Human Fertility最新文献

Anonymous egg donation is prohibited in Australia, with all states allowing donor-conceived people (DCPs) to access their donor's identity at age 18 or 16, depending on the state. However, early contact, well before age 18, is becoming more common. A key driver of this trend is recipients' and donors' use of online platforms (OPs) like Facebook to find one another, enabling donor-recipient contact before donation and/or after the donor-conceived children are born. This study reports on interviews with 24 egg donors who met recipients via OPs and had early contact post-birth. Using reflexive thematic analysis, the study found that donors were primarily motivated by empathy and saw donation as a relational act. They selected recipients with shared values around early contact and negotiated post-birth relationships. Early contact often led to meaningful kinship connections, with relationships described using extended family terms. The donor-recipient relationship unfolded as a progressive relational model: motivations informed recipient choice and contact expectations, and early contact deepened relational bonds. However, some donors experienced relationship breakdowns with recipients, illustrating the emotional complexity of (early) contact, even when agreed to. Findings underscore the importance of psychosocial support to ensure donor conception practices promote the wellbeing of all parties involved.

Retained products of conception (RPOC) is a common complication following first-trimester pregnancy loss. However, there are no formal recommendations regarding the diagnosis of RPOC. This systematic review aimed to synthesise and critically appraise the existing evidence on the definition and diagnostic criteria for RPOC. We registered this systematic review prospectively with PROSPERO (CRD42023444456). A comprehensive literature search was conducted in October 2024 using the following databases: Embase (OVID), Medline (OVID), Global Health, CINAHL on EBSCOhost, Cochrane Central and Web of Science. Databases were searched using free-text keywords and subject headings for the key concepts of 'early', 'miscarriage' and 'retained'. Data were extracted and 2 by 2 tables populated. Risk of bias and quality assessments were performed using the QUADAS-2 tool. The literature search yielded 2,014 articles that were screened for eligibility, resulting in the inclusion of 17 studies in the final analysis. Ultrasound scan was the primary diagnostic tool, used in 16 of the 17 included studies. Ultrasound diagnostic markers included: endometrial thickness (ET), the presence of hyperechoic or echogenic material, and colour flow Doppler. One study used persistent bleeding for more than 14 days as the primary diagnostic marker. There was significant variation in the diagnostic thresholds used and no single ultrasound marker demonstrated consistent reliability in diagnosing RPOC. The findings of this review highlight the limitations of ultrasound as a standalone diagnostic tool for RPOC. Given the lack of clear diagnostic criteria, clinicians should integrate ultrasound findings with clinical symptoms to improve diagnostic accuracy. RPOC appears to be a distinct pathology within the spectrum of early pregnancy loss, characterised by the persistence of pregnancy tissue within the uterine cavity despite initial management which distinguishes it from incomplete miscarriage. This review provides a foundation for future research and calls for a Delphi consensus to refine the diagnosis and management of RPOC.

Over the past two decades, mitochondrial DNA (mtDNA) content has been studied as a potential biomarker for embryo viability and implantation success during in vitro fertilization (IVF) procedures. However, its reliability for embryo selection remains uncertain. Therefore, our study aimed to examine the relationship between blastocyst mtDNA content and blastocyst quality, timing of fully expanded blastocyst formation, and cleavage-stage embryo quality in blastocysts biopsied at the uniform expansion stage. We analyzed bioinformatics data from 125 day-5 and day-6 blastocysts from women aged 18 to 35 years. Each blastocyst was biopsied at expansion stage 4 and classified as euploid through preimplantation genetic testing for aneuploidy using next-generation sequencing. Blastocysts were categorized into four groups based on quality and the day of biopsy. Poor-quality day-6 blastocysts exhibited lower mtDNA levels compared to good-quality day-5 blastocysts (p = 0.006), poor-quality day-5 blastocysts (p = 0.008), and good-quality day-6 blastocysts (p = 0.003). Embryos with day-3 grades lower than 2.5 displayed lower blastocyst mtDNA levels compared to those graded 1 (p < 0.001), 1.5 (p < 0.001), and 2 (p < 0.001). These findings suggest further insights into the interplay between blastocyst mtDNA content and preimplantation embryo morphology. Nonetheless, mtDNA remains an unreliable biomarker for assessing embryo viability, warranting further investigation to determine its clinical relevance.

To evaluate whether oocyte cryopreservation affects obstetric and perinatal outcomes, 350 donor oocyte recipients with live-born singletons were divided into three groups: frozen embryo transfer (FET) with fresh oocytes (n = 101), fresh embryo transfer (ET) with frozen oocytes (n = 190), FET with frozen oocytes (n = 59). Gestational age differed significantly (P = 0.025), with the FET with frozen oocytes group showing longer gestational age than FET with fresh oocytes group (276 days vs. 272 days, P = 0.04). Other outcomes were comparable among groups. Subgroup analysis of FET pregnancies revealed no significant differences between frozen and fresh oocyte groups in gestational age (B 1.38, P = 0.749), birth weight (B -0.11, P = 0.530), premature birth rates (6.8% vs. 11.9%, P = 0.746), low birth weight (LBW) (5.1% vs. 12.9%, P = 0.865), macrosomia (5.1% vs. 4.0%, P = 0.976), small for gestational age (SGA) (6.8% vs. 11.9%, P = 0.599), large for gestational age (LGA) (22.0% vs. 18.8%, P = 0.943), gestational diabetes mellitus (GDM) (10.2% vs. 11.9%, P = 0.343), hypertensive disorders of pregnancy (HDP) (8.5% vs. 17.8%, P = 0.143) or placental abnormalities (8.5% vs. 19.8%, P = 0.133). The study confirmed oocyte cryopreservation did not affect birth weight or obstetrical complications in donor oocyte recipients.

