Human Fertility最新文献

A generation on from the Warnock Report, the regulatory system it proposed remains largely intact, despite significant changes in the fertility sector, legal culture and wider society. In this article, we trace Warnock's legacy, focusing on the context of gamete donor conception. Drawing on illustrative examples from the ConnectedDNA research project, we analyse two aspects of Warnock's proposals - its recommendation that gamete donors should be anonymous and its key assumption that only the 'triad' of donor, recipient(s) and donor-conceived people have an interest in receiving information about each other. The jettisoning of donor anonymity coupled with a questioning of Warnock's assumptions about the meaning of 'family', illustrate the challenges inherent in a key Warnock objective: to 'future proof' fertility law. Both the global market in gametes and embryos and the accessibility of Direct-to-Consumer Genetic Testing (DTCGT) technologies were wholly unforeseen by Warnock. Similarly, contemporary understandings of donation, families, kinship and relatedness exist in tension with Warnock's original assumptions and, thus, with the principles underpinning the legislative framework. Given this, we recommend three specific reforms to the regulation of donor conception: (1) an urgent review and reformulation of information-sharing provisions, particularly with regard to donor-siblings; (2) an expansion of counselling and support provisions for those affected by donor conception; and (3) the effective imposition of a global ten-family limit. More generally, we suggest that piecemeal and ad hoc reforms to the Human Fertilisation and Embryology Act 1990 have often appeared contradictory and have failed to grapple with the global nature of fertility practice. Thus, we conclude by arguing that a comprehensive review of the legislative framework is needed to create a system of legal governance which meets the needs of the donor conceived community and remains fit for purpose in the twenty-first century.

The objective was to evaluate patient knowledge, attitudes and perceptions on the use of artificial intelligence (AI) technology within a fertility clinic. Patients were undergoing treatment between June 2024 and December 2024. The Main Outcome Measure(s) were Likert Comfort levels scale and Qualitative analysis of responses. Overall, 206 responses were received. While 41% believed that AI could improve outcomes, most (56%) indicated that they 'did not know'. Overall, respondents were comfortable with AI being used in administrative tasks (69%), assisting with clinical decisions (67%) and assisting an embryologist (74%). However, respondents were not comfortable with AI alone performing embryo selection (93.1%), conducting semen analysis (89.2%), sperm selection in ICSI (90.2%) or reporting an ultrasound scan (84.5%). Men were more likely to be comfortable with AI alone determining which embryo to transfer (p = 0.0037), conducting semen analysis (p = 0.01), and sperm selection for ICSI (p = 0.02). Dominant themes regarding the benefits of AI included its use as an assistant, improving efficiency, and reducing error, while dominant themes of patient concerns included human replacement, loss of empathy, and the need for monitoring. Patients have concerns regarding the introduction of AI into fertility care, with men more likely than women to be comfortable.

The objective was to compare the preventive effect of combined oral contraceptive pills (COCs) to the expectant management approach on the incident of corpus luteal cysts following oocyte retrieval in in vitro fertilization (IVF). A total of 130 IVF patients at the Infertility Unit of Siriraj Hospital were randomized into two groups following ovarian stimulation and oocyte retrieval. Participants in the study group received COCs containing 0.15 mg desogestrel and 0.02 mg ethinyl oestradiol per pill for 21 days (n = 65), while the comparison group underwent expectant management (n = 65). Transvaginal ultrasonography was performed to detect corpus luteal cysts (mean cyst diameter ≥ 10 mm) at 2 and 4 weeks after oocyte retrieval. Baseline characteristics were similar between groups. At 2 weeks, the incidence of persistent corpus luteal cysts was 58.4% in the COC group and 69.2% in the expectant management group (p = 0.2). A comparable, non-significant difference was also observed at 4 weeks (26.2% vs. 36.9%, p = 0.19). However, the mean cyst diameter at 4 weeks was significantly smaller in the COC group (5.74 mm vs. 9.39 mm, p < 0.01). The use of COCs does not effectively prevent the formation of corpus luteal cysts at 2 and 4 weeks after oocyte retrieval in the IVF process.

Sexual and reproductive health (SRH) education in the United States has undergone significant change in the past fifty years, driven by shifting global fertility trends and an increased emphasis on identity-related topics. It has traditionally emphasized biological function, disease prevention, and risk reduction, often overlooking identity development and the psychosocial dimensions of reproductive decision-making. Reproductive Identity (RI) is an emerging construct that may provide a new direction that expands SRH education by integrating reproductive self-concept, future reproductive intentions and social justice perspectives that is strengths-based and inclusive of all genders and sexualities. This study examined how SRH educators conceptualize RI, its perceived novelty, familiarity and relevance for SRH curricula, and its alignment with the National Sex Education Standards (NSES). A mixed methods design analyzed survey responses from SRH educators who participated in a fully-funded, six-week, online professional development training programme in RI. Findings indicate that while RI was largely unfamiliar pre-training (62%), it was considered somewhat novel (65%) and relevant (78%) for SRH curricula post-training. Thematic analysis of pre- and post-training responses demonstrated that educators shifted their conceptualizations of RI from viewing RI through biologically-oriented perspectives to recognizing its broader relevance to self-concept, decision-making and reproductive justice. Although RI demonstrated partial alignment with the NSES, gaps remained in areas such as reproductive life planning and future parenting intentions. RI complements existing approaches by addressing the psychosocial and developmental aspects of reproductive decision-making. While RI has not yet been tested with adolescents, the parallel learning process observed among educators suggests its feasibility for integration into SRH curricula.

