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Assistive reproductive therapy

Salvatore Giovanni Vitale, Paola Rossetti, Francesco Corrado, Agnese Maria Chiara Rapisarda, Sandro La Vignera, Rosita Angela Condorelli, Gaetano Valenti, Fabrizio Sapia, Antonio Simone Laganà, Massimo Buscema
Assisted reproductive technologies (ART) have experienced growing interest from infertile patients seeking to become pregnant. The quality of oocytes plays a pivotal role in determining ART outcomes. Although many authors have studied how supplementation therapy may affect this important parameter for both in vivo and in vitro models, data are not yet robust enough to support firm conclusions. Regarding this last point, in this review our objective has been to evaluate the state of the art regarding supplementation with melatonin and myo-inositol in order to improve oocyte quality during ART...
2016: International Journal of Endocrinology
Constantinos Kanaris
In 2008 the Human Fertilisation and Embryology Act amendments made deliberately choosing to bring disability into the world, using assisted reproduction, a criminal offence. This paper considers whether the legal prohibition above, should influence other policy areas concerning the welfare of future children such as new possibilities presented by foetal surgery and in utero gene therapy. If we have legal duties to avoid disability in one context should this influence our avoidance of disability in this other context? This paper investigates whether the State might have a stake in wider promotion of practices to reduce the degree of disability in foetuses that will come to exist (as opposed to those that will be aborted)...
September 8, 2016: Medicine, Health Care, and Philosophy
Sarah A Robertson, Min Jin, Danqing Yu, Lachlan M Moldenhauer, Michael J Davies, M Louise Hull, Robert J Norman
There is ongoing interest in immune-suppressant corticosteroid drugs such as prednisolone to treat infertility in women with repeated IVF failure and recurrent miscarriage. The rationale draws on the pervasive but flawed view that immune activation is inconsistent with normal pregnancy. This ignores clear evidence that controlled inflammation and activation of the immune response is essential for embryo implantation. Generally, the immune response actively promotes reproductive success - by facilitating endometrial receptivity and tolerance of the foreign embryo, and promoting vascular adaptation to support placental morphogenesis...
October 2016: Human Reproduction
Vassilis Fragoulakis, Chris P Pescott, Jesper M J Smeenk, Evert J P van Santbrink, G Jur E Oosterhuis, Frank J M Broekmans, Nikos Maniadakis
BACKGROUND AND OBJECTIVE: Subfertility represents a multidimensional problem associated with significant distress and impaired social well-being. In the Netherlands, an estimated 50,000 couples visit their general practitioner and 30,000 couples seek medical specialist care for subfertility. We conducted an economic evaluation comparing recombinant human follicle-stimulating hormone (follitropin alfa, r-hFSH, Gonal-F(®)) with two classes of urinary gonadotrophins-highly purified human menopausal gonadotrophin (hp-HMG, Menopur(®)) and urinary follicle-stimulating hormone (uFSH, Fostimon(®))-for ovarian stimulation in women undergoing in vitro fertilization (IVF) treatment in the Netherlands...
August 31, 2016: Applied Health Economics and Health Policy
Koji Chiba, Masato Fujisawa
Varicoceles are a major cause of impaired spermatogenesis and the most common correctable cause of male infertility. They are found in approximately 40% of men with primary infertility and 80% of men with secondary infertility, although they also occur in 12% of men with normal semen parameters. The presence of a varicocele does not always affect spermatogenesis, as it has been reported that only 20% of men with documented varicoceles suffer fertility problems. However, varicocele repair appears to have beneficial effects in men with impaired semen parameters and palpable varicoceles...
August 2016: World Journal of Men's Health
T Totev, T Tihomirova, S Tomov, G Gorchev
Development of assisted reproductive technologies (ART) for treatment of infertility poses many questions about potential involvement of the drugs used in ART in the process of ovarian carcinogenesis. The presence of other etiological factors makes the assessment of risks implied by administering these drugs rather difficult. The results obtained in the study are controversial and inconclusive, yet theoretical and epidemiological data suggest that caution is needed in IVF patients, receiving such drug therapy...
