI. Overall, 16 of the 31 couples achieveda pregnancy with assisted reproductive technologies (52%).Conclusion: This data indicates high pregnancy success rates withthe use of banked semen samples from men with cancer.Contexte : Une revue rétrospective de dossiers a été effectuée afind’examiner le recours à des échantillons de sperme provenantde patients cancéreux pour le traitement de l’infertilité dans uncentre de soins tertiaires.Méthodes : Entre 2002 et 2005, des échantillons de spermeprovenant d’un total de 367 patients atteints de cancer ont été misen banque. Durant la même période, 31 patientes ont utilisé ceséchantillons au cours de 48 cycles de traitement. Les échantillonsont été utilisés pour insémination intra-utérine (IIU) lors de28 cycles et pour fertilisation in vitro (FIV) avec ou sans injectionintracytoplasmique de sperme (ICSI) lors de 20 cycles.Résultats : Le taux de grossesse par cycle était de 21 % avecl’IIU et de 50 % pour la FIV avec ou sans ICSI. Au total, 16 des31 patientes sont devenues enceintes (52 %).Conclusion : Ces données montrent des taux élevés de grossesseobtenus par l’utilisation d’échantillons de sperme provenantd’hommes atteints de cancer.

Reproductive technologies, female infertility, and the risk of imprinting-related disorders

Clinical Epigenetics ◽

10.1186/s13148-020-00986-3 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Patricia Fauque ◽

Jacques De Mouzon ◽

Aviva Devaux ◽

Sylvie Epelboin ◽

Marie-José Gervoise-Boyer ◽

...

Keyword(s):

Molecular Mechanisms ◽

Female Infertility ◽

Global Risk ◽

Vitro Fertilization ◽

Increased Risk ◽

Genomic Imprints

Abstract Background Epidemiological studies suggest that singletons born from assisted reproductive technologies (ART) have a high risk of adverse perinatal outcomes, specifically for imprinting disorders. Because ART processes take place at times when epigenetic reprogramming/imprinting are occurring, there is concern that ART can affect genomic imprints. However, little is currently known about the risk of imprinting defects according to the type of ART or the type of underlying female infertility. From the French national health database, a cohort of 3,501,495 singletons born over a 5-year period (2013–2017) following fresh embryo or frozen embryo transfers (fresh-ET or FET from in vitro fertilization), intrauterine insemination, or natural conception was followed up to early childhood. Based on clinical features, several syndromes/diseases involving imprinted genes were monitored. The effects of ART conception and the underlying cause of female infertility were assessed. Results Compared with infants conceived naturally, children born after fresh-ET had a higher prevalence of imprinting-related diseases, with an aOR of 1.43 [95% CI 1.13–1.81, p = 0.003]. Namely, we observed an increased risk of neonatal diabetes mellitus (1.96 aOR [95% CI 1.43–2.70], p < 0.001). There was an overall independent increase in risk of imprinting diseases for children with mothers diagnosed with endometriosis (1.38 aOR [95% CI 1.06–1.80], p = 0.02). Young and advanced maternal age, primiparity, obesity, smoking, and history of high blood pressure or diabetes were also associated with high global risk. Conclusions This prospective epidemiological study showed that the risk of clinically diagnosed imprinting-related diseases is increased in children conceived after fresh embryo transfers or from mothers with endometriosis. The increased perturbations in genomic imprinting could be caused by controlled ovarian hyperstimulation and potentially endometriosis through the impairment of endometrial receptivity and placentation, leading to epigenetic feto-placental changes. Further studies are now needed to improve understanding of the underlying molecular mechanisms (i.e. genetic or epigenetic causes).

EFFECTIVENESS OF ASSISTED REPRODUCTIVE TREATMENT PROGRAMS DEPENDING ON THE CHARACTERISTICS OF SPERMOGRAM CHANGES

Andrology and Genital Surgery ◽

10.17650/2070-9781-2018-19-2-82-87 ◽

2018 ◽

Vol 19 (2) ◽

pp. 82-87 ◽

Cited By ~ 1

Author(s):

S. I. Gamidov ◽

R. I. Ovchinnikov ◽

A. Yu. Popova ◽

V. V. Polozov ◽

N. P. Naumov ◽

...

Keyword(s):

