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PubMed2002

Assisted reproductive technology in the United States: 1999 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of ART initiated in the United States in 1999. DESIGN: Data were collected electronically by using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Three hundred sixty programs submitted data on procedures performed in 1999. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULT(S): Programs reported initiating 88,077 cycles of ART treatment. Of these, 63,639 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 29.4%; 838 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 27.9%; 945 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.8%. The following additional ART procedures were also initiated: 6,509 fresh donor oocyte cycles, with a delivery rate per transfer of 41.8%; 12,005 frozen embryo transfer procedures, with a delivery rate per transfer of 18.6%; 2,488 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.6%, and 821 cycles using a host uterus, with a delivery rate per transfer of 33.6%. In addition, 398 cycles were reported as combinations of more than one treatment type, 18 cycles as research, and 416 as embryo banking. As a result of all procedures, 21,904 deliveries were reported, resulting in 30,967 neonates. CONCLUSION(S): In 1999, more programs reported ART treatment and reported cycles increased significantly (7.5%) compared to 1998. In comparable cycle types, the overall success rate (deliveries per retrieval) increased by 0.4%, which represents an increase of 1.2% compared to the success rate for 1998.

Adult↗
PubMed2001

Bioethics for clinicians: 26. Assisted reproductive technologies.

Assisted reproductive technologies (ARTs) can be very helpful for certain patients, but ethical concerns have been raised about the inherent nature of specific techniques and the contexts in which many techniques are used. Physicians play important roles in supporting those who wish to become parents and in educating patients about impediments to fertilization and way to promote conception. We discuss various ethical issues surrounding ARTs, including family relationships, informed choice, gender issues, embryo status and the commercialization of reproduction, as well as legal and policy issues. We examine the empirical evidence of the effectiveness of ARTs and suggest ways to approach ARTs in practice.

Bioethics↗
PubMed2006

Neonatal behavior and infant cognitive development in rhesus macaques produced by assisted reproductive technologies.

Assisted reproductive technologies (ART) used in fertility clinics include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), followed by embryo transfer into the biological or a surrogate mother. Over 1,000,000 liveborn offspring--an estimated 1 in 150 United States newborns--have been produced worldwide by ART since 1978. IVF appears to produce healthy children in singleton pregnancies, though concerns remain regarding preterm deliveries, multiple pregnancies, as well as the longer-term consequences of all ART procedures. Clinical studies remain difficult to interpret and subject to confounding variables, as developmental problems may be due to a parent's reproductive conditions rather than, or in addition to, an ART procedure. Also, because of expense and time commitments, the United States ART clinical population is not fully representative of society diversities. This socio-economic skewing might compensate for negative effects, masking small, or modest developmental deficits. Embryo splitting (ES), an ART procedure used only with animals, can produce genetically identical offspring. ES involves dividing four- to eight-cell embryos into separate blastomeres and implanting them into empty zona pellucida, followed by embryo transfer. Although these ART techniques have produced nonhuman primate offspring, there has been no research on behavioral safety. Here, we report the first study of behavioral development by rhesus macaques infants produced through ES, ICSI, and IVF. We assessed neonatal reflexes, self-feeding ability, recognition memory, object concept attainment, simple discrimination learning and reversal, and learning set (LS) acquisition. Although the sample sizes are small, we found no overall ART group delayed development. Surprisingly, the ES and ICSI monkeys appeared to be accelerated in attaining age milestones involving sensory-motor behaviors and a difficult Well Hiding object concept task. We conclude that macaque monkeys may provide an excellent model for the study of early human development by offspring of parents with conditions requiring ART pregnancies, as well as a model for the behavioral study of genetic-environment interactions using identical twins produced by ES.

Analysis of Variance↗
PubMed1996

Social workers' attitudes toward participants' rights in adoption and new reproductive technologies.

New reproductive technologies and issues of adoptees' rights have generated much debate and controversy. This article discusses a study in which 300 social workers expressed their opinions about these topics with special emphasis on their views toward the rights of the participants. The results show that the social workers did not favor withholding information from adoptees, favored adoptive parents over biological parents, and did not favor government regulation.

Adoption↗
PubMed2001

Superovulation strategies for assisted reproductive technologies.