2016: Akusherstvo i Ginekologii︠a︡
A-L Barbotin, C Ballot, J Sigala, M Leroy, J-M Rigot, D Dewailly, G Robin, V Mitchell
In the management of azoospermia, a combination of testicular sperm extraction and intracytoplasmic sperm injection (ICSI) is usually the most successful option for fatherhood. However, an outstanding question remains: How can at least a few spermatozoa be obtained from the ejaculate, thus avoiding the need for a surgical procedure? A 36-year-old man presented to Assisted Reproduction Unit with his 26-year-old wife. The ultrasound assessment revealed bilateral microlithiasis. Two spermograms revealed absolute azoospermia...
July 29, 2016: Andrologia
Michael Feichtinger, Kenny A Rodriguez-Wallberg
BACKGROUND: Although cancer in general affects an aged population, a significant number of women develop cancer at childbearing age. Long-term survival rates after gynecological cancer, especially in young patients are increasing and all quality-of-life aspects, including preservation of fertility have become of major relevance. OUTCOMES: Surgical techniques aimed at sparing reproductive organs and preserving fertility have been developed for women presenting with gynecological cancer found at early stages...
2016: Gynecologic Oncology Research and Practice
Andrea Garolla, Marco Ghezzi, Ilaria Cosci, Barbara Sartini, Alberto Bottacin, Bruno Engl, Andrea Di Nisio, Carlo Foresta
The purpose of this study is to evaluate whether follicle-stimulating hormone treatment improves sperm DNA parameters and pregnancy outcome in infertile male candidates to in-vitro fertilization.Observational study in 166 infertile male partners of couples undergoing in-vitro fertilization. Eighty-four patients were receiving follicle-stimulating hormone treatment (cases) and 82 refused treatment (controls). Semen parameters, sexual hormones, and sperm nucleus (fluorescence in-situ hybridization, acridine orange, TUNEL, and γH2AX) were evaluated at baseline (T0) and after 3 months (T1), when all subjects underwent assisted reproduction techniques...
July 27, 2016: Endocrine
L Andreoli, G K Bertsias, N Agmon-Levin, S Brown, R Cervera, N Costedoat-Chalumeau, A Doria, R Fischer-Betz, F Forger, M F Moraes-Fontes, M Khamashta, J King, A Lojacono, F Marchiori, P L Meroni, M Mosca, M Motta, M Ostensen, C Pamfil, L Raio, M Schneider, E Svenungsson, M Tektonidou, S Yavuz, D Boumpas, A Tincani
OBJECTIVES: Develop recommendations for women's health issues and family planning in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). METHODS: Systematic review of evidence followed by modified Delphi method to compile questions, elicit expert opinions and reach consensus. RESULTS: Family planning should be discussed as early as possible after diagnosis. Most women can have successful pregnancies and measures can be taken to reduce the risks of adverse maternal or fetal outcomes...
July 25, 2016: Annals of the Rheumatic Diseases
Herman Tournaye, Csilla Krausz, Robert D Oates
An accurate medical history and directed physical examination are essential in diagnosis of male infertility. We review the hormonal assessments and specific genetic analyses that are useful additional tests, and detail other evidence-based examinations that are available to help guide therapeutic strategies. By contrast with female infertility treatments-especially hormonal manipulations to stimulate or enhance oocyte production-spermatogenesis and sperm quality abnormalities are much more difficult to affect positively...
July 6, 2016: Lancet Diabetes & Endocrinology
Sheridan M Hoy
The subcutaneous recombinant human follicle-stimulating hormone XM17 follitropin alfa (Ovaleap(®)) is approved in the EU as a biosimilar of follitropin alfa (Gonal-f(®)) for use in all indications for which the reference product is approved, including as a multifollicular stimulant in women undergoing superovulation for assisted reproductive technology (ART) treatment. In a nonblind, phase I study in healthy female volunteers, the pharmacokinetic profile of XM17 follitropin alfa was bioequivalent to that of reference follitropin alfa following single dosing...
August 2016: BioDrugs: Clinical Immunotherapeutics, Biopharmaceuticals and Gene Therapy
Devina K S McCray, Ashley B Simpson, Rebecca Flyckt, Yitian Liu, Colin O'Rourke, Joseph P Crowe, Stephen R Grobmyer, Halle C Moore, Stephanie A Valente
BACKGROUND: Breast cancer is the most frequently occurring cancer in women of reproductive age, and systemic treatments may adversely affect childbearing plans. Use of assisted reproductive technologies and therapies for ovarian protection improve fertility prospects. We evaluated whether patients had a documented fertility discussion (FD) with their oncology physician prior to therapy, what options were chosen, and if pregnancy was achieved. METHODS: A retrospective chart review from 2006 to 2014 was performed to evaluate women aged 40 years and younger who were diagnosed with breast cancer and treated with chemotherapy and/or antihormonal therapy...