Intracytoplasmic Sperm Injection ◽

Sperm Concentration ◽

Motile Sperm ◽

Study Objective ◽

Normal Morphology ◽

Live Births ◽

Significant Difference

Introduction. There’re some pathological mechanisms of male fertility disorders that still don’t have proper diagnostic tests. This significantly decreases diagnostic value of a spermogram and makes the problem of evaluation of the characteristics of spermogram changes and their effects on the effectiveness of assisted reproductive technologies (ART) a pressing problem.The study objectiveis to identify the correlation between effectiveness of ART programs and the characteristics of spermogram changes, in particular sperm concentration, motility, and morphology Materials and methods. At the V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology in the period from December of 2012 to December of 2016, 10,042 married couples who underwent treatment using ART (2221 – in vitro insemination (IVF), 7821 – IVF with intracytoplasmic sperm injection) were examined.Results. In patients after IVF, the frequency of live births significantly depended on sperm concentration: 28.6 % for concentration above 5 mil/ml and 51.5 % for concentration above 15 mil/ml (p <0.0001). No significant difference was observed for the dependence of the frequency of live births on the number of progressive-motile sperm (grade А): 38.2 % for <5 % and 57.7 % for >15 % (p = 0.11), or on the number of spermatozoa with normal morphology: 50 % for ≥4 % and 45.5 % for <4 % (p = 0,23). In patients after IVF with intracytoplasmic sperm injection, the concentration of spermatozoa, number of progressive-motile sperm (grade А), and number of spermatozoa with normal morphology didn’t affect the frequency of live births in a statistically significant way.Conclusion. Sperm concentration, motility, and morphology can affect the frequency of live births in the IVF program, but statistically significant correlation was observed only for sperm concentration. After IVF with intracytoplasmic sperm injection, only sperm morphology affects the frequency of live births, but not in a statistically significant way.

Trends in safe infertility treatment with assisted reproductive technologies

Journal of obstetrics and women s diseases ◽

10.17816/jowd69483-88 ◽

2020 ◽

Vol 69 (4) ◽

pp. 83-88

Author(s):

Svetlana S. Paskar ◽

Alla S. Kalugina ◽

Anna G. Tkachuk

Keyword(s):

Clinical Practice ◽

Assisted Reproductive Technology ◽

Perinatal Outcomes ◽

Infertility Treatment ◽

Reproductive Technology ◽

Correct Prediction ◽

Vitro Fertilization

The expansion of indications for assisted reproductive technology has led to significant implications for assisted reproductive technology (ART) programs worldwide. More than 7 million children in the world were born using ART. Modern clinical practice in the field of reproductive sciences is aimed not only at increasing the effectiveness, but also at the safety of treatment. ART, like any other type of therapy, may be combined with negative side effects. Both the correct prediction of the risks associated with treatment and a personalized approach ensure the absolute safety of infertility treatment using in vitro fertilization. In this regard, over the past decade, a number of new research approaches have been noted that use ART methods integrated into clinical practice: cycle segmentation with subsequent embryo transfer and the elective transfer of one embryo. New approaches provide a control in relation to ovarian stimulation and a reduction in the number of transferred embryos, which helps to minimize primarily adverse perinatal outcomes. Predicting the risks and outcomes of treatment using mathematical modeling is the application of good clinical practice.

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

Journal of Paediatrics and Child Health ◽

10.1111/jpc.12257 ◽

2013 ◽

Vol 49 (9) ◽

pp. 733-740 ◽

Cited By ~ 17

Author(s):

Woei Bing Poon ◽

Wee Bin Lian

Keyword(s):

Intracytoplasmic Sperm Injection ◽

Risk Group ◽

Perinatal Outcomes ◽

In Vitro Fertilisation ◽

Intermediate Risk

Clinical significance of sperm morphology in male infertility treatment

Experimental and Сlinical Urology ◽

10.29188/2222-8543-2021-14-3-127-132 ◽

2021 ◽

Vol 14 (3) ◽

pp. 127-132

Author(s):

Yu.V. Olefir ◽

◽

D.M. Monakov ◽

◽

Keyword(s):

Male Infertility ◽

Clinical Significance ◽

Sperm Morphology ◽

Vitro Fertilization ◽

Normal Sperm ◽

Starting Point

Introduction. Sperm morphology is one of the most common tests in fertility practice. The interlaboratory variability is the main drawback of the method. The clinical significance of sperm morphology in assisted reproductive technologies is controversial. The aim of the review is to address this question. Materials and methods. The search of relevant publications was carried out in PubMed and e-Library databases using the keywords «male infertility», «sperm morphology», «teratozoospermia», «IUI», «IVF», «ICSI». Conference abstracts and dissertations were excluded from analysis and 56 publications were included in this literature review. Results. The small numbers of studies were evaluated to the effect of teratozoospermia on the likelihood of natural pregnancy. The pregnancy rate was higher in the group of couples with normozoospermia. In the couples with severe teratozoospermia pregnancies rate was also detected. The most studies did not reveal a statistically significant effect of tertozoospermia on the frequency of pregnancy during intrauterine insemination. The data about the influence of sperm morphology on in vitro fertilization are contradictory. Early studies showed a positive correlation between normal sperm morphology and frequency of conception, but these results were not confirmed in further studies. The most studies have not been revealed the correlation between normal sperm morphology male fertility status, clinical and live birth rate. Discussion. To date the spermatozoa mofophology studying remains the «starting point» ofa man's examination for infertility. However, the data available do not confirm its role in choosing the method ofassisted reproductive technologies or predicting their results. Conclusions. To date the role of sperm morphology on conceive and pregnancy frequencies in ART use is controversal. The data available does not confirm the value of this test as a proxy of higher pregnancy and birth of healthy child probability. The further studies are required to address this question.