Assisted reproductive technologies (ART) pregnancy rates improve with the replacement of multiple embryos. The specific number of embryos to be transferred (typically between two and four) is based on a patient's age and past history and a morphologic assessment of embryo quality. Superovulation, with the goal of multifollicular recruitment and the harvest of multiple preovulatory oocytes, is therefore an integral aspect of in vitro fertilization and related techniques. Given the considerable interindividual variability in response to superovulation, the selection of an appropriate ovarian stimulation protocol is critical both for the safety and success of ART. Specific superovulation strategies have therefore been developed for treatment of abnormal response patients as well as for patients expected to manifest a "normal" response to ovulation inducing agents.

Age Factors↗
PubMed2001

Altruism in assisted reproductive technologies.

What makes reproductive technology unique is that it is in the forefront of creating human life, with an emphasis on 'giving'. Not surprisingly therefore, a significant appeal to altruism has crept into the language of reproductive technologies. If altruistic donations and behaviour involving reproductive technologies are to be encouraged we need to have a uniform understanding of the terminology. For this we need to explore how the term altruism has been used historically and is being used in modern language. It is also important to acknowledge that gender differences may influence altruistic behaviour. The suggested working definition for altruism has three major components; a motivational state, an ultimate goal and a desire to increase another's welfare. Within this framework definition, self-benefit is permissible provided the ultimate goal is not self-benefit. Altruistic donation is possible provided receiving money is not the primary motive. It is important in our efforts to improve the quality of donor and donations, which are central to assisted reproductive technologies, that any reference to altruism be restricted to the situation where only the ultimate goal, with a single motive, can be discerned. The success of recruiting altruistic donors will inevitably be associated with the attitudes and structures in which reproductive technologists operate. Through such transparency it is hoped more effective control will be achieved for donors over their donations. Irrespective of the setting, a true measure of an altruistic donation or behaviour can only be assessed by giving consideration to the primary motivational state, ultimate goal and benefit to another's welfare.

Journal Article↗
PubMed1998

Recent advances in assisted reproductive technologies.

Assisted reproductive technologies (ART) have received considerable attention, both clinically and empirically. Drs. Steptoe and Edwards removed one oocyte surgically from a woman with infertility related to tubal disease. They fertilized this oocyte in vitro and transferred the formed embryo to the woman's uterus and achieved pregnancy and delivery. The technique of in vitro fertilization (IVF) and embryo transfer (ET) quickly became widely utilized for other causes of infertility as well as for tubal disease. In the last 5 years there has been a number of new developments that are reviewed in this article. The most important and now widely practiced technology has been direct intracytoplasmic injection (ICSI) of the husband's sperm into the wife's oocyte. This was developed for treatment of infertility related to low sperm count. Subsequently it was shown that sperm can be aspirated from epididymis or found in testicular biopsy in obstructive azoospermia. Another promising development is in vitro maturation (IVM) of immature oocytes. This has the potential of avoiding ovarian hyperstimulation, which can be uncomfortable and occasionally dangerous. Some oocytes are unable to fertilize and/or develop into normal embryos. It may be possible that the problem is with the machinery of cytoplasm of the oocyte. Therefore cytoplasmic transfer from a normal oocyte to an abnormal oocyte may overcome the problem. Infertile couples may be faced with many psychological problems that become even more complex with various treatments. Whereas donation of oocytes or embryos can be technically quite simple, there are many psychological issues involved. As can be gathered from aforementioned discussions, the treatments developed for infertility appear to be somewhat illogical and in the style of "shot gun therapy." In the field of infertility, as in other areas of medicine, it is of paramount importance to know the details of disease mechanisms. This in turn will allow specific and logical treatments to be developed.

Animals↗
PubMed1993

New reproductive technologies: Equity and access to reproductive health care.

While attention has focused on the promise of new reproductive technologies to provide cures for infertility, efforts aimed at preventing infertility have languished, and the major cause of infant morbidity and morality--lack of prenatal care--has worsened. This article explores the social and ethical issues arising out of the uses of three new reproductive technologies: surrogacy, in vitro fertilization, and prenatal screening. In addition, coerced medical interventions during pregnancy are described. Examination of the social circumstances surrounding the use of these medical technologies supports the conclusion that new reproductive technologies have increased, rather than decreased, inequities in access to and allocation of health care resources.

Coercion↗
PubMed2006

Just another reproductive technology? The ethics of human reproductive cloning as an experimental medical procedure.

