The Role of Melatonin to Ameliorate Oxidative Stress in Sperm Cells.

It is widely accepted that oxidative stress (OS) coming from a wide variety of causes has detrimental effects on male fertility. Antioxidants could have a significant role in the treatment of male infertility, and the current systematic review on the role of melatonin to ameliorate OS clearly shows that improvement of semen parameters follows melatonin supplementation. Although melatonin has considerable promise, further studies are needed to clarify its ability to preserve or restore semen quality under stress conditions in varied species. The present review examines the actions of melatonin via receptor subtypes and its function in the context of OS across male vertebrates.

Healthcare workers' attitudes about vaccination of pregnant women and those wishing to become pregnant.

OBJECTIVES: We designed an electronic query that was distributed to healthcare workers in order to evaluate their attitudes towards COVID-19 vaccination of women that wish to conceive and those that are pregnant. METHODS: An electronic survey was designed and distributed through a network of 5.654 e-mails. The query was uploaded in Google Forms. RESULTS: Overall, 1,226 answers were retrieved. Ninety percent of respondents replied that they prescribe COVID-19 vaccination in women that wish to conceive, however, the rate falls to 80% for those that have schedules for imminent artificial reproductive techniques. Approximately 1 in 2 physicians (obstetricians and pediatricians) suggests that a delay in assisted reproduction following immunization is not recommended. At least 13% of women of reproductive age and 30% of women wishing to conceive with ART declined to do so according to respondents, report. Only 75% of respondents favored immunization during pregnancy and of those 48% responded that vaccination could be done in all trimesters of pregnancy. Approximately 40% of women decline; however, to receive vaccination. CONCLUSIONS: Despite the directions provided by international organizations; physician and patient hesitancy towards vaccination during pregnancy (and particularly the first trimester) remains an issue that deserves further attention.

On the Donation of Eggs, Sperm, and Selves.

Every single human being who has ever been conceived has come into existence precisely because God wants him or her to exist. The present article offers psychological and spiritual considerations to assist people who, in a variety of settings, are evaluating medical-assisted technologies that require the removal of gametes from the body, especially those procedures that involve the buying and selling of gametes. Gamete "donation" is a misnomer when the transactions involve cash payment. Gamete "donation" is contrasted with the "self-donation" that a married couple makes to each other, and by extension to their children, in the marital embrace. The article draws out some of the implications of this contrast, particularly to the child's sense of identity. Particular attention is drawn to the mistakes and mix-ups that can occur when the gametes are removed from the body, which would be literally impossible under the circumstances of natural procreation. I conclude that the perennial teaching of the Catholic Church makes a uniquely humane and personalist contribution to the important public conversation about the use of assisted reproduction.

Early-Pregnancy Dydrogesterone Supplementation Mimicking Luteal-Phase Support in ART Patients Did Not Provoke Major Reproductive Disorders in Pregnant Mice and Their Progeny.

Progestogens are frequently administered during early pregnancy to patients undergoing assisted reproductive techniques (ART) to overcome progesterone deficits following ART procedures. Orally administered dydrogesterone (DG) shows equal efficacy to other progestogens with a higher level of patient compliance. However, potential harmful effects of DG on critical pregnancy processes and on the health of the progeny are not yet completely ruled out. We treated pregnant mice with DG in the mode, duration, and doses comparable to ART patients. Subsequently, we studied DG effects on embryo implantation, placental and fetal growth, fetal-maternal circulation, fetal survival, and the uterine immune status. After birth of in utero DG-exposed progeny, we assessed their sex ratios, weight gain, and reproductive performance. Early-pregnancy DG administration did not interfere with placental and fetal development, fetal-maternal circulation, or fetal survival, and provoked only minor changes in the uterine immune compartment. DG-exposed offspring grew normally, were fertile, and showed no reproductive abnormalities with the exception of an altered spermiogram in male progeny. Notably, DG shifted the sex ratio in favor of female progeny. Even though our data may be reassuring for the use of DG in ART patients, the detrimental effects on spermatogenesis in mice warrants further investigations and may be a reason for caution for routine DG supplementation in early pregnancy.

Young childless women with breast cancer in the UK: a qualitative study of their fertility-related experiences, options, and the information given by health professionals.

