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Frontiers in Endocrinology 2020Societal changes and the increasing desire and opportunity to preserve fertility have increased the demand for effective assisted reproductive technologies (ART) and... (Review)
Review
Societal changes and the increasing desire and opportunity to preserve fertility have increased the demand for effective assisted reproductive technologies (ART) and have increased the range of scenarios in which ART is now used. In recent years, the "freeze-all" strategy of cryopreserving all oocytes or good quality embryos produced in an IVF cycle to transfer later-at a time that is more appropriate for reasons of medical need, efficacy, or desirability-has emerged as an accepted and valuable alternative to fresh embryo transfer. Indeed, improvements in cryopreservation techniques (vitrification) and the development of more efficient ovarian stimulation protocols have facilitated a dramatic increase in the practice of elective frozen embryo transfer (eFET). Alongside these advances, debate continues about whether eFET should be a standard treatment option available to the whole IVF population or if it is important to identify patient subgroups who are most likely to benefit from such an approach. Achieving successful outcomes in ART, whether by fresh or frozen embryo transfer, is influenced by a wide range of factors. As well as the efficiency of IVF and embryo transfer protocols and techniques, factors affecting implantation include maternal aging, sperm quality, the vaginal and endometrial microbiome, and peri-implantation levels of serum progesterone. The safety of eFET, both during ART cycles and on longer-term obstetric and neonatal outcomes, is also an important consideration. In this review, we explore the benefits and risks of freeze-all strategies in different scenarios. We review available evidence on the outcomes achieved with elective cryopreservation strategies and practices and how these compare with more traditional IVF cycles with fresh embryo transfers, both in the general IVF population and in subgroups of special interest. In addition, we consider how to optimize and individualize "freeze-all" procedures to achieve successful reproductive outcomes.
Topics: Birth Rate; Cryopreservation; Embryo Transfer; Female; Humans; Ovulation Induction; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Reproductive Techniques, Assisted
PubMed: 32153506
DOI: 10.3389/fendo.2020.00067 -
Fertility and Sterility May 2020Gestational surrogacy can provide an effective family-building method for women whose uterus is absent or dysfunctional and with contraindications to pregnancy, single...
Gestational surrogacy can provide an effective family-building method for women whose uterus is absent or dysfunctional and with contraindications to pregnancy, single men, and same-sex male couples. Over the past 30 years, gestational surrogacy cases have represented a growing percentage of third-party reproduction cases, both in the United States and internationally. The following series of articles provides a summary of current topics in optimizing GS arrangements. They focus on medical and psychological screening; psychosocial adjustment of carriers, children, and their families; legal considerations with precedent-setting cases that every clinician should know; and an international overview of cross-border surrogacy.
Topics: Female; Humans; Policy Making; Pregnancy; Reproductive Medicine; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 32312561
DOI: 10.1016/j.fertnstert.2020.03.016 -
Journal of Dairy Science Dec 2017Reproductive technology revolutionized dairy production during the past century. Artificial insemination was first successfully applied to cattle in the early 1900s. The... (Review)
Review
Reproductive technology revolutionized dairy production during the past century. Artificial insemination was first successfully applied to cattle in the early 1900s. The next major developments involved semen extenders, invention of the electroejaculator, progeny testing, addition of antibiotics to semen during the 1930s and 1940s, and the major discovery of sperm cryopreservation with glycerol in 1949. The 1950s and 1960s were particularly productive with the development of protocols for the superovulation of cattle with both pregnant mare serum gonadotrophin/equine chorionic gonadotrophin and FSH, the first successful bovine embryo transfer, the discovery of sperm capacitation, the birth of rabbits after in vitro fertilization, and the development of insulated liquid nitrogen tanks. Improved semen extenders and the replacement of glass ampules with plastic semen straws followed. Some of the most noteworthy developments in the 1970s included the initial successes with in vitro culture of embryos, calves born after chromosomal sexing as embryos, embryo splitting resulting in the birth of twins, and development of computer-assisted semen analysis. The 1980s brought flow cytometric separation of X- and Y-bearing sperm, in vitro fertilization leading to the birth of live calves, clones produced by nuclear transfer from embryonic cells, and ovum pick-up via ultrasound-guided follicular aspiration. The 20th century ended with the birth of calves produced from AI with sexed semen, sheep and cattle clones produced by nuclear transfer from adult somatic cell nuclei, and the birth of transgenic cloned calves. The 21st century has seen the introduction of perhaps the most powerful biotechnology since the development of artificial insemination and cryopreservation. Quick, inexpensive genomic analysis via the use of single nucleotide polymorphism genotyping chips is revolutionizing the cattle breeding industry. Now, with the introduction of genome editing technology, the changes are becoming almost too rapid to fully digest.
