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Human Fertility (Cambridge, England) Jun 2015Islam acknowledges that infertility is a significant hardship. Attempts to cure infertility are not only permissible, but also encouraged in Islam. Over the last three... (Review)
Review
BACKGROUND
Islam acknowledges that infertility is a significant hardship. Attempts to cure infertility are not only permissible, but also encouraged in Islam. Over the last three decades, a multitude of advances in assisted reproductive technologies (ARTs) have appeared. This review was carried out to inform readers, who are not familiar with Islamic doctrine, about the Sunni perspective on this topic.
STUDY DESIGN
Systematic review of the literature.
METHOD
A series of searches was conducted of Medline databases published in English between January 1978 and December 2013 with the following
KEYWORDS
assisted reproduction, infertility, gender selection, ethics, bioethics, and Islam.
RESULTS
In Islamic Sunni law, all ARTs are allowed, provided that the source of the sperm, ovum, and uterus comes from a legally married couple during the span of their marriage. All forms of surrogacy are forbidden. A third-party donor is not allowed, whether he or she is providing sperm, eggs, embryos, or a uterus. Frozen preimplantation may be transferred to the wife in a successive cycle provided the marital bondage is not absolved by death or divorce. Gender selection for medical reasons is permitted. It is allowed for limited social reasons by some jurists, provided it does not involve discrimination against either sex.
CONCLUSIONS
ART is acceptable and commendable in Islamic Sunni law provided it is practiced within the husband and wife dyad during the span of their marital contract. No third party should intrude upon the marital function of procreation. Surrogacy is not accepted by Sunni Islamic authorities.
Topics: Cryopreservation; Humans; Infertility; Islam; Marriage; Reproductive Techniques, Assisted
PubMed: 25660098
DOI: 10.3109/14647273.2014.997810 -
Human Reproduction Update Apr 2021IVM was implemented in medically assisted reproduction 25 years ago. IVM does not involve controlled ovarian stimulation (COS) and is mainly indicated in patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
IVM was implemented in medically assisted reproduction 25 years ago. IVM does not involve controlled ovarian stimulation (COS) and is mainly indicated in patients with a high risk of ovarian hyperstimulation syndrome, in particular in patients with polycystic ovary syndrome (PCOS); it is also an acknowledged option in fertility protection. However, the in-vitro culture of immature oocytes raises concerns over their developmental potential and the putative impact on children's health. Although an increasing number of studies on obstetric and neonatal outcomes of IVM children and their development have been published in recent years, study designs are difficult to compare, since IVM is used in women with various indications and IVM protocols do not follow the same standards.
OBJECTIVE AND RATIONALE
The aim of this systematic review was to evaluate the current evidence from IVM children of an impact of in-vitro culture of immature oocytes. Primary outcome parameters were birthweight and children's development up to the age of 2 years. We also compared pregnancy pathologies and the outcome of IVM children and COS children in relation to maternal indications, in particular PCOS, and to the type of IVM protocols with or without ovulation trigger as the secondary outcome parameters. IVM is an accepted clinical option for many centres; however, a comprehensive analysis of the available data is needed to establish whether the use of human oocytes that are fully matured in vitro is safe for both children and their mothers.
SEARCH METHODS
Google Scholar and PubMed were used for identifying peer-reviewed original articles and reviews through January 2020. A total of 191 studies were screened and 16 studies were included in the qualitative synthesis. Studies were stratified according to indications, the use of an ovulation trigger and multiplicity.
OUTCOMES
Birthweights of IVM singletons and multiples were comparable to their respective COS controls: birthweights were also similar if the analysis was restricted to mothers with PCOS. IVM children had a comparable birthweight to COS children, irrespective of whether an ovulation trigger was used in IVM cycles or not. The frequency of gestational diabetes (GD) in singleton pregnancies was comparable between IVM and COS, regardless of infertility background. There was also no difference in GD frequency between IVM and COS, if an hCG ovulation trigger in IVM cycles was used or not. Hypertensive disorders in singleton pregnancies of women with PCOS were significantly more frequent after IVM compared to COS, in particular if IVM cycles were performed only with in-vitro matured oocytes. There was no difference in the preterm birth rate of singleton pregnancies between IVM and COS. Preterm birth rates were still similar if only women diagnosed with PCOS were compared and whether an ovulation trigger in IVM was used or not. The malformation rate in IVM children did not differ in COS children versus children after natural conception. At the age of 2 years, IVM singletons showed similar anthropometric and mental development compared to COS children or children from natural conception.
