RESUMO
Many studies exist on the impact of female age on fertility, success of assisted reproductive technologies and on obstetric, fetal and neonatal adverse outcomes. Late paternity seems commonplace especially in the media But there are reliable scientific data which confirm decline of fertility related to male age but also an increased risk of genetic diseases for the offspring. The objective of this article is to make a synthesis of the literature on this subject.
Assuntos
Fertilidade/fisiologia , Idade Paterna , Técnicas de Reprodução Assistida , Resultado do Tratamento , Adulto , Feminino , Feto/fisiologia , Doenças Genéticas Inatas/epidemiologia , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Fatores de RiscoRESUMO
In France, there does exist any age limit for infertile men management neither in the law nor for the coverage by the "French Assurance Maladie". French law specifies only that both partners of the couple have to be "of childbearing age", but there is no definition for men of childbearing age. Does legislation have to determine a limit on man management in function of his age? Could ART practitioners decide (themselves) whether they take care of infertile men or not? Should male age be a criteria to decide this management? Would ART practitioners "need" a legislation to help them to decide? In 2016, the "French Assurance Maladie" covers all costs for infertile couple if woman is less than 43 years old, whatever male age. If an age-threshold should be establish for the coverage of infertile men management by the "French Assurance Maladie", then what should be this threshold? In order to try to answer these questions, we asked them to French ART practitioners (gynecologists and embryologists) and gynecologists. The first questionnaire included 13 questions and was filled by 244 ART specialists; the second was filled by 138 gynecologists. Most of them agree to limit the male management and the coverage by the "French Assurance Maladie" at 60 for men in ART. Gynecologists who does not practice ART wish a limit for insurance (80% of them but are only 57% to wish a legal limit).
Assuntos
Fatores Etários , Infertilidade Masculina/terapia , Técnicas de Reprodução Assistida/legislação & jurisprudência , Adulto , Feminino , França , Humanos , Infertilidade/terapia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Técnicas de Reprodução Assistida/economia , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
The population attempting pregnancy and having babies is ageing. The declining fertility potential and the late age of motherhood are increasing significantly the number of patients over forty consulting infertility specialists. Assisted reproductive technologies (ART) cannot compensate the natural decline in fertility with age. In France, in public hospital, ART is free of charge for women until 43 years, over 43, social insurance does not reimburse ART. Hence, 43 years is the usual limit, but between 40 and 42 is ART useful? The answer varies according to physicians, couples or society. On medical level, the etiology of the infertility must be taken into account. If there is an explanation to infertility (male or tubal infertility) ART is better than abstention. If the infertility is only due to age the question is raised. In France, the reimbursement by the society of a technique with very low results is discussed. However efficacy is not absolutely compulsory in Medicine. On the opposite to give false hopes may be discussed too. To obtain a reasonable consensus is rather difficult.
Assuntos
Envelhecimento , Infertilidade/terapia , Técnicas de Reprodução Assistida , Adulto , Contraindicações , Feminino , Fertilização in vitro , França , Humanos , Infertilidade/etiologia , Infertilidade Feminina/terapia , Infertilidade Masculina/terapia , Masculino , Gravidez , Mecanismo de Reembolso , Técnicas de Reprodução Assistida/economia , Técnicas de Reprodução Assistida/ética , Resultado do TratamentoAssuntos
Mães Substitutas , Temas Bioéticos , Feminino , França , Humanos , Infertilidade Feminina/terapia , GravidezRESUMO
In today's society, many women push pregnancy further away from the "right" childbearing age. Assisted reproduction, except egg donation, is unable to fully overcome the effect of age on fertility loss. The effectiveness of oocyte vitrification is demonstrated, and oocyte vitrification is allowed in the French Bioethics law of 2011. In the French law, oocyte' s cryopreservation is proposed to oocyte donors without child. Social egg freezing for non-medical reason is already legal in some countries, but leads to new debates and discussions.
Assuntos
Criopreservação/ética , Idade Materna , Oócitos , Temas Bioéticos/legislação & jurisprudência , Feminino , França , Humanos , Infertilidade Feminina/etiologia , GravidezRESUMO
In France, access to Assisted Reproductive Technologies (ART) is strictly controlled. ART is only authorized for medical infertility. The revision of the law of bioethics has not modified access to ART. It is still forbidden to take charge of lesbian couples or gay-male couples, surrogacy is prohibited. The only change is that unmarried couples have no more to prove they live together since 2 years.
Assuntos
Temas Bioéticos/legislação & jurisprudência , Homossexualidade Feminina , Homossexualidade Masculina , Pais , Técnicas de Reprodução Assistida/legislação & jurisprudência , Mães Substitutas/legislação & jurisprudência , Adulto , Feminino , França , Acessibilidade aos Serviços de Saúde/ética , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Técnicas de Reprodução Assistida/ética , Cônjuges/legislação & jurisprudênciaRESUMO
Oocyte donation is offered to patients with premature ovarian failure to achieve pregnancy when no other assisted reproductive technology is possible. Some clinical and biological factors have been identified for influencing the outcome of oocyte donation cycles. Embryo implantation depends on embryo quality, method for the embryo transfer, and endometrial differentiation. In our center, the oocyte recipients receive for the endometrial preparatory cycle the same treatment that for the patients undergoing frozen embryos transfers, with good clinical pregnancy rates, about 35% per transfer. Estrogen and progesterone supplementation with GnRH agonist down regulation are used in synchronized protocols or for frozen embryos transfers. The synchronization between recipient's endometrium and donor's ovarian stimulation is very restrictive. Nowadays, the oocytes vitrification lithens the oocyte donation process: the endometrial preparation has a limited duration and is well controlled, and embryos that are transferred are all fresh embryos.
