ABSTRACT
With the improvement of the anticancerous treatments, the preservation of the feminine fertility before gonadotoxic treatment tends at present to stand out as a legal obligation, with a duty of information to patients. When emergency IVF can be performed, the cryopreservation of embryos is the best mastered method which offers most chances to patients to obtain a pregnancy after cancer remission thanks to the transfer of frozen embryos. This article proposes an overview about the indications, the feasibility and the ethical and practical limitations of IVF emergency for embryo freezing before gonadotoxic anticancerous treatment.
Subject(s)
Cryopreservation , Embryo, Mammalian , Fertility Preservation/methods , Fertilization in Vitro , Antineoplastic Agents/adverse effects , Embryo Transfer , Feasibility Studies , Female , Fertility Preservation/ethics , Fