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Journal of Assisted Reproduction and... Mar 2024This work aimed to study clinical and neonatal outcomes of embryos derived from frozen compared to fresh donor oocytes in gestational carrier cycles.
Similar pregnancy outcomes from fresh and frozen donor oocytes transferred to gestational carriers: a SART database analysis isolating the effects of oocyte vitrification.
PURPOSE
This work aimed to study clinical and neonatal outcomes of embryos derived from frozen compared to fresh donor oocytes in gestational carrier cycles.
METHODS
This is a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database between 2014 and 2015, comprising of 1284 fresh transfer cycles to gestational carrier recipients of embryos resulting from fresh (n = 1119) and vitrified/thawed (n = 165) donor oocytes. Models were adjusted for gestational carrier age, preimplantation genetic testing (PGT-A), number of embryos transferred, multiple gestation, and fetal heart reduction. As our models were part of a larger analysis, intended parent BMI, smoking status, and parity were also adjusted for, but did not influence outcomes in this analysis.
RESULTS
There was no significant difference in probability of live birth rates when comparing embryos derived from fresh and frozen donor oocytes in gestational carrier cycles. There were also no significant differences in biochemical pregnancy losses or clinical miscarriage. There were no significant differences noted in low birthweight or high birthweight infants derived from fresh versus frozen donor oocyte after transfer into a gestational carrier.
CONCLUSIONS
The analysis of fresh and frozen donor oocytes in gestational carrier cycles provides the opportunity to assess for a possible effect of vitrification on the oocyte by controlling for differences in the uterine environment. We observed no significant differences in live birth, pregnancy loss, low birthweight or high birthweight infants when comparing fresh and frozen donor oocytes in gestational carrier cycles.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Vitrification; Surrogate Mothers; Birth Weight; Retrospective Studies; Embryo Transfer; Cryopreservation; Abortion, Spontaneous; Oocytes; Pregnancy Rate
PubMed: 38200285
DOI: 10.1007/s10815-023-03016-2 -
PLoS Neglected Tropical Diseases Jan 2024Proper evaluation of therapeutic responses in Chagas disease is hampered by the prolonged persistence of antibodies to Trypanosoma cruzi measured by conventional...
BACKGROUND
Proper evaluation of therapeutic responses in Chagas disease is hampered by the prolonged persistence of antibodies to Trypanosoma cruzi measured by conventional serological tests and by the lack of sensitivity of parasitological tests. Previous studies indicated that tGPI-mucins, an α-Gal (α-d-Galp(1→3)-β-d-Galp(1→4)-d-GlcNAc)-rich fraction obtained from T. cruzi trypomastigotes surface coat, elicit a strong and protective antibody response in infected individuals, which disappears soon after successful treatment. The cost and technical difficulties associated with tGPI-mucins preparation, however, preclude its routine implementation in clinical settings.
METHODS/PRINCIPLE FINDINGS
We herein developed a neoglycoprotein consisting of a BSA scaffold decorated with several units of a synthetic α-Gal antigenic surrogate (α-d-Galp(1→3)-β-d-Galp(1→4)-β-d-Glcp). Serological responses to this reagent, termed NGP-Tri, were monitored by means of an in-house enzyme-linked immunosorbent assay (α-Gal-ELISA) in a cohort of 82 T. cruzi-infected and Benznidazole- or Nifurtimox-treated children (3 days to 16 years-old). This cohort was split into 3 groups based on the age of patients at the time of treatment initiation: Group 1 comprised 24 babies (3 days to 5 months-old; median = 26 days-old), Group 2 comprised 31 children (7 months to 3 years-old; median = 1.0-year-old) and Group 3 comprised 26 patients (3 to 16 years-old; median = 8.4 years-old). A second, control cohort (Group 4) included 39 non-infected infants (3 days to 5 months-old; median = 31 days-old) born to T. cruzi-infected mothers. Despite its suboptimal seroprevalence (58.4%), α-Gal-ELISA yielded shorter median time values of negativization (23 months [IC 95% 7 to 36 months] vs 60 months [IC 95% 15 to 83 months]; p = 0.0016) and higher rate of patient negative seroconversion (89.2% vs 43.2%, p < 0.005) as compared to conventional serological methods. The same effect was verified for every Group, when analyzed separately. Most remarkably, 14 out of 24 (58.3%) patients from Group 3 achieved negative seroconversion for α-Gal-ELISA while none of them were able to negativize for conventional serology. Detailed analysis of patients showing unconventional serological responses suggested that, in addition to providing a novel tool to shorten follow-up periods after chemotherapy, the α-Gal-ELISA may assist in other diagnostic needs in pediatric Chagas disease.
CONCLUSIONS/SIGNIFICANCE
The tools evaluated here provide the cornerstone for the development of an efficacious, reliable, and straightforward post-therapeutic marker for pediatric Chagas disease.
Topics: Infant; Female; Humans; Child; Infant, Newborn; Child, Preschool; Adolescent; Trypanosoma cruzi; Retrospective Studies; Seroepidemiologic Studies; Chagas Disease; Enzyme-Linked Immunosorbent Assay; Mucins; Biomarkers; Antibodies, Protozoan
PubMed: 38236916
DOI: 10.1371/journal.pntd.0011910 -
Culture, Health & Sexuality Jun 2024Building on existing scholarship examining how audiences interpret reproductive experiences on film and television, we investigate how viewers make meaning of...