Topics: Animals; Breeding; Cattle; Dairying; Female; Insemination, Artificial; Male; Pregnancy; Reproductive Techniques; Semen; Sheep
PubMed: 29153167
DOI: 10.3168/jds.2017-13138 -
Fertility and Sterility May 2021The feasibility of freezing and thawing ovarian tissue is nowadays widely documented. However, ovarian tissue transplantation (OTT) is happening at a much slower pace,... (Review)
Review
The feasibility of freezing and thawing ovarian tissue is nowadays widely documented. However, ovarian tissue transplantation (OTT) is happening at a much slower pace, and clinical experience is somewhat limited. In this review, five European centers present their collective experience of transplanting ovarian tissue in 285 women. The focus is on surgical techniques and OTT outcomes, reproductive outcomes, the impact of chemotherapy before ovarian tissue cryopreservation (OTC), the risk of relapse, and endocrine resumption and longevity of transplanted tissue. The risk of relapse due to reimplantation of ovarian tissue appears to be very low according to current data. Recovery of endocrine function is seen in almost all women undergoing transplantation of ovarian tissue, and about one in four gives birth to a healthy child. The efficacy of in vitro fertilization in these patients is not very high, however, and needs to be substantially improved. Radiation to the pelvis, especially with relatively high doses, appears to considerably decrease the likelihood of a successful pregnancy and may be contraindicated. Our results demonstrate that chemotherapy before OTC does not impair the chances of success, depending, of course, on the total dose and type of chemotherapy administered. At this early stage of development of OTT for restoration of fertility, the results are encouraging and demonstrate clear potential. However, the method is far from being fully developed and requires continued research efforts to optimize our approach.
Topics: Child; Cryopreservation; Europe; Female; Fertility Preservation; Humans; Infant, Newborn; Ovary; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Retrospective Studies; Transplantation, Autologous
PubMed: 33933173
DOI: 10.1016/j.fertnstert.2021.03.008 -
Fertility and Sterility Apr 2023Oocyte in vitro maturation (IVM) is an assisted reproductive technology with a long and sometimes checked history. It is a minimally invasive technique involving the... (Review)
Review
Oocyte in vitro maturation (IVM) is an assisted reproductive technology with a long and sometimes checked history. It is a minimally invasive technique involving the deliberate collection of immature oocytes from patients that have received no or minimal ovarian stimulation and the culture of oocytes to maturity in vitro, before standard procedures thereafter. Now, IVM is classified as nonexperimental and is primarily indicated for patients with a high antral follicle count, especially patients with polycystic ovaries or polycystic ovary syndrome, as well as for fertility preservation in cancer patients. In the recent past, IVM practice has had a confusing array of clinical protocols and has been slow to adapt to new scientific insights; however, recently, significant advances have been made in IVM culture methods based on new knowledge from animal studies, combined with defining a simple patient treatment protocol. These improvements have led to significant recent progress in IVM practice to the extent that IVM is now routinely practiced in a growing number of centers with specialized expertise around the world.
Topics: Female; Animals; Humans; In Vitro Oocyte Maturation Techniques; Oocytes; Reproductive Techniques, Assisted; Fertility Preservation; Ovulation Induction; Polycystic Ovary Syndrome
PubMed: 36804961
DOI: 10.1016/j.fertnstert.2023.02.010 -
Journal of Assisted Reproduction and... Jan 2021Intracytoplasmic sperm injection (ICSI) is the most widely utilized assisted reproductive technique (ART) worldwide. In this feature, we review the early assisted... (Review)
Review
PURPOSE
Intracytoplasmic sperm injection (ICSI) is the most widely utilized assisted reproductive technique (ART) worldwide. In this feature, we review the early assisted fertilization attempts that eventually led to the development of ICSI, and discuss its current utilization in cases of male and non-male factor infertility.
METHODS
We researched the literature related to the development, indications, and current use of ICSI, such as sperm structural abnormalities, male genetic indications, surgically retrieved sperm, high sperm chromatin fragmentation, oocyte dysmorphism, and preimplantation genetic testing (PGT). We also describe the potential future applications of ICSI.
RESULTS
This review summarizes the early micromanipulation techniques that led to the inception of ICSI. We also explore its current indications, including non-male factor infertility, where its use is more controversial. Finally, we consider the benefits of future advancements in reproductive biology that may incorporate ICSI, such as in vitro spermatogenesis, neogametogenesis, and heritable genome editing.
CONCLUSION
The versatility, consistency, and reliability of ICSI have made it the most prevalently utilized ART procedure worldwide.
Topics: Chromosomes; Female; Fertilization in Vitro; Genetic Testing; Humans; Infertility; Male; Oocytes; Pregnancy; Pregnancy Rate; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic; Spermatozoa
PubMed: 33155089
DOI: 10.1007/s10815-020-01987-0 -
BMC Pregnancy and Childbirth Jun 2021Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypertensive disorders of pregnancy (HDP) is one of the most common pregnancy complications and causes of maternal morbidity and mortality. Assisted reproductive technology (ART) has been associated with adverse pregnancy outcomes, including HDP. However, the impact of multiple pregnancies, oocyte donation, as well as fresh and frozen embryo transfer needs to be further studied. We conducted a systematic review and meta-analyses to evaluate the association between ART and HDP or preeclampsia relative to spontaneous conception (SC).
