Human Fertility最新文献

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.

The need for fertility education arises from changing patterns of family formation in recent times. Young people feel unprepared for how best to plan their career and family and have little idea of the various factors that may influence their fertility later in their life. Research shows young people would like to know more and need the information to be conveyed in a way that is engaging and helps them to integrate it at their current life stage. The Fertility Education Initiative (FEI) was founded in 2016 to address the need for improved fertility and reproductive health awareness and ensure young people are equipped with the relevant information to meet their reproductive and family building needs. This paper serves as a historical record of the genesis of the FEI and its impact to date.

The effect of an increase in luteinizing hormone levels on pregnancy outcomes in patients undergoing artificial endometrial preparation for frozen embryo transfer has not been definitively elucidated. We aimed to investigate the effect of elevated luteinizing hormone levels, measured prior to progesterone administration, on the ongoing pregnancy rate in patients undergoing artificial endometrial preparation for single vitrified-warmed blastocyst transfer. Patients began taking oral oestradiol valerate on menstrual day 2-3. When the endometrial thickness reached ≥7 mm, they were tested for oestradiol, progesterone, and luteinizing hormone, and luteal phase support was started. The participants were divided into four groups based on luteinizing hormone percentiles, and differences in pregnancy outcomes were examined. No significant differences were observed for on-going pregnancy rate and the other pregnancy outcomes between the groups. In multivariate logistic regression analysis, not the luteinizing hormone levels but the quality of embryo had a significant influence on ongoing pregnancy (p = 0.004; adjusted odds ratio, 1.8; 95% confidence interval, 1.213-2.675). The elevation of luteinizing hormone levels during artificial endometrial preparation did not have an impact on the ongoing pregnancy or the other pregnancy outcomes.

This study investigated whether the difference between endometrial thickness in the frozen embryo transfer (FET) cycle and the preceding fresh stimulated cycle predicts clinical pregnancy in women with thin endometrium. A retrospective analysis of 335 cycles in 227 women (age < 43) with endometrium < 8 mm in the FET cycle was conducted. Endometrial thickness was assessed using the ratio (ET^frozen/fresh) and absolute difference (ET^fresh-frozen) between the maximal endometrial thickness measured during the stimulated IVF cycle and that measured in the FET cycle. We hypothesized that a smaller difference and higher ratio during FET will be associated with higher pregnancy rate. No embryo implantation occurred in women with an FET endometrial thickness < 5.9 mm and an ET^frozen/fresh < 0.86. Cycles with a positive beta-human chorionic gonadotropin (ß-hCG) showed a significantly lower mean ET^fresh-frozen (1.89 ± 1.78 vs 2.30 ± 1.81, p = 0.03), and a significantly higher ET^frozen/fresh ratio (0.82 ± 0.17 vs. 0.77 ± 0.15, p = 0.024). Endometrial thickness in the FET cycle normalized to the preceding stimulated cycle is associated with implantation and may constitute a novel predictor of FET success in women with thin endometrium.

The Association of Reproductive and Clinical Scientists (ARCS) has long promoted the importance of externally accredited training and assessment of scientific staff within assisted conception centres to ensure professional registration and relevant training at all levels. This not only gives scientific staff the opportunity to empower themselves but also acts to ensure assisted conception centres maintain the highest standards of care and quality for patients whilst meeting HFEA requirements for staffing and training. It also provides assurance to patients that treatment is being delivered by highly trained and competent staff. Clinical embryology practice requires intense concentration, with increasingly complex treatment plans and options coupled with the ever-present consequences of clinical error at the forefront of practitioners' minds, exhaustion and burn out are very real risks. Overloading embryology teams is likely to lead to increased error rates and serious incidents. This guideline aims to bring the sector in line with other Clinical Science specialities to optimise patient care, increase safety, reduce risk (including the risk of legal action against centres and individuals), ensure the use of recognised job titles with appropriate levels of remuneration, and provide centres with a template to work towards for appropriate levels of scientific staffing.

Epigenetic mechanisms, including DNA methylation and histone modifications, govern chromatin arrangement in sperm, enhancing motility and safeguarding DNA integrity for accurate epigenetic inheritance. Abnormal methylation is linked to poor sperm quality and fertility issues, underscoring the need to study sperm DNA methylation and its impact on sperm function and embryo development in assisted reproductive technology. In this study, processed spermatozoa from 75 normozoospermic and 15 abnormal ejaculates were examined for sperm global DNA methylation levels using a colourimetric absorbance method. Although semen characteristics were poor in abnormal ejaculates, no significant correlation was found between sperm global DNA methylation levels and sperm characteristics in either normozoospermic or abnormal cohorts. However, mean global DNA methylation levels were significantly lowered in abnormal sperm samples compared to normozoospermic samples (p < 0.05). Furthermore, injecting spermatozoa from these patients (N = 50) into donor oocytes did not show a significant relationship between sperm global DNA methylation and embryo developmental competence. These findings highlight the limitation of sperm global DNA methylation as a biomarker for embryo development and quality.