October 2016: Annals of Surgical Oncology
Michelle Fabian
PURPOSE OF REVIEW: This article provides a review of the available data on reproductive issues that arise in patients with multiple sclerosis (MS). RECENT FINDINGS: Recent findings have replicated earlier findings that pregnancy and possibly breast-feeding bring about a favorable immunomodulatory effect in patients with MS. Use of disease-modifying therapies prior to pregnancy may further decrease a patient's risk for postpartum disease activity. SUMMARY: The annualized relapse rate in MS decreases during pregnancy, with a nadir in the third trimester, and rebounds significantly in the 3-month postpartum period...
August 2016: Continuum: Lifelong Learning in Neurology
David Mark Robertson, Robert B Gilchrist, William Leigh Ledger, Angela Baerwald
There is a need to develop rapid protocols for ovarian stimulation for women who wish to preserve their fertility following diagnosis of cancer. Conventional gonadotropin stimulation protocols are lengthy and are delayed until the start of the next menstrual period, potentially compromising cancer treatments. The development of random start IVF/in vitro maturation has made significant strides for enabling couples undergoing cancer therapy to achieve a family. However, several unanswered questions still remain...
June 2016: Women's Health
Claire Villette, Antoine Bourret, Pietro Santulli, Vanessa Gayet, Charles Chapron, Dominique de Ziegler
OBJECTIVE: To study possible associations among endometriosis, pelvic infectious disease, and ART. DESIGN: Retrospective cohort analysis over 4 consecutive years, based on medical records and insurance coding in a tertiary endometriosis reference center. SETTING: Tertiary university-based reference center for endometriosis. PATIENT(S): We retrieved all charts carrying the diagnoses infectious process and endometriosis in 2009-2012...
August 2016: Fertility and Sterility
Andrea Bähr, Tobias Käser, Elisabeth Kemter, Wilhelm Gerner, Mayuko Kurome, Wiebke Baars, Nadja Herbach, Kirsti Witter, Annegret Wünsch, Stephanie C Talker, Barbara Kessler, Hiroshi Nagashima, Armin Saalmüller, Reinhard Schwinzer, Eckhard Wolf, Nikolai Klymiuk
We have successfully established and characterized a genetically modified pig line with ubiquitous expression of LEA29Y, a human CTLA4-Ig derivate. LEA29Y binds human B7.1/CD80 and B7.2/CD86 with high affinity and is thus a potent inhibitor of T cell co-stimulation via this pathway. We have characterized the expression pattern and the biological function of the transgene as well as its impact on the porcine immune system and have evaluated the potential of these transgenic pigs to propagate via assisted breeding methods...
2016: PloS One
Cheryce L Harrison, Wendy J Brown, Melanie Hayman, Lisa J Moran, Leanne M Redman
The rise in obesity and associated morbidity is currently one of our greatest public health challenges. Women represent a high risk group for weight gain with associated metabolic, cardiovascular, reproductive and psychological health impacts. Regular physical activity is fundamental for health and well-being with protective benefits across the spectrum of women's health. Preconception, pregnancy and the early postpartum period represent opportune windows to engage women in regular physical activity to optimize health and prevent weight gain with added potential to transfer behavior change more broadly to children and families...
March 2016: Seminars in Reproductive Medicine
Erik Malmqvist
The idea of paying donors in order to make more human bodily material available for therapy, assisted reproduction, and biomedical research is notoriously controversial. However, while national and international donation policies largely oppose financial incentives they do not treat all parts of the body equally: incentives are allowed in connection to the provision of some parts but not others. Taking off from this observation, I discuss whether body parts differ as regards the ethical legitimacy of incentives and, if so, why...
September 2016: Medicine, Health Care, and Philosophy
Nalini Mahajan, S Sharma
A thin endometrium is encountered infrequently (2.4%) in assisted reproductive technology cycles. When it does occur it is a cause of concern as it is associated with lower implantation rate and pregnancy rate. Though pregnancies have been reported at 4 and 5 mm it is apparent that an endometrial thickness <6 mm is associated with a trend toward lower probability of pregnancy. Hormone replacement therapy - frozen embryo transfer (FET) cycles appear to give better results due to an improvement in endometrial receptivity (ER)...
January 2016: Journal of Human Reproductive Sciences
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