Human reproductive cloning (HRC) has not yet resulted in any live births. There has been widespread condemnation of the practice in both the scientific world and the public sphere, and many countries explicitly outlaw the practice. Concerns about the procedure range from uncertainties about its physical safety to questions about the psychological well-being of clones. Yet, key aspects such as the philosophical implications of harm to future entities and a comparison with established reproductive technologies such as in vitro fertilisation (IVF) are often overlooked in discussions about HRC. Furthermore, there are people who are willing to use the technology. Several scientists have been outspoken in their intent to pursue HRC. The importance of concerns about the physical safety of children created by HRC and comparisons with concerns about the safety of IVF are discussed. A model to be used to determine when it is acceptable to use HRC and other new assisted reproductive technologies, balancing reproductive freedom and safety concerns, is proposed. Justifications underpinning potential applications of HRC are discussed, and it is determined that these are highly analogous to rationalisations used to justify IVF treatment. It is concluded that people wishing to conceive using HRC should have a prima facie negative right to do so.

Cloning, Organism↗
PubMed2002

Epigenetic risks related to assisted reproductive technologies: short- and long-term consequences for the health of children conceived through assisted reproduction technology: more reason for caution?

Does the manipulation of gametes and embryos as practised in human IVF invoke perturbations in fetal and neonatal phenotype? There is increasing evidence that the answer is 'yes', although the degree of perturbation may be less acute than observed in other species. However, the long-term consequences are not known, and may prove to be considerable. There is now a substantial body of evidence from animal models suggesting that assisted reproductive technologies (ART) are associated with altered outcomes in fetal and neonatal development. Epigenetic modification of gene expression is an attractive hypothesis that accounts for these differences and is one of a number of causal pathways that may be activated by cellular stress invoked during manipulation. Here we widen the debate to propose that environment-induced cellular stress also acts to modify fetal and placental gene expression, potentially also contributing to phenotype skewing after ART.

Animals↗
PubMed1990

Current trends in human IVF and other assisted reproductive technologies.

The new reproductive technologies such as IVF, GIFT, ZIFT, and micromanipulation have had a profound influence on the therapeutic and diagnostic management of infertility, and in turn have resulted in better understanding of human fertilization and embryo development. While the clinical pregnancy rates in GIFT and ZIFT procedures are comparable to the natural fecundity in the population at large, pregnancy rates in IVF have been generally lower. Further investigations should be directed to improve the implantation rates, and to develop better controlled methods of multiple follicle development. Although more studies are needed, a recent report of potential utilization of nonstimulated oocytes for donor programs as well as IVF-cryopreservation was a promising new development (Cha et al. 1989). Other exciting prospects on the horizon are the possibilities of gene transfer for the treatment of certain genetic diseases and diagnostic applications of embryonal biopsy. These new technologies have also generated serious ethical and legal issues. Any ethical or legal guidelines affecting new reproductive technologies should be developed to protect all participants only when the need for regulation is clear. Ethical guidelines and appropriate legislations with contributions from the medical and scientific community are gradually being established worldwide.

Cryopreservation↗
PubMed2000

Patient selection for assisted reproductive technology treatments.

Assisted reproductive technologies refer to procedures in which the oocyte is handled or manipulated in vitro before replacement, either as an oocyte or an embryo. Because of rapid advances in this area, infertile couples may seek direct referral for assisted reproductive treatments, instead of trying simpler measures such as ovulation induction and intrauterine insemination. It is important to establish whether these conventional infertility treatments are appropriate, as such treatments are generally safer, less stressful, and more affordable. On the other hand, subjecting infertile couples to unnecessary delay by offering inappropriate treatments-for example, ovulation induction for tubal infertility or intrauterine insemination for severe male-factor infertility-would reduce the overall chance of success because of the age-related decline in female fecundity. The choice of infertility treatments thus depends on a balance of factors: the chance of pregnancy without treatment; the chance with simpler and safer, but less successful, infertility treatments; or the chance with the more complex and costly, but more effective, assisted reproductive treatments. The factors that should be taken into consideration include the age of the woman, the duration of infertility, the causes of infertility, the availability and cost of alternative treatments, and-most importantly-the acceptability.

Anovulation↗
PubMed1992

Creating brave new families with advanced reproductive technologies.

The advanced reproductive technologies such as in vitro fertilization, gamete intrafallopian transfer, and donor gametes have created "brave new families," which can no longer be described by traditional definitions based on genetics and gestation. Understanding the particular stresses and issues that these families face can be particularly helpful to the clinician working with these couples and their children. The potential long-term effects also are explored.

Adoption↗
PubMed2005

Assisted reproductive technology has been detrimental to academic reproductive endocrinology and infertility: depth of the problem and possible solutions.