In recent years, there has been an increase in people using websites, social media groups and mobile apps to connect with potential sperm donors or recipients. We undertook a systematic review of existing research which sought to: explore the characteristics, motivations and experiences of people who use online sperm donation platforms; assess the quality of the existing literature; identify gaps in the evidence base; and make recommendations for future research. Ten academic and grey literature databases and search engines (MEDLINE, CINAHL, PsycINFO, Scopus, Core, Google Scholar, Open Access Theses and Dissertations, NICE Evidence, Open Grey and Google) were searched in December 2019 and again in June 2024. The quality of the studies was assessed using the Mixed Methods Appraisal Tool and we undertook a thematic synthesis of the findings. The searches produced 18,614 results, of which 30 reports were included in the synthesis. The reports were published between 2010 and 2024, by authors from nine countries, and were qualitative (n = 19), quantitative (n = 7) and mixed methods (n = 4) in design. Four themes and two subthemes pertaining to participants' motivations and experiences were constructed from the data. The themes demonstrate that OSD is an improvised practice that is laden with stigma and can produce imbalances of power between donors and recipients. The findings point to a need for further research, including prospective research, to be undertaken with more diverse samples, including populations in the Global South, Black and minority ethnic populations, and inexperienced donors.

Online sperm donation (OSD) is reshaping donor conception by enabling direct connections between donors and recipients outside clinical settings. This systematised narrative review triangulates existing research on sperm donors and recipients who connect through OSD platforms, comparing their perceptions and experiences across different stages of the donation process. By exploring the complex interplay between donors' and recipients' motivations, it fosters dialogue between research areas often examined in isolation. Studies show that donors and recipients, who often explore alternatives alongside OSD, turn to this option to establish contact, gain flexibility, and sometimes facilitate a relationship between the donor and the child. Donors are primarily motivated by altruism or the desire to transmit their genetic heritage, while recipients often turn to OSD for its affordability and flexibility. Both parties engage in negotiations regarding expectations, insemination methods, and future contact, with both parties assessing trust and compatibility. While many report positive experiences, some-especially recipients-face challenges such as communication difficulties, unsolicited advances or sexual misconduct. In the absence of regulation, recipients bear the burden of managing risks related to safety and donor reliability, whereas donors are mainly concerned with legal parentage. Donors and recipients also differ on the donor's role in the child's life, ranging from no involvement to ongoing contact, with post-conception agreements sometimes evolving. Further research is needed to address key gaps, particularly long-term post-conception experiences and perspectives of recipients and online-donor-conceived individuals. This review highlights that rather than eliminating OSD, policies should prioritise safety, transparency, and informed decision-making while expanding access to fertility clinics and establishing a clear legal framework. A balanced approach-one that respects autonomy while mitigating risks-will be essential to fostering ethical and sustainable donor-recipient arrangements, ensuring positive outcomes, especially for recipients and their families.

Donation of substances of human origin (SoHO) is essential for the treatment of many patients and ranges from the donation of whole organs to the donation of tissue or cell products, including also gamete donation. In order to ensure the safety of recipients of SoHOs there are multiple steps taken in the donation pathway of all such substances to ensure the quality and safety of the donation. However, despite this, there is always a residual risk associated with SoHOs. The recent Infected Blood Inquiry (IBI) report has described in detail the background to the inadvertent transmission of HIV and hepatitis C to many patients in the past and has provided a number of recommendations. While the IBI focused on blood donation and the risk of blood borne virus transmission, the underlying principles are pertinent to all SoHOs, including gamete donation, and to all risks associated with SoHOs not just the risk of blood borne virus transmission.

Sperm DNA contains strand breaks and base damage that can potentially affect reproductive health. This study aims to determine to what extent sperm DNA integrity and alkylation is associated with semen quality and assisted reproduction technology (ART) treatment outcomes, in particular fertilisation and cleavage rates. Male partners of couples attending for infertility treatment were recruited. DNA integrity (% tail DNA, sperm with either low (LDD) or high (HDD) damage levels) was measured by a neutral Comet assay and N7-methyldeoxyguanosine (N7-MedG) DNA levels by an immunoslotblot in sperm prepared by density gradient centrifugation. Associations between DNA damage, semen quality and ART treatment outcomes were assessed. N7-MedG levels were lower and the proportion of LDD sperm higher in prepared than in neat sperm samples. The proportion of HDD sperm and % tail DNA were significantly negatively associated and the proportion of LDD sperm positively associated with semen quality. Fertilisation, but not cleavage, rate nor live birth, was significantly negatively associated with N7-MedG levels, the proportion of HDD sperm and % tail DNA and was positively associated with the proportion of LDD sperm. These results confirm that DNA damage, even in prepared sperm, is associated with adverse semen quality and suggest that sperm DNA damage affects the early stages of embryo formation.