This British Fertility Society (BFS) Policy and Practice guideline aims to support clinicians in preventing ovarian hyperstimulation syndrome (OHSS) in patients undergoing gonadotropin ovarian stimulation. A systematic literature search of the medical databases was performed. The Guideline Development Group (GDG) identified the risk factors of OHSS before and during ovarian stimulation. The relation of different pre-treatment measures and different ovarian stimulation protocols with OHSS was evaluated. The optimal monitoring during treatment was assessed. The current evidence on preventive strategies during and after ovarian stimulation and the available adjuvant preventive agents were examined. Based on this, the GDG developed evidence-based, graded recommendations for clinical practice. The evidence was evaluated within context, considering the effectiveness, cost and practical problems of assisted reproductive technology for patients and healthcare providers. Early identification and application of preventive measures identified in this guideline may reduce the incidence of OHSS or reduce its severity. Suggestions for future research on OHSS prevention are provided.

In 2020, the Dutch government issued a call to investigate age limits for donor-conceived people to access donor information because there was insufficient justification for such limits in the Dutch law. This question is equally important in a changing landscape of donor conception due to searching using direct-to-consumer genetic tests and social media. This paper describes recommendations for policy and practice based on an interdisciplinary (ethical, legal, psychosocial and empirical) research. Findings show that no age limits can be adequately justified, including the current ones. Consequently, we recommended modification of the law by dropping age limits and by making donor information accessible upon the birth of a donor-conceived person. Moreover, we set forth recommendations for due diligence in providing donor information. Integrating donor information into one's life's story is a gradual process that should be tailored to a child's development and individual needs. Because this process is more than a single moment of accessing donor information, we see parents as being best suited to align accessing donor information with their child's needs. We recommend that donor-conceived people, parents and donors are given support in this process, provided by professionals with experience and knowledge about donor conception.

Donor conception that occurs outside of clinical fertility settings is understood to be increasingly common, yet research on this practice remains limited. Drawing on interviews with eleven participants, this study explored the motivations and experiences of same-sex and gender diverse couples who used known donors and home insemination methods to conceive. While participants were parents of children conceived after the introduction of the Human Assisted Reproductive Technology [HART] Act (2004) in Aotearoa New Zealand, conception outside regulated settings meant they were not subject to the medical, ethical, or legal procedures implicit within fertility clinics. Four main themes were identified (1) Finding the 'ideal donor'- participants sought donors who were 'good' people; known donors were chosen to enable relational processes and facilitate ongoing connections, (2) Home insemination - perceived as affordable, personal, and offering greater agency; though revealing potential relational awkwardness, (3) Relationship planning/envisaged relationships: not the 'donor dad' - participants constructed donors as 'helping uncles' or extended family members with ongoing, contracted roles, (4) Lack of and need for knowledge, understanding and relevant support for self-insemination using known donors. This study highlights the need for accessible, evidence-based resources and psychosocial support to benefit and protect all donor conception stakeholders.

This study aimed to evaluate the effectiveness of changing the insemination method in women who experienced poor embryonic development during the preceding cycle. A total of 15,886 conventional IVF in 9,311 women, performed between August 2015 and June 2023, were included in this study. Of these, 270 couples experienced IVF failure due to poor embryonic development in the first oocyte retrieval (OR) cycle, which was cancelled before transfer. The patients were stratified based on whether or not they switched to ICSI for subsequent attempts. Cumulative live birth rates (CLBRs) and a series of secondary outcomes were compared. The embryo utilization, high-quality embryo, blastocyst formation, implantation, cumulative clinical pregnancy, CLBR and miscarriage rates were comparable between the two groups, whereas the fertilization rate per oocyte retrieved was significantly lower in the ICSI group during the second OR cycle (60.76% vs. 70.42%, p < 0.001) and all OR cycles (60.02% vs. 71.69%, p < 0.001). Furthermore, the CLBRs in the ICSI and IVF groups after up to seven OR cycles were 41.35% and 36.84%, respectively. Most patients achieved live births during the second OR cycle (58.33%, ICSI vs. 62.86%, IVF). ICSI did not improve clinical or embryonic outcomes in women who experienced poor embryonic development in their preceding cycle.

Assisted reproductive technology (ART) is a fast-moving, innovative, and exciting field. Education and training of new as well as experienced ART professionals is vital, not only to obtain the fundamental learning of reproductive sciences but to keep abreast of advances in technology and strategies, and to guarantee the best care for our patients. Providing a clear road map of training to gain competence, followed by continual, high-quality education and competence evaluation, aims to improve performance and time efficiency of daily practice. This review article aims to summarise the essential points to consider when planning education, training, and ongoing competency assessment.

Adolescents require a specific set of fertility information and services to promote reproductive health and wellbeing extending into adulthood. Due to a common focus on preventing unplanned pregnancy in adolescents, fertility education can be perceived as antithetical. This study explores awareness and attitudes about fertility in adolescents to guide relevant inclusion of fertility in future information and service delivery. Twenty-five adolescents aged 15 to 18 years who had attended secondary schooling in Australia were recruited to participate in nine focus groups. Reflexive thematic analysis revealed three themes (with seven sub-themes) in the transcripts. The importance of fertility education, stigma associated with infertility, and gender roles in the context of reproductive health were identified as being key themes. Broadly, awareness of infertility was seen as important, to navigate potential health consequences and to emotionally support stigmatised people experiencing infertility. This is the first qualitative study about perspectives of fertility and infertility in adolescents aged 18 and under in an Australian context. We make recommendations for developing age-appropriate fertility education, regarding the incorporation of appropriate frameworks in adolescent education to enhance discussions around sex and gender in fertility to align with contemporary preferences.