Dr. Soules' editorial points out some, but not all, of the detrimental effects of assisted reproductive technology on the subspecialty of academic reproductive endocrinology and infertility. This response adds to the list of problems (i.e., discussing the loss of pure endocrinology) but points out an example of a creative solution (i.e., merging academic units with private practices).

Decision Making, Organizational↗
PubMed1996

A closer look at reproductive technology and postmenopausal motherhood.

Although reproductive technologies have been aimed at young, infertile women, evidence suggests that postmenopausal women are also taking advantage of them. Dr. Eike-Henner Kluge asserts in an article in CMAJ (1994; 151; 353-355) that there are ethical reasons to deny older women access to these technologies. Kluge's comparison of postmenopausal women to prepubescent girls is fallacious. His assertion that older parents harm children by denying them a "normal" childhood is not supported by any empiric data. Kluge's distinction between medical intervention, in offering reproductive technologies to a woman in her reproductive years, and "improving on nature", by offering these technologies to postmenopausal a woman is spurious. Unless technologies that are expensive and minimally successful, such as in-vitro fertilization, are denied to everyone, there are no grounds for denying them to postmenopausal women.

Adolescent↗
PubMed2004

Incidence of spontaneous abortion among pregnancies produced by assisted reproductive technology.

BACKGROUND: There has been increasing number of pregnancies following assisted reproductive technology treatment and their survival is understandably a matter of interest. The relative risk of spontaneous abortion in these pregnancies remains unclear. The objectives of this study were to quantify the relative risk in assisted reproductive technology pregnancies in relation to two cohorts of naturally conceived pregnancies and to assess the possible risk factors for spontaneous abortion among assisted reproductive technology pregnancies. METHODS: Three cohorts of pregnancies, 1945 pregnancies conceived following assisted reproductive technology treatment in a tertiary infertility clinic, 549 natural pregnancies in a prospective study of lifestyle and pregnancy (the Ford cohort), and 4265 pregnancies from another cohort (the Treloar cohort), were used in the study. RESULTS: After adjusting for age, the relative risk of spontaneous abortion was 1.20 (95% CI 1.03-1.46) in the assisted reproductive technology cohort in comparison with the Ford cohort. Within the assisted reproductive technology cohort, a history of spontaneous abortion predicted increased risk, while a low level of ovarian stimulation seemed to be related to a reduced risk. CONCLUSIONS: The study showed that the risk of spontaneous abortion was slightly increased in the assisted reproductive technology pregnancies after adjusting for maternal age and previous spontaneous abortion. Within the assisted reproductive technology cohort, several variables, including the level of stimulation, appeared to be linked with the risk of spontaneous abortion.

Abortion, Spontaneous↗
PubMed2002

Preeclampsia in multiple gestation: the role of assisted reproductive technologies.

OBJECTIVE: To estimate the relationship of assisted reproductive technologies and ovulation-inducing drugs with preeclampsia in multiple gestations. METHODS: This historical cohort study was conducted on 528 multiple gestations from a Colorado health maintenance organization. Using univariate and logistic regression analysis, we determined if women who conceived a multiple gestation as a result of assisted conception were at a greater risk of preeclampsia than those who conceived spontaneously. RESULTS: Between January 1994 and November 2000, there were 330 unassisted and 198 assisted multiple gestations. Sixty-nine multiple gestations followed assisted reproductive technologies (in vitro fertilization and gamete intrafallopian transfer). Human menopausal gonadotropins and clomiphene citrate were associated with 38 and 91 of the multiple gestations, respectively. Compared with unassisted multiple gestations, the relative risk of mild or severe preeclampsia among mothers who received assisted reproductive technologies was 2.7 (95% confidence interval [CI] 1.7, 4.7) and 4.8 (CI 1.9, 11.6), respectively. Adjusted for maternal age and parity, women who received assisted reproductive technologies were two times more likely to develop preeclampsia (odds ratio 2.1, CI 1.1, 4.1) compared with those who conceived spontaneously. The adjusted odds ratios of nulliparity and maternal age for preeclampsia were 2.1 (CI 1.3, 3.4) and 1.1 (CI 1, 1.1), respectively. Although the incidence of preeclampsia was greater in mothers who received clomiphene citrate and human menopausal gonadotropins, this association did not reach statistical significance at the P <.05 level. CONCLUSION: Women who conceive multiple gestations through assisted reproductive technologies have a 2.1-fold higher risk of preeclampsia than those who conceive spontaneously.

Adult↗