WIDER IMPLICATIONS
The higher incidence of hypertensive disorders in IVM pregnancies needs monitoring during pregnancy. Current data on the development of IVM children are encouraging, although the quality of many studies is limited and long-term data beyond 2 years are scarce. Further studies should be based on generally accepted IVM protocols. Studies on long-term outcomes beyond 2 years are needed to search for potential long-time sequelae of IVM.
Topics: Child, Preschool; Female; Humans; Infant, Newborn; Oocytes; Ovulation; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Premature Birth
PubMed: 33377477
DOI: 10.1093/humupd/dmaa056 -
Journal of Assisted Reproduction and... Mar 2023While delayed parenthood is increasing worldwide, the effect of paternal age on in vitro fertilization (IVF) outcomes remains unclear. The egg donation model appears to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
While delayed parenthood is increasing worldwide, the effect of paternal age on in vitro fertilization (IVF) outcomes remains unclear. The egg donation model appears to be relevant to studying the independent impact of paternal age on clinical outcome, but the available studies are heterogeneous and contradictory. This systematic review and meta-analysis aimed to assess the relationship between paternal age and live birth rate (LBR) in egg donation cycles.
METHODS
A systematic search of the literature was conducted in PubMed, Embase, and the Cochrane Library from inception to June 30, 2021. All studies on egg donation cycles where LBR is reported according to male age were included. Study selection, bias assessment, and data extraction were performed by two independent reviewers according to the Cochrane methods.
RESULTS
Eleven studies involving 10,527 egg donation cycles were finally included. The meta-analysis showed a slight but significant and linear decrease in LBR with increasing paternal age (estimate - 0.0055; 95% CI (- 0.0093; - 0.0016), p = 0.006), with low heterogeneity (I = 25%). No specific threshold was identified. A similar trend toward decreased clinical pregnancy rate with advancing paternal age was found but did not reach statistical significance (p = 0.07).
CONCLUSION
This meta-analysis demonstrates that increasing paternal age is associated with a slight but significant and linear decrease in the live birth rate in egg donation cycles, with no apparent threshold effect. Although this requires further confirmation, this information is important for counseling men who are considering delayed childbearing.
Topics: Pregnancy; Female; Male; Humans; Birth Rate; Paternal Age; Pregnancy Rate; Fertilization in Vitro; Oocytes; Live Birth; Retrospective Studies; Oocyte Donation
PubMed: 36652117
DOI: 10.1007/s10815-023-02714-1 -
Human Reproduction (Oxford, England) Jun 2022Does the addition of hyaluronic acid (HA) to embryo transfer medium improve pregnancy outcomes in both autologous and oocyte donation IVF cycles? (Meta-Analysis)
Meta-Analysis
STUDY QUESTION
Does the addition of hyaluronic acid (HA) to embryo transfer medium improve pregnancy outcomes in both autologous and oocyte donation IVF cycles?
SUMMARY ANSWER
The best available evidence indicates that the addition of HA to embryo transfer medium is clinically beneficial in cycles with autologous oocytes.
WHAT IS KNOWN ALREADY
There is a known clinical benefit of HA addition to embryo transfer media but it is not known if HA affects donor and autologous oocyte cycles differently.
STUDY DESIGN, SIZE, DURATION
A systematic review with meta-analysis was performed. The Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL via Cochrane Register of Studies Online (CRSO), MEDLINE, Embase and PsycINFO electronic databases (until 8 January 2020) were searched for randomized controlled trials (RCTs) examining the effect of HA in embryo transfer medium on pregnancy outcomes.
PARTICIPANTS/MATERIALS, SETTING, METHODS
RCTs with separate donor and autologous oocyte data that compared embryo transfer medium with functional HA concentrations (0.5 mg/ml) to those containing no or low HA concentrations (0.125 mg/ml) were included. Two review authors independently selected trials for inclusion, extracted data and assessed the included studies using the Cochrane risk of bias assessment tool. Pooled risk ratios and 95% CIs were calculated. A summary of findings table was generated using Grading of Recommendations, Assessment, Development and Evaluation criteria. Judgements about evidence quality were justified and incorporated into the reported results for each outcome.
