Human Fertility最新文献

Patients with endometriosis have greater risk of infertility, which is associated with compromised ovarian function. Dysfunction in follicular granulosa cells and hyperactivation of oestrogen receptor beta (ERβ) are evident in endometriosis. It is also known that anti-Müllerian hormone (AMH)/Smad signalling pathway regulates ovarian activity. In this study, we aimed to explore effects of oestradiol (E2)/ERβ on follicular granulosa cells and on AMH/Smad signalling in endometriosis. The human ovarian granulosa cells were obtained from patients with tubal factor infertility and ovarian endometriosis, respectively, who underwent IVF/ICSI-ET using GnRH antagonist protocol in our hospital. A human ovarian granulosa tumour cell line (KGN) was cultured and subject to treatments with oestradiol and/or PHTPP (a selective ERβ antagonist). Cell viability, apoptosis, migration, and invasion were assessed. The mRNA and protein expressions were also investigated. It was found that AMH/Smad signalling pathway was suppressed in human ovarian granulosa cells in patients with ovarian endometriosis. Then, in KGN cells, E2 treatment (10^-10 mol/L for 72 h) did not alter cell viability or apoptosis, but E2 decreased migration and invasion via ERβ. Further, E2 inhibited AMH/Smad signalling pathway via ERβ in KGN cells. Conversely, selective inhibition of ERβ could reverse these effects. In conclusion, activation of E2/ERβ compromised the function of follicular granulosa cells in endometriosis, which may be mediated by AMH/Smad signalling pathway.

As demand for donor conception (DC) rises the landscape is becoming increasingly complex. DC-linking now occurs through various means, including direct-to-consumer DNA testing, which may reveal DC where this has not been disclosed and make those genetically related known to each other, including earlier than is possible through identity-release provisions in many jurisdictions. Early contact between donors and recipient parents, as well as same-donor siblings is becoming more common. Large sibling groups within and across jurisdictions are increasingly being identified and there is also growing reliance on imported gametes and online donor recruitment platforms. These developments can be associated with challenges for donor-conceived people (DCP), parents, donors and their families, and have led to calls for more accessible and responsive psycho-social support services. This paper maps the DC context in ten Western countries, including the availability of psychosocial support and counselling. Given the growing complexity of DC and its lifelong impact on all involved, we pay particular attention to post-donation counselling support related to disclosure, long-term psychosocial wellbeing, and DC-linking. We identify key challenges in existing DC provisions and support systems and propose improvements that support DCP, donors, parents, siblings, and their families in managing the longer-term implications of DC.

In an altruistic surrogacy arrangement, interpersonal relationships are crucial, particularly as many arrangements may be based on pre-existing relationships between intended parent/s and surrogate (and partner if applicable). Thus, if interpersonal difficulties were to occur, they could adversely impact the surrogacy itself and long-term extended family and friendships. In Australia, surrogacy is altruistic, with legal requirements for independent pre-surrogacy counselling of all parties to the surrogacy. This study aims to describe the application of an implications and assessment counselling protocol (IAC), including validated psychometric testing, and an assessment of suitability of parties legally required for surrogacy in the state of New South Wales (NSW). Pre-surrogacy relationships are assessed using observation, clinical interview, and psychometric measures to highlight potential interpersonal problems. From the comprehensive interpersonal assessment, preventive measures may be recommended by the surrogacy counsellor to ameliorate potential relationship issues during the surrogacy. In total, 87 consecutive arrangements (N = 322), 80 gestational and 7 traditional surrogacies, comprising 61 intended mothers (IM) (5% single), 110 intended fathers (IF) (47% same sex male relationships), 87 surrogates (S) and 64 partners (SP) (94% male) consented to participate. As part of the IAC protocol, two psychometric tests [Personality Assessment Inventory (PAI), Psychological Entitlement Scale (PES)] were completed by 98% of the 322 parties. Findings from the interpersonal scales of the PAI (Warmth and Dominance), five PAI sub scales, and the PES were used to assess interpersonal dimensions. Overall, 97% of the 87 cases were assessed as suitable to proceed, including 29% with qualified approval. However, in 11 cases assessed as suitable to proceed, there were individual interpersonal test scores at least one standard deviation from the mean, indicating possible relationship disparities. The findings of this study demonstrate the application and value of psychometric testing, as an integral part of clinical assessment in surrogacy counselling.

