Clinical significance of sperm DNA damage in assisted reproduction outcome.

BACKGROUND: Sperm DNA damage shows great promise as a biomarker of infertility. The study aim is to determine the usefulness of DNA fragmentation (DF), including modified bases (MB), to predict assisted reproduction treatment (ART) outcomes. METHODS: DF in 360 couples (230 IVF and 130 ICSI) was measured by the alkaline Comet assay in semen and in sperm following density gradient centrifugation (DGC) and compared with fertilization rate (FR), embryo cumulative scores (ECS(1)) for the total number of embryos/treatment, embryos transferred (ECS(2)), clinical pregnancy (CP) and spontaneous pregnancy loss. MB were also measured using formamidopyrimidine DNA glycosylase to convert them into strand breaks. RESULTS: In IVF, FR and ECS decreased as DF increased in both semen and DGC sperm, and couples who failed to achieve a CP had higher DF than successful couples (+12.2% semen, P = 0.004; +9.9% DGC sperm, P = 0.010). When MB were added to existing strand breaks, total DF was markedly higher (+17.1% semen, P = 0.009 and +13.8% DGC sperm, P = 0.045). DF was not associated with FR, ECS or CP in either semen or DGC sperm following ISCI. In contrast, by including MB, there was significantly more DNA damage (+16.8% semen, P = 0.008 and +15.5% DGC sperm, P = 0.024) in the group who did not achieve CP. CONCLUSIONS: DF can predict ART outcome for IVF. Converting MB into further DNA strand breaks increased the test sensitivity, giving negative correlations between DF and CP for ICSI as well as IVF.

Stress and coping in parents of newly born twins.

OBJECTIVE: Research indicates that parents of twins have poorer psychosocial outcomes than parents of singletons. Parents who have conceived using assisted reproductive technology (ART) have been found to be at higher risk of negative psychosocial outcomes compared to parents who have conceived spontaneously. The current study aimed to model the factors associated with parenting stress of newly-born twins, using the Transactional Model of Stress. METHODS: Data were collected using a cross-sectional survey design with participants identified from delivery records across Northern Ireland. Mothers and fathers (n = 104) of twins aged between 1 and 12 months old returned a questionnaire pack containing the Parenting Stress Index, Impact on the Family Scale-Financial Burden, Coping Orientation to Problems Experienced - Brief Version, Multidimensional Scale of Perceived Social Support, General Health Questionnaire and a demographic questionnaire. RESULTS: There were no differences on psychological outcomes between parents who had conceived via ART and those who conceived spontaneously. Regression analyses found that social interaction and support is an important variable in terms of the psychological outcomes experienced by parents of twins. CONCLUSION: Parents of newly-born twins regardless of the mode of conception should be considered an at risk group for parental distress. Support groups such as the Twins and Multiple Births Association could be important in providing that crucial social interaction and support that seems to be important in the emotional well-being of parents of twins.

Sperm DNA damage measured by the alkaline Comet assay as an independent predictor of male infertility and in vitro fertilization success.

OBJECTIVE: To evaluate sperm DNA fragmentation and semen parameters to diagnose male factor infertility and predict pregnancy after IVF. DESIGN: Prospective study. SETTING: Academic research laboratory. PATIENT(S): Seventy-five couples undergoing IVF and 28 fertile donors. INTERVENTION(S): Sperm DNA fragmentation was measured by the alkaline Comet assay in semen and sperm after density gradient centrifugation (DGC). Binary logistic regression was used to analyze odds ratios (OR) and relative risks (RR) for IVF outcomes. MAIN OUTCOME MEASURE(S): Semen parameters and sperm DNA fragmentation in semen and DGC sperm compared with fertilization rates, embryo quality, and pregnancy. RESULT(S): Men with sperm DNA fragmentation at more than a diagnostic threshold of 25% had a high risk of infertility (OR: 117.33, 95% confidence interval [CI]: 12.72-2,731.84, RR: 8.75). Fertilization rates and embryo quality decreased as sperm DNA fragmentation increased in semen and DGC sperm. The risk of failure to achieve a pregnancy increased when sperm DNA fragmentation exceeded a prognostic threshold value of 52% for semen (OR: 76.00, CI: 8.69-1,714.44, RR: 4.75) and 42% for DGC sperm (OR: 24.18, CI: 2.89-522.34, RR: 2.16). CONCLUSION(S): Sperm DNA testing by the alkaline Comet assay is useful for both diagnosis of male factor infertility and prediction of IVF outcome.

The impact of an assisted conception unit on the workload of a general gynaecology unit.

The burden placed on a hospital by the presence of an assisted conception unit has been emphasised only in terms of its impact on neonatal services. This paper examines the previously neglected subject of the gynaecological workload generated by a tertiary fertility centre that provides treatments by assisted conception. As many IVF units operate independently this additional workload may not be appreciated. It has, however, significant practical and financial implications for neighbouring hospitals and trusts. This is of particular relevance in view of the move towards more uniform health service funding of assisted conception throughout the United Kingdom.

Política de la OPS sobre investigación para la salud / PAHO policy on research for health

La Organización Panamericana de la Salud (OPS) ha adoptado una nueva política sobre investigación para la salud. El propósito de esta política esvelar por que la OPS siga siendo una organización basada en el conocimiento, que existan en todos los países de las Américas sistemas sólidos y sosteniblesde investigación sanitaria y que los datos de la investigación constituyan una piedra angular de todas lasactividades encaminadas a lograr el nivel más alto de salud y equidad. Para alcanzar estos objetivos, la Secretaría de la Oficina Sanitaria Panamericana, losEstados Miembros y los aliados deberán trabajar juntos para sacar provecho de la ciencia, la tecnología, la innovación y los conocimientos más amplios.