MAIN RESULTS AND THE ROLE OF CHANCE
Fifteen studies, totalling 4686 participants, were analysed. In autologous oocyte cycles, live birth increased from 32% to 39% when embryo transfer media contained functional HA concentrations (risk ratio (RR) 1.22, 95% CI 1.11-1.34; nine studies, 3215 participants, I2 = 39%, moderate-quality evidence (number needed to treat (NNT) 14). HA-enriched media increased clinical pregnancy and multiple pregnancy rates by 5% and 8%, respectively (RR 1.11, 95% CI 1.04-1.18; 13 studies, 4014 participants, I2 = 0%, moderate-quality evidence, NNT 21) and (RR 1.49, 95% CI 1.27-1.76; 5 studies, 2400 participants, I2 = 21%, moderate-quality evidence, number needed to harm 13). Conversely, in donor oocyte cycles, HA addition showed little effect on live birth and clinical pregnancy (RR 1.12 95% CI 0.86-1.44; two studies, 317 participants, I2 = 50%, low-quality evidence) and (RR 1.06, 95% CI 0.97-1.28; three studies, 351 participants, I2 = 23%, low-quality evidence). There was insufficient available information on multiple pregnancy in donor oocyte cycles and on total adverse effects in both groups to draw conclusions.
LIMITATIONS, REASONS FOR CAUTION
There were limited studies with separate data on donor oocyte cycles and limited information on oocyte quality. Additionally, one-third of the included studies did not include the main outcome, live birth rate.
WIDER IMPLICATIONS OF THE FINDINGS
There is a moderate level of evidence to suggest that functional HA concentration in embryo transfer medium increases clinical pregnancy, live birth and multiple pregnancy rates in IVF cycles using autologous oocytes. This effect was not seen in donor oocyte cycles, indicating either intrinsic differences between donor and autologous oocytes or lack of statistical power. The combination of HA addition to transfer media in cycles using autologous oocytes and a single embryo transfer policy might yield the best combination, with higher clinical pregnancy and live birth rates without increasing the chance of multiple pregnancies.
STUDY FUNDING/COMPETING INTEREST(S)
No financial assistance was received. The authors have no competing interests.
REGISTRATION NUMBER
N/A.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Hyaluronic Acid; Live Birth; Oocytes; Pregnancy; Pregnancy Rate
PubMed: 35595183
DOI: 10.1093/humrep/deac097 -
Reproductive Biomedicine Online Feb 2022The preservation of fertility in women of childbearing age with breast cancer is challenging because the time for ovarian stimulation is restricted and only a limited... (Meta-Analysis)
Meta-Analysis Review
The preservation of fertility in women of childbearing age with breast cancer is challenging because the time for ovarian stimulation is restricted and only a limited number of oocytes can be retrieved before gonadotoxic therapies. The aim of this meta-analysis was to evaluate the fertility preservation outcomes after ovarian stimulation with various protocols in women with breast cancer. PubMed, Embase and the Cochrane Library were searched. Twenty-two studies comparing the outcomes of women with breast cancer receiving random-start ovarian stimulation or conventional protocol; single or double ovarian stimulation cycles; and coadministration of aromatase inhibitors or tamoxifen were included. Random-start ovarian stimulation resulted in a comparable number of retrieved oocytes to the conventional protocol. Two ovarian stimulation cycles had significantly higher numbers of total retrieved oocytes than one cycle (mean difference 7.91, 95% confidence interval [CI] 3.42 to 12.40). Coadministration of letrozole and tamoxifen showed similar results for retrieved oocytes to those without. A significantly lower peak serum oestradiol concentration was observed in letrozole-based groups than in letrozole-free groups (mean difference -1.22; 95% CI -1.42 to -1.02). In conclusion, this study indicated that implementing random-start protocols to shorten the duration of waiting for ovarian stimulation, applying two ovarian stimulation cycles, and coadministration of letrozole can lead to more desirable outcomes.
Topics: Breast Neoplasms; Cryopreservation; Female; Fertility Preservation; Humans; Letrozole; Oocytes; Ovulation Induction; Tamoxifen
PubMed: 34656436
DOI: 10.1016/j.rbmo.2021.08.003 -
The Journal of International Medical... Apr 2014To investigate the effect of recombinant human luteinizing hormone supplementation (rLH priming) during the early follicular phase on in vitro fertilization (IVF) and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To investigate the effect of recombinant human luteinizing hormone supplementation (rLH priming) during the early follicular phase on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes.
METHODS
In order to evaluate available evidence regarding the efficacy of rLH priming in IVF/ICSI procedures, a systematic review and meta-analysis was preformed. Searches were conducted on MEDLINE®, EMBASE and the Cochrane Database of Clinical Trials without language limitation, but were restricted to randomized controlled trials (RCTs).