Building on existing scholarship examining how audiences interpret reproductive experiences on film and television, we investigate how viewers make meaning of representations of motherhood, abortion, adoption, and surrogacy on the Hulu television miniseries . We recruited twenty-one participants to watch the series and conducted three virtual focus groups of seven women each. Based on the racial identities of the main characters in the series, we segmented these groups by race: one group each of white women, Black women, and Chinese American women. Focus groups were facilitated by moderators who matched the racial and ethnic backgrounds of each group. We asked participants about their overall reactions to the series, their impressions of various characters, and each reproductive health plotline. Participants expressed both tender and critical reactions to characters who endured motherhood, surrogacy and adoption, yet most participants were overtly critical of Lexie, the character who obtained an abortion. We argue that this is likely because the character of Lexie is written as largely unsympathetic, leaving audiences with little opportunity to form a parasocial relationship with her. We discuss the implications of this for cultural conversations and understandings of abortion more broadly.
Topics: Humans; Female; Adult; Abortion, Induced; Focus Groups; Adoption; Surrogate Mothers; United States; Television; Pregnancy; Young Adult
PubMed: 37548147
DOI: 10.1080/13691058.2023.2242436 -
Journal of Viral Hepatitis Jan 2024Pregnant mothers with chronic hepatitis B infection (CHB) need peri-partum antiviral prophylaxis (PAP) to reduce the risk of mother-to-child-transmission. Currently, PAP...
Pregnant mothers with chronic hepatitis B infection (CHB) need peri-partum antiviral prophylaxis (PAP) to reduce the risk of mother-to-child-transmission. Currently, PAP is recommended in those with high viral load (VL) that is, HBV DNA >200,000 IU/mL. Quantitative hepatitis B surface antigen (qHBsAg) >10,000 IU/mL, a cut-off derived primarily from hepatitis B e-antigen (HBeAg) positive antenatal cohorts in Chinese populations, is advocated as a surrogate marker of VL for guiding PAP. We investigated the utility of qHBsAg to predict high-VL in a multi-ethnic urban cohort with CHB. A consecutive cohort of women with CHB was identified from Barts Health NHS Trust databases in the United Kingdom. We included women with paired HBV DNA and qHBsAg during pregnancy. Women already on antiviral at conception were excluded. A total of 769 pregnancies in 678 CHB pregnant mothers (median age 31 years-old, 8.6% HBeAg+) were included. At median gestational age of 15.3 weeks, HBV DNA was 336 (IQR 44-2998) IU/mL, with 65 (8.5%) being high-VL. Serum qHBsAg was most useful in Black/Black-British/Caribbean/African (AUROC 0.946) with 100% sensitivity and 80.6% specificity to predict high-VL; but it performed less well for other ethnicities: Asian (AUROC 0.877), White (AUROC 0.797) and mixed ethnicities (AUROC 0.742). In conclusion, for settings where healthcare resources are not limited, HBV DNA remains the optimal marker to identify highly viraemic pregnancies for guiding PAP. For resource-limited settings where the prevailing cost is treatment, serum qHBsAg can be used in Black/Black British/Caribbean/African sub-cohorts, but not for other ethnicities.
Topics: Female; Humans; Pregnancy; Adult; Infant; Hepatitis B virus; Hepatitis B Surface Antigens; Hepatitis B e Antigens; DNA, Viral; Infectious Disease Transmission, Vertical; Hepatitis B, Chronic; Hepatitis B; Antiviral Agents
PubMed: 37881873
DOI: 10.1111/jvh.13893 -
Fertility and Sterility Oct 2023Physicians involved in third-party assisted reproductive technology arrangements who discover material misconduct or other undisclosed information by a party to the...
Physicians involved in third-party assisted reproductive technology arrangements who discover material misconduct or other undisclosed information by a party to the arrangement (such as a gamete or embryo donor, gestational carrier, or intended parent) or by a nonmedical professional participant or entity (such as a recruiting program, gamete or embryo bank, or lawyer) should encourage that party or professional participant to disclose such misconduct or information. In some instances, it is ethically permissible for the physician to either disclose material information to the affected party or to decline to provide or continue to provide care. In all cases involving the legal status or rights of the parties, physicians should recommend that patients seek independent legal professional advice. This document replaces the document "Misconduct in third-party assisted reproduction," last published in 2018. The use of a physician's own gametes for the purpose of reproduction without the informed consent of the recipient(s) is unethical and illegal, as well as never permissible.
Topics: Humans; Female; Pregnancy; Embryo, Mammalian; Ethics Committees; Germ Cells; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 37656092
DOI: 10.1016/j.fertnstert.2023.07.002 -
Medical Law Review Feb 2024For the court to grant a parental order recognising intended parents as legal parents of a surrogate-born child, the gametes of at least one of the intended parents must...
For the court to grant a parental order recognising intended parents as legal parents of a surrogate-born child, the gametes of at least one of the intended parents must have been used to create the embryo, under section 54(1)(b) and section 54A(1)(b) Human Fertilisation and Embryology Act 2008. In the Law Commission and Scottish Law Commission's consultation paper, there was a provisional proposal to remove the genetic link requirement in cases of medical necessity. However, this proposal was not included in the Law Commissions' Final Report, instead recommending the retention of the requirement for a genetic link in almost all circumstances. This article contends that the Law Commissions' recommendation should be reconsidered in light of the child's right to identity. By reviewing how identity has been used by the courts when determining whether to grant a parental order, as well as a developing interpretation of Article 8 of the United Nations Convention on the Rights of the Child and European Convention on Human Rights, it can be asserted that the identity of surrogate-born children necessitates recognition of the relationship between the child and intended parent(s), irrespective of a genetic link. On this basis, it is argued that there should be the possibility for intended parents to establish legal parenthood following surrogacy without the requirement for a genetic link.
Topics: Child; Humans; Female; Pregnancy; Parents; Human Rights; Surrogate Mothers
PubMed: 37717271
DOI: 10.1093/medlaw/fwad032