Assuntos
Endométrio/fisiologia , Infertilidade Feminina/terapia , Doação de Oócitos , Insuficiência Ovariana Primária/complicações , Gonadotropina Coriônica/administração & dosagem , Criopreservação , Implantação do Embrião/fisiologia , Transferência Embrionária/métodos , Estradiol/administração & dosagem , Feminino , Fertilização in vitro , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Infertilidade Feminina/etiologia , Ciclo Menstrual/efeitos dos fármacos , Ciclo Menstrual/fisiologia , Oócitos/fisiologia , Gravidez , Progesterona/administração & dosagemRESUMO
Is it possible to safely avoid weekend oocyte retrievals and embryo transfers? It is possible to safely avoid Sunday oocyte retrieval and embryo transfers during GnRH agonist or antagonist cycles, to avoid oocyte retrievals 2 days seem also possible by delaying or advancing hCG administration in both analogs cycles but it is more difficult to avoid embryo transfers during two days. In intra uterine insemination programs, it is possible to avoid ovulation monitoring and inseminations by the use of GnRH antagonists. In IVF programs, ovulation monitoring could be avoid on weekends but the risk of ovarian hyperstimulation would exists in case of polycystic ovary or polycystic like ovary.
Assuntos
Transferência Embrionária/métodos , Oócitos , Técnicas de Reprodução Assistida , Coleta de Tecidos e Órgãos/métodos , Gonadotropina Coriônica/administração & dosagem , Feminino , Fertilização in vitro , Hormônio Liberador de Gonadotropina/agonistas , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Síndrome de Hiperestimulação Ovariana/epidemiologia , Gravidez , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the results of controlled ovarian hyperstimulation (COH) for IVF in patients with low anti-Müllerian hormone (AMH) and normal basal follicle stimulating hormone (FSH) and Estradiol levels (≤50 pg/mL). PATIENTS AND METHODS: A retrospective cohort study including 704 patients for whom AMH and FSH levels (measured between days 3 and 5 of the menstrual cycle) were available, is performed in the IVF center at the Sèvres Hospital (France). Three groups are designed and analyzed: group 1 with AMH less or equal to 2 ng/mL and FSH less or equal to 10 mUI/mL (study group), Group 2 with AMH greater than 2 ng/mL and FSH less or equal to 10 mUI/mL (control group) and Group 3 with AMH less or equal to 2 ng/mL and FSH greater than 10 mUI/mL (group with decreased ovarian reserve). RESULTS: IVF outcome for patients from the study group is significantly worse than that of the second but not than that of the third group. In the first group, the number of retrieved oocytes, the number of total obtained embryos, the clinical pregnancy rate and the live birth rate are significantly lower than in the second group; moreover, there are more cancelled cycles because of poor response in the first group. There is no difference with the third group. DISCUSSION AND CONCLUSIONS: This study shows that women with a low baseline AMH have a similar response to COH to the poor responders patients with a decreased ovarian reserve revealed by an elevated FSH level. Thus, when a woman undergoing IVF cycle presents a low AMH, she might be considered as a poor responder patient regardless of the FSH level and, although the clinical pregnancy rate is not so disappointing (18%), the couple should be informed of a higher risk of cycle cancellation.
Assuntos
Hormônio Antimülleriano/sangue , Estradiol/sangue , Fertilização in vitro , Hormônio Foliculoestimulante/sangue , Indução da Ovulação , Adulto , Coeficiente de Natalidade , Feminino , Humanos , Recuperação de Oócitos , Gravidez , Taxa de Gravidez , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVES: ART transparency of results and ways to submit are in centre of present biologists and clinical cares. This work aims at identifying ART results' presentation pertinent tests. PATIENTS AND METHODS: At first time, we propose a questions' list to French ART professionals. Next, we apply results on Amiens' ART center 2006, 2007 and 2008 IVF parameters. RESULTS: One hundred and twenty questions' lists were analysed. Ninety percent of interrogated people were in favour of the results' center public communication. Most quoting criterions hold to define a reference population are (percentage of favourable opinions): IVF/ICSI treatment (96%), first of second rank's attempts (71%), women age less than 35 years old (68%), one or two top embryos quality transfer (60%). In 2007, 2008 and 2009, we made 1123 tentative IVF±ICSI in Amiens' ART center. Pregnancy rates were analysed for these years with criterions next quoting as most pertinent (women's age and rank's attempt), and in function of puncture retrieval oocytes number and indications. DISCUSSION AND CONCLUSION: Most of professionals are in favour of ART transparency of results. All would like that results presentation holds to special criterions to allow a fair comparison. Pregnancy predictive factors, which are women age, rank attempt, puncture retrieval oocytes number, seem to be main criterions for evaluation. These criterions pertinence has been shown thanks to Amiens ART center results.
Assuntos
Infertilidade Feminina/terapia , Papel do Médico , Técnicas de Reprodução Assistida/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Transferência Embrionária/estatística & dados numéricos , Feminino , França/epidemiologia , Pesquisas sobre Atenção à Saúde , Humanos , Idade Materna , Recuperação de Oócitos/estatística & dados numéricos , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Fatores de Risco , Injeções de Esperma Intracitoplásmicas/estatística & dados numéricos , Inquéritos e Questionários/normasRESUMO
The surgical approach has been a long-lasting option for ovulation restoration in patients presenting with polycystic ovarian syndrome. It consists of ovarian drilling with monopolar, bipolar energy or laser through laparoscopic or vaginal hydrolaparoscopic route. It is intended to be used as a second line therapy as an alternative to gonadotropins in patients with resistance or failure after clomiphene citrate. The results in terms of ovulation restoration and live births make it an attractive alternative with less complications such as multiple pregnancies and ovarian hyperstimulation syndrome.