RESULTS
Three RCTs including 346 patients were included in this meta-analysis, which demonstrated that rLH priming did not increase ongoing pregnancy rate. Although less recombinant follicle-stimulating hormone (rFSH) was required and the oestradiol level was higher on the day of human chorionic gonadotropin administration in the rLH priming group, the numbers of oocytes retrieved and embryos produced were comparable between patients treated with rLH priming and those treated with rFSH alone.
CONCLUSIONS
This systematic review and meta-analysis has demonstrated that at present there is insufficient evidence that patients undergoing IVF/ICSI may benefit from rLH priming during the early follicular phase.
Topics: Chorionic Gonadotropin; Estradiol; Female; Follicle Stimulating Hormone; Follicular Phase; Humans; Luteinizing Hormone; Oocytes; Ovulation Induction; Pregnancy; Pregnancy Rate; Recombinant Proteins; Sperm Injections, Intracytoplasmic
PubMed: 24595152
DOI: 10.1177/0300060513509044 -
Human Reproduction Update 2010Various models have been developed for the prediction of pregnancy after in vitro fertilization (IVF). These models differ from one another in the predictors they... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Various models have been developed for the prediction of pregnancy after in vitro fertilization (IVF). These models differ from one another in the predictors they include. We performed a systematic review and meta-analysis to identify the most relevant predictors for success in IVF.
METHODS
We systematically searched MEDLINE and EMBASE for studies evaluating IVF/ICSI outcome. Studies were included if they reported an unconditional odds ratio (OR) or whenever one could be calculated for one or more of the following factors: age, type of infertility, indication, duration of infertility, basal FSH, number of oocytes, fertilization method, number of embryos transferred and embryo quality.
RESULTS
Fourteen studies were identified. A summary OR could be calculated for five factors. We found negative associations between pregnancy and female age [OR: 0.95, 95% confidence interval (CI): 0.94-0.96], duration of subfertility (OR: 0.99, 95% CI: 0.98-1.00) and basal FSH (OR: 0.94, 95% CI: 0.88-1.00). We found a positive association with number of oocytes (OR 1.04, 95% CI: 1.02-1.07). Better embryo quality was associated with higher pregnancy chances. No significant association was found for the type of infertility and fertilization method. A summary OR for IVF indication and number of embryos transferred could not be calculated, because studies reporting on these used different reference categories.
CONCLUSIONS
Female age, duration of subfertility, bFSH and number of oocytes, all reflecting ovarian function, are predictors of pregnancy after IVF. Better quality studies are necessary, especially studies that focus on embryo factors that are predictive of success in IVF.
Topics: Adult; Age Factors; Embryo Transfer; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Middle Aged; Oocytes; Time Factors; Treatment Outcome
PubMed: 20581128
DOI: 10.1093/humupd/dmq015 -
Fertility and Sterility Aug 2010To determine whether a policy of elective single-embryo transfer (e-SET) lowers the multiple birth rate without compromising the live birth rate. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine whether a policy of elective single-embryo transfer (e-SET) lowers the multiple birth rate without compromising the live birth rate.
DESIGN
Systematic review and meta-analysis.
SETTING
Tertiary referral center for reproductive medicine and IVF unit.
PATIENT(S)
None.
INTERVENTION(S)
Searches of the Cochrane Controlled Trials Register, Meta-register for Randomized Controlled Trials (RCTs), EMBASE, MEDLINE, and SCISEARCH with no limitation on language and publication year, 1974 to 2008.
SELECTION CRITERIA
randomized, controlled trials comparing e-SET with double-embryo transfer (DET) for live birth and multiple birth rates after in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI). Nonrandomized trials and studies that included only patients who had blastocyst transfer were excluded.
MAIN OUTCOME MEASURE(S)
The likelihood of live birth per patient and multiple birth per total number of live births. Other outcomes included implantation rate, pregnancy rate, miscarriage and ectopic pregnancy rates, clinical pregnancy rate, ongoing pregnancy rate per patient, and preterm delivery rate per live birth.
RESULT(S)
Six trials (n=1354 patients) were included in the meta-analysis. Compared with DET, the e-SET policy was associated with a statistically significant reduction in the probability of live birth (RR 0.62; 95% CI, 0.53-0.72) and multiple birth (RR 0.06; 95% CI, 0.02-0.18).