This article explores how connections brought about through practices of donor conception are changing in the context of mediatisation and, in particular, how digital technologies shape possibilities for donors and recipient families to know one another. We focus on the growing practice of 'informal' donor conception (IDC) in the UK - donor conceptions which are arranged outside of medical institutions and often facilitated via online platforms. Drawing on interviews with 30 (intended) parents via IDC and 19 informal sperm donors, we show how donors and recipients carefully manage, or attempt to manage, the ways in which they are known and knowable to one another, and to a potential donor-conceived person. We identify four ways of knowing, and being known, within participants' accounts: 1) selective sharing of identifying information; 2) (dis)embedding donation connections within wider communities; 3) communicative forms of knowing; and 4) via the creation and management of digital artefacts. Donors and recipients sought to use and limit these different modes of knowing in varied combinations, shaped by their knowledge of (clinical) assisted reproduction practices, changing digital cultures and the legal marginalisation of IDC practices.

Congenital cervical agenesis is a rare but important obstructive cause of primary amenorrhoea. Initial diagnosis is often delayed. With advances in reconstructive surgery, fertility restoration is now a realistic option for some women. We present a case of complete cervical and vaginal agenesis diagnosed in a 16-year-old girl who presented with cyclical pelvic pain and primary amenorrhoea. Following successful vaginoplasty and direct uterovaginal anastomosis, regular, pain-free menses, and later, uncomplicated sexual intercourse was achieved. Following a 10-year period of primary infertility and unsuccessful assisted reproduction treatment, natural pregnancy was achieved with the birth of a healthy male infant by caesarean section at term. This report aims to highlight the potential complexities of both natural and assisted conception following corrective uterine surgery. The importance of an individualised, multi-disciplinary approach to care is also highlighted.

Animal studies have demonstrated that mitochondrial distribution within the oocyte is closely associated with nuclear and cytoplasmic maturation. Aberrant mitochondrial localisation patterns have been linked to incomplete cytoplasmic maturation and reduced developmental competence. The aim of this study was to characterise the dynamics of mitochondrial distribution in human oocytes across different stages of maturation. Using discarded oocytes from patients undergoing intracytoplasmic sperm injection (ICSI) we analysed the concentration of mitochondria and their distribution patterns. Homogeneously diffuse, centrally located, and peripheral distributions were detected in mature metaphase II (MII), immature metaphase I (MI) and immature germinal vesicle (GV) oocytes, respectively. Of the MII oocytes, 61% presented an evenly diffuse pattern and of the GV oocytes, 53% presented a peripheral distribution. The mean mitochondrial density increased significantly from 278,501 ± 65,989 area units in GV oocytes to 352,340 ± 37,942 in MII oocytes (p = 0.003). For cytoplasmic occupancy, which followed a non-normal distribution, the median percentage increased from 73.7% (IQR: 66.9%-78.7%) in GV oocytes to 100.0% (IQR: 84.8%-100.0%) in MII oocytes (p < 0.001). Upon maturation, human oocytes demonstrate an increase in mitochondria density and cytoplasm occupancy. Importantly, the mitochondria tend to be located mainly at the periphery in immature oocytes, achieving a more diffuse homogeneous pattern as the oocyte matures. This pattern of distribution may play an important role in cytoplasmic maturation of human oocytes and their further development.

Endometrial polyps are localised hyperplastic growths of the endometrial lining that project into the uterine cavity. These growths, composed of glandular and stromal tissue formed around a vascular core, are a common finding in reproductive-aged women and have been associated with infertility and reduced efficacy of assisted conception treatment. This guideline aims to synthesise the evidence available for the assessment and management of endometrial polyps in the context of fertility. The guideline addresses the definition, prevalence, diagnosis, fertility prognosis, and treatment options for endometrial polyps.