OBJECTIVE: A proportion of young women diagnosed with breast cancer are childless. Fertility can be impaired by treatment, and women may have to wait for a number of years before pregnancy is advised. The aim of this qualitative study was to investigate in detail the fertility-related experiences of young childless women with breast cancer, including the information they received, the fertility preservation options given, and the dilemmas they faced. METHOD: Interviews were conducted with 19 childless women aged below 45 with first episode breast cancer diagnosed at least 6 months before. They were recruited by contacting the breast cancer charities and were asked to tell their story, with an emphasis on fertility issues. Transcripts were analyzed using the thematic method developed by Braun and Clarke. RESULTS: The amount of information given to women from health professionals varied considerably. Only half were given the opportunity to pursue assisted reproductive techniques prior to chemotherapy. Most women were worried about what the future might hold, including their fertility, the impact of pregnancy on recurrence, and the health of the child. They were generally given little information or support on these issues. CONCLUSIONS: Young women should be given more detailed information about fertility issues shortly after diagnosis, after chemotherapy, and during follow-up appointments. More holistic care should include emotional support to enable them to make decisions regarding their fertility options and planning for the future.

Effectiveness of Parental Preparedness Package among Couples Conceived with Artificial Reproductive Techniques.

Introduction: The problem of infertility is experienced as a crisis or major life stressor with potentially serious negative effects on the couple's relationship and preparation toward the parenthood. According to Sharlip et al., it has been estimated that about 15% of couple would have trouble in conception, and at present, 48.5 million couples experience infertility globally. To decrease the stress among parents to be and to promote healthy parenting for bringing out healthy parent-child relationships, an intervention of Parent Education Program was planned and executed. A study was conducted with the aim to assess the effectiveness of parental preparedness package (PPP) on physical health among couple conceived with artificial reproductive techniques (ART). Materials and Methods: The study was conducted to evaluate the effectiveness of PPP in fifty couples conceived with ART at Dayanand Medical College and Hospital, Ludhiana. Quantitative approach was used to collect the data of couples by doing pre- and postinterventional assessment of physical health of couple using the Structured Physical Health Assessment Scale. Analysis was done with the help of descriptive and inferential statistics. Results: The study revealed that mean score of physical health of couple (both husband and wife) increased significantly after the intervention which infers the effectiveness of PPP (P = 0.001). Conclusion: Our study concludes that PPP should be incorporated in the antenatal care protocol in all couples who conceive using ART.

How Can We Introduce ART into Wild Felid Conservation in Practice? Joint Experience in Semen Collection from Captive Wild Felids in Europe.

Although artificial reproductive techniques (ART) are considered to be a valuable tool for species conservation, information about their introduction into clinical practice for wild felids is limited. The aim of this paper was to jointly describe cases of non-experimental sperm collection from males of various species of wild felids, performed by three European centers focused on feline reproduction. In total, the article presents 22 attempts of semen collection in 12 species of wild felids. The reasons for semen collection were: fertility assessment (10 cases), artificial insemination (5 cases), sperm rescue (postmortem collection for cryopreservation, 5 cases), and sperm banking (in vivo collection for cryopreservation, 2 cases). Semen collection was successful (defined as at least 1 × 106 spermatozoa) in 15 cases. The failures in obtaining spermatozoa were most probably due to (1) male infertility, (2) wrong age/non-breeding season, or (3) recent multiple copulations. The cases presented here confirm that although ART have been introduced into clinical practice, they are mostly used in cases of infertility, not as routine breeding tools. Higher involvement of zoological gardens and private breeders is required, as many chances for preservation of valuable material are lost.

Clinical Andrologists: Do We Really Need Them in the Era of ART?

Infertility is on a rise, and so is the availability of assisted reproductive technique (ART) centres. The sole aim of these centers is to help these unfortunate couples achieve pregnancy. Hence, the concentration of the treatment is on the female partner, while the male is relegated to just being a source for sperm. In the era of intracytoplasmic sperm injection, when pregnancy is possible even with a single mature sperm, evaluation and management of male factor infertility (MFI) is often neglected. MFI and poor semen parameters are markers of male health. He could be suffering from erectile or ejaculatory issues or with correctable obstructive azoospermia. A simple timely varicocele correction may help resolve the issue. It is important to understand that MFI is not a disease but may be a symptom of major underlying clinical condition like testicular or brain tumors. Infertility treatment could be the only occasion when a male seeks health-care evaluation. India has a large pool of qualified urologists trained in andrological care. In contrast, gynecologists may not be trained in the management of male patients, hence there is an important place for andrological services to be an integral part of ART centers. Andrologists would offer minimal andrological evaluation and condition-specific treatment. This could avoid or reduce the need for invasive and expensive ART. Andrologists could also choose the most appropriate mode of sperm retrieval. Undoubtedly, availability of andrological services would improve the overall quality of care, reduce the costs and complications, and would also be medicolegally safe.

First effective mHealth nutrition and lifestyle coaching program for subfertile couples undergoing in vitro fertilization treatment: a single-blinded multicenter randomized controlled trial.