CONCLUSION(S)
Elective-SET of embryos at the cleavage stage reduces the likelihood of live birth by 38% and multiple birth by 94%. Evidence from randomized, controlled trials suggests that increasing the number of e-SET attempts (fresh and/or frozen) results in a cumulative live birth rate similar to that of DET. Offering subfertile women three cycles of IVF will have a major impact on the uptake of an e-SET policy.
Topics: Cleavage Stage, Ovum; Embryo Transfer; Female; Humans; Infant, Newborn; Likelihood Functions; Live Birth; Pregnancy; Pregnancy Rate; Pregnancy, Multiple; Single Embryo Transfer; Treatment Outcome
PubMed: 19446809
DOI: 10.1016/j.fertnstert.2009.04.003 -
Reproductive Biomedicine Online Nov 2019This systematic review and meta-analysis determined the association between aspirated after ovarian stimulation and top/good quality embryos obtained in women undergoing... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis determined the association between aspirated after ovarian stimulation and top/good quality embryos obtained in women undergoing ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI). MEDLINE, EMBASE, Scopus, CINAHL and Web of Science were searched for English-language publications on top/good-quality embryos at cleavage (day 2/3) and/or blastocyst (day 5/6) developmental stages, up to 18 November 2017. Twenty-eight studies (three prospective and 25 retrospective) reporting data on 291,752 assisted reproductive technology (ART) cycles were considered eligible. We confirmed a strong positive association between oocytes retrieved and top/good-quality day 2/3 embryos (weighted correlation coefficient [r] = 0.791), day 5/6 embryos (r = 0.901), metaphase II oocytes (r = 0.988), oocytes exhibiting two pronuclei (r = 0.987) and euploid embryos (r = 0.851); P < 0.001 for all correlations (evaluated in subsets of the 17 studies). Data from 5657 cycles showed that the group with the most oocytes aspirated had the most top/good-quality day 2/3 embryos (pooled standardized mean differences (high [>15] versus low [<4] 1.91, 95% confidence interval [CI] 1.05-2.77, P < 0.0001; high versus medium [4-15] 1.15, 95% CI 0.74-1.55, P < 0.0001; medium versus low 1.41, 95% CI 0.79-2.03, P < 0.0001). Individual participant meta-analysis would enable accurate determination of these associations and other outcomes.
Topics: Blastocyst; Embryo Transfer; Female; Fertilization; Humans; Male; Oocytes; Ovulation Induction; Prospective Studies; Regression Analysis; Reproductive Techniques, Assisted; Retrospective Studies; Risk; Sperm Injections, Intracytoplasmic; Spermatozoa; Treatment Outcome
PubMed: 31540848
DOI: 10.1016/j.rbmo.2019.06.013 -
Tropical Animal Health and Production Jul 2023The inclusion of Moringa oleifera leaf meal (MLM) in chicken diets especially in developing countries is on the increase due to scarcity of traditional feedstuffs.... (Meta-Analysis)
Meta-Analysis Review
The inclusion of Moringa oleifera leaf meal (MLM) in chicken diets especially in developing countries is on the increase due to scarcity of traditional feedstuffs. Therefore, this investigation aimed to explore the effects of MLM on lipid profiles and production characteristics of laying hens. Twenty-three publications retrieved from Web of Science, PubMed, Scopus and Google Scholar search engines were used for the analysis. Data from the 23 studies were analysed using random-effects model in OpenMEE software. Results were presented as standardised mean difference (SMD) at a 95% confidence interval. The results show significant improvement in feed conversion ratio (SMD = - 0.49; p < .001), egg mass (SMD = 0.35; p = .003), Haugh unit (SMD = 0.39; p < .001), eggshell thickness (SMD = 0.63; p < .001) and eggshell weight (SMD = 0.45; p < .001) at a reduced feed intake. On the other hand, egg weight, hen-day egg production and blood high-density lipoprotein cholesterol were not statistically different from controls. Results reveal that dietary MLM enhanced blood cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides and yolk cholesterol concentrations in laying hens. There is presence of significant heterogeneity and meta-regression revealed that study country, number of hen, housing system, hen age, inclusion level and layer strains were predictors of the treatment effect. In conclusion, the results of this meta-analysis suggest that inclusion of MLM in the diet of laying hens improved feed conversion ratio, aspects of egg quality and blood/yolk cholesterol concentrations in laying hens at a reduced feed intake.
Topics: Animals; Female; Dietary Supplements; Chickens; Moringa oleifera; Egg Yolk; Animal Feed; Ovum; Diet; Cholesterol
PubMed: 37500961
DOI: 10.1007/s11250-023-03693-2