In the forty years since the publication of the Warnock Report, the fertility field has changed dramatically-in part due to the growing influence of finance capital. This article examines how private equity (PE) and venture capital (VC) investments are reshaping the organisation, practice and future of assisted reproduction. While Warnock anticipated sufficient provision of IVF through the NHS, contemporary IVF has become one of the most privatised and financialised areas of medicine. PE-backed acquisitions introduce short-term return-on-investment logics centred on scaling up, cost-cutting and revenue expansion-all of which have implications for pricing, labour, clinical practice, research and training. Meanwhile, VC investments in fertility start-ups embed reproductive innovation within Silicon Valley's cultures of disruptive innovation and speculative futures. From AI-driven embryo selection and DIY fertility apps to stem-cell based innovations and automated embryology, the approximation between the tech and fertility industries increasingly frames reproduction as a process to be engineered, optimised and platformised. Together, the financial forces of PE and VC reshape power relations in assisted reproduction and reconfigure the future direction of reproductive medicine within their logics of valuation. Revisiting Warnock in this context highlights the need for regulatory frameworks that address not only the ethics of fertility treatments, but the consequences of the expanding financial infrastructures that now underpin the fertility sector.

Since the introduction of the Dutch Artificial Fertilisation Donor Data Act (Wdkb) in 2004, individuals conceived through donor conception have had the right to access identifying donor information from the age of 16. The first group became eligible in 2021, yet little is known about how adolescents with identifiable donors navigate this process. Fiom, a Dutch centre of expertise on questions about ancestry, offers counselling to donors and donor-conceived people during the exchange of information and any subsequent contact. The organisation has seen an increase in requests from adolescents, highlighting the need for tailored support. As adolescents are at a critical stage of identity formation and usually live with their families, requests for donor information can affect family dynamics. To improve understanding of these adolescents' specific needs and experiences, this study explores their motivations for seeking sperm donor information, their experiences with information exchange and contact, and the professional support required throughout their journey. Between June 2021 and April 2023, qualitative semi-structured interviews were conducted with 19 donor-conceived people (17-26 years old) to explore these topics. This study highlights the diverse and evolving needs, motivations and experiences of donor-conceived adolescents in their search for donor information and contact. These are shaped by identity development, family dynamics, social support, personal circumstances and broader societal influences. While donor information can foster recognition and a sense of completeness, contact with the donor often involves emotional and practical challenges. Adolescents value tailored counselling that supports them requesting and exchanging donor information at their own pace. They also emphasise the importance of retaining agency as they explore and define the personal meaning of this information. In addition, participants expressed the need for long-term professional support to help them integrate information about the sperm donor, his family and donor siblings into their lives. The findings underscore the importance of open communication, personalised professional support and encouragement of their social network throughout this journey.

Some Australian women who require donor oocytes to achieve parenthood travel to South Africa, where egg donors are more readily available and egg donation comparatively affordable. In South Africa, egg donation arranged through donor agencies or egg banks is anonymous, whereas Australian las does not permit donor anonymity. This study explored Australian recipients' views on the implications of donor anonymity for their children, including the potential for future donor identification through direct-to-consumer genetic testing and social media. It also examined whether South African infertility counsellors, inform donors about possible future identification. Semi-structured interviews were conducted with twelve Australian egg recipient parents, twelve South African egg donors, and nine South African counsellors between 2021 and 2023, and analysed thematically. Australian recipients commonly hoped their donor-conceived children might learn the donor's identity and some had already engaged in online sleuthing or anticipated future identification through genetic testing. In contrast, South African donors generally expected anonymity to be permanent and expressed mixed feelings about potential future contact. Counsellors reported that identification risks were not consistently discussed with donors. This mismatch in expectations may have psychological consequences for all parties, highlighting the need for more robust implications counselling in cross-border egg donation arrangements.