OBJECTIVE: To study compliance and effectiveness of the mHealth nutrition and lifestyle coaching program Smarter Pregnancy in couples undergoing in vitro fertilization (IVF) treatment with or without intracytoplasmic sperm injection (ICSI). DESIGN: Multicenter, single-blinded, randomized controlled trial, conducted from July 2014 to March 2017. SETTING: IVF clinics. PATIENT(S): A total of 626 women undergoing IVF treatment with or without ICSI and 222 male partners. INTERVENTIONS(S): Couples were randomly assigned to the light (control group) or regular (intervention group) Smarter Pregnancy program. Both groups filled out a baseline screening questionnaire on nutrition and lifestyle behaviors, and the intervention group received coaching tailored to inadequate behaviors during the 24-week period. MAIN OUTCOME MEASURE(S): Difference in improvement of a composite dietary and lifestyle risk score for the intake of vegetables, fruits, folic acid supplements, smoking, and alcohol use after 24 weeks of the program. RESULT(S): Compared with control subjects, women and men in the intervention group showed a significantly larger improvement of inadequate nutrition behaviors after 24 weeks of coaching. At the same time, the women also showed a significantly larger improvement of inadequate lifestyle behaviors. CONCLUSION(S): The mHealth coaching program Smarter Pregnancy is effective and improves the most important nutritional and lifestyle behaviors among couples undergoing IVF/ICSI treatment. International multicenter randomized trials are recommended to study the effect of using Smarter Pregnancy on pregnancy, live birth, and neonatal outcome. NETHERLANDS TRIAL REGISTER NUMBER: NTR4150.

Conflicts of interest in Australia's IVF industry: an empirical analysis and call for action.

In Australia, the growing assisted reproductive technologies (ART) industry has recently received some public criticism. Much of this criticism centres on the concern that doctors are increasingly motivated by profit, rather than patient interests. These concerns appear to suggest that the growing business of ART generates conflicts of interest (COI) for clinicians. While media reports may be rhetorically compelling, claims that ART practice is distorted by COI must be supported by empirical evidence. This preliminary study sought to engage with people involved with the ART industry and map out their concerns related to COI in ART. A small convenience sample of eight professionals was interviewed. Here, we present the major themes uncovered, including a richer understanding of the 'interests' of various parties involved in Australian ART. We then propose a strategy for how this topic could be constructively explored.

Non-invasive prediction of implantation window in controlled hyperstimulation cycles: Can the time from the menstrual day at embryo transfer to expected menstrual cycle give a clue?

OBJECTIVE: The aim of this study was to assess whether the time from the menstrual day at embryo transfer to expected menstrual cycle (TETEMC) is associated with the implantation in women with regular cycles or not. MATERIALS AND METHODS: Forty women with successful implantation and forty women without implantation with regular cycles were randomly selected from prospectively collected database of assisted reproductive technology clinic of Zeynep Kamil Women And Children's Health Training and Research Hospital. TETEMC was calculated for each case to assess relationship with the successful implantation. RESULTS: Comparison of groups revealed significant differences with regard to TETEMC and the menstrual period (p<0.05). In ROC analyses both the TETEMC (AUC=0.824, p<0.001) and the menstrual period (AUC=0.797, p<0.001) were significant predictors for clinical pregnancy. Cut off value for the menstrual period was found to be 27.5 days with 82.6% sensitivity and 65% specificity. Cut off value for TETEMC was 11.5 days with 75% sensitivity and 63.2% specificity. CONCLUSION: Longer menstrual cycle and the TETEMC seem to be associated with the implantation failure.

Is Three a Crowd in Reproduction? (The Authorization of Mitochondrial Donation in the UK).

Regulations recently passed in the UK to allow mitochondrial donation through artificial reproductive techniques have heated up the debate about this procedure, which in the near future may be extended to other parts of the world. Detractors of mitochondrial donation invoke the excessive risks inherent to the very novelty of the procedure and the lack of knowledge of its consequences. In the ethical and legal context, the main concerns relate to motherhood determination, the notion of social individuality, its association with genetic manipulation and all the issues accompanying it, the risk of opening the door to more dangerous practices, the potential discrimination toward existing individuals suffering with mitochondrial diseases, the fact that the same outcome - preventing the transmission of mitochondrial diseases - can be achieved by means of less risky procedures, and the modification of the genetic pool of humanity. However, most of the underlined risks are more uncertain than actual, and, indeed, natural to every new technique. Considering the major benefits offered by the procedure, and as long as we act under the auspices of the principles of precaution and prevention, there are no obstacles to the transference of mitochondrial material through artificial reproductive techniques.