METHODS
We identified studies from EMBASE, MEDLINE, and Cochrane Library (up to April 8, 2020) and manually using structured search strategies. Cohort studies that included pregnancies after in vitro fertilization (IVF) with or without intracytoplasmic sperm fertilization (ICSI) relative to SC with HDP or preeclampsia as the outcome of interest were included. The control group was women who conceived spontaneously without ART or fertility medications. The pooled results were reported in odds ratios (OR) with 95% confidence intervals based on random effects models. Numbers needed to harm (NNH) were calculated based on absolute risk differences between exposure and control groups.
RESULTS
Eighty-five studies were included after a screening of 1879 abstracts and 283 full text articles. Compared to SC, IVF/ICSI singleton pregnancies (OR 1.70; 95% CI 1.60-1.80; I = 80%) and multiple pregnancies (OR 1.34; 95% CI 1.20-1.50; I = 76%) were both associated with higher odds of HDP. Singleton pregnancies with oocyte donation had the highest odds of HDP out of all groups analyzed (OR 4.42; 95% CI 3.00-6.51; I = 83%). Frozen embryo transfer resulted in higher odds of HDP (OR 1.74; 95% CI 1.58-1.92; I = 55%) than fresh embryo transfer (OR 1.43; 95% CI 1.33-1.53; I = 72%). The associations between IVF/ICSI pregnancies and SC were similar for preeclampsia. Most interventions had an NNH of 40 to 100, while singleton and multiple oocyte donation pregnancies had particularly low NNH for HDP (16 and 10, respectively).
CONCLUSIONS
Our meta-analysis confirmed that IVF/ICSI pregnancies are at higher odds of HDP and preeclampsia than SC, irrespective of the plurality. The odds were especially high in frozen embryo transfer and oocyte donation pregnancies.
Topics: Embryo Transfer; Female; Fertilization in Vitro; Humans; Hypertension, Pregnancy-Induced; Odds Ratio; Oocyte Donation; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Sperm Injections, Intracytoplasmic
PubMed: 34182957
DOI: 10.1186/s12884-021-03938-8 -
Advances in Clinical and Experimental... May 2020Endometriosis is a pseudoneoplastic disease that has a significant personal and social impact. Unlike other neoplastic diseases, its management is burdened by... (Review)
Review
Endometriosis is a pseudoneoplastic disease that has a significant personal and social impact. Unlike other neoplastic diseases, its management is burdened by uncertainty and controversy. The aim of this article is to furnish clinicians with a simple, useful and updated tool to select an appropriate diagnostic-therapeutic care pathway for affected women. Guidelines and recommendations cite advances in diagnostics, novel medications and optimized assisted reproductive techniques; however, such advancements have not simplified the management of endometriosis, since they often lack an integrated, multidisciplinary view of diagnostic, therapeutic and reproductive scenarios that inevitably overlap in the management of the disease. We selected and compared major society guidelines on the diagnosis and treatment of endometriosis. Three international and 5 national guidelines were analyzed. The overlapping recommendations were extracted and mapped, developing a simplified diagnostic-therapeutic care pathway in the form of an algorithm. We subdivided the patient population attending our tertiary referral center according to 4 decision nodes: type (deep infiltrating endometriosis or isolated endometrioma); stage (I-IV according to the revised American Society for Reproductive Medicine classification); predominant health problem (pain or infertility); and fertility potential of the couple (normal/abnormal screening fertility). We identified 9 classes, each corresponding to a suggested mode of treatment (medical, surgical or assisted reproductive technique) according to the most recent evidence published. This simplified scheme is designed to standardize treatment and is intended for use as a tool in diagnostic and therapeutic planning with a view to reduce inappropriate treatment.
Topics: Algorithms; Endometriosis; Female; Guidelines as Topic; Humans; Infertility, Female; Laparoscopy; Precision Medicine; Reproductive Techniques, Assisted
PubMed: 32437595
DOI: 10.17219/acem/118849 -
Fertility and Sterility May 2023
Topics: Humans; Female; COVID-19; Reproductive Techniques, Assisted; Fertilization in Vitro
PubMed: 36965597
DOI: 10.1016/j.fertnstert.2023.03.022 -
The Yale Journal of Biology and Medicine Sep 2020Endometriosis, despite only affecting 10-15% of women of fertile age, is still an enigmatic disease. Recent developments in assisted reproductive technology have... (Review)
Review
Endometriosis, despite only affecting 10-15% of women of fertile age, is still an enigmatic disease. Recent developments in assisted reproductive technology have contributed to a better understanding of where and how endometriosis could compromise fertility. In this mini-review we will show how the main point of damage in endometriosis is quantitative impairment of the ovaries, if the "less is more" mantra should be applied when considering ovarian surgery, and when fertility preservation prior to ovarian surgery could be considered. Endometrial receptivity, however, does not seem to be affected.
Topics: Endometriosis; Female; Fertility; Fertility Preservation; Humans; Reproduction; Reproductive Techniques, Assisted
PubMed: 33005121
DOI: No ID Found