Heterotopic Pregnancy after In Vitro Fertilisation and Embryo Transfer Post-unilateral Salpingectomy: A Case Report and Literature Review

Heterotopic pregnancy (HP) is the simultaneous occurrence of intrauterine and ectopic pregnancies (EP). The incidence of HPs occurring spontaneously ranges from 1 in 10,000 to 1 in 30,000. However, this incidence is reported to be 1 in 100 pregnancies following artificial reproductive techniques. HP is a potentially life-threatening condition that is frequently misdiagnosed, as most diagnoses for HPs are delayed, and are only made after rupture of the EP. A high index of suspicion is, therefore, required for an accurate and timely diagnosis in order to reduce maternal morbidity and mortality, which currently stands at 1 in 200,000 live births. The most common risk factors include pelvic inflammatory disease, previous EP, assisted reproduction techniques, and ovarian hyperstimulation syndrome. Transvaginal ultrasound is the gold standard for diagnosis. As detection of an intrauterine pregnancy often leads to the mistaken exclusion of a concomitant EP, a careful transvaginal scanning of the uterus and appendages should be performed in all females of reproductive age with a positive pregnancy test and red flags in anamnesis, and/or with clinical symptoms. Routine transvaginal ultrasound at Day 27 after embryo transfer could facilitate the diagnosis of HP; however, symptoms onset before or after Day 27 are clues to early diagnosis. MRI can be very helpful in diagnosing atypical cases.

Differences between sperm sharing and egg sharing are morally relevant

Sperm sharing arrangements involve a man (‘the sharer’) allowing his sperm to be used by people seeking donor sperm (‘the recipients’) in exchange for reduced price in vitro fertilisation. Clinics in the UK have offered egg sharing since the 1990s and the arrangement has been subjected to regulatory oversight and significant ethical analysis. By contrast, until now no published ethical or empirical research has analysed sperm sharing. Moreover the Human Fertilisation and Embryology Authority (HFEA) does not record the number of sperm sharing arrangements taking place.This paper describes the sperm sharing process providing an analysis of all the UK clinics advertising sperm sharing services. The ethical rationale for egg sharing is described: reducing the number of women exposed to the risks of stimulation and retrieval. This advantage is absent in sperm sharing where donation has no physical drawbacks. The key adverse social and emotional outcome of gamete sharing arises when the sharer’s own treatment is unsuccessful and the recipient’s is successful. This outcome is more likely in sperm sharing than in egg sharing given sperm from sharers can be used by up to 10 families whereas shared eggs only go to one other family.Given its morally relevant differences from egg sharing, sperm sharing requires its own ethical analysis. The HFEA should begin recording sperm sharing arrangements in order to enable meaningful ethical and policy scrutiny.

Communication Experiences of Pekanbaru City Patients Receiving In Vitro Fertilisation (IVF) Treatment in Malaysia Fertility Clinics

Doctor-patient communication is important in all medical consultations including for In Vitro Fertilisation (IVF) treatment. An unfavourable communication experience can cause a patient to stop taking the treatment, move to another local fertility clinic, or even seek treatment abroad. There are still few studies documenting communication experiences of patients with infertility seeking reproductive treatment in other countries. This study aimed to describe the communication experiences of Indonesian IVF patients receiving IVF treatment from medical practitioners in fertility clinics in Malaysia. This study used Benner's interpretive phenomenology framework in its approach and when analysing the results. Data collection was carried out using in-depth and semi-structured interviews with 11 IVF patients from Pekanbaru city Indonesia who received IVF treatment in fertility clinics in Malaysia. This study found three main themes shared by the IVF patients’ communication experiences: 1) memorable experiences (friendliness and caring, empathy, honesty and openness, clarity and adequacy of the information, and easiness of communication; 2) less memorable experiences (less interpersonal communication, less warm non-verbal communication, and miscommunication); and 3) communication barriers (English). These findings have important implications for both the prospective patients receiving cross-border fertility treatment in the future and for service providers providing fertility treatment to improve doctor-patient communication. Keywords: Health communication, doctor-patient communication, communication experience, infertility, cross-border reproductive care, in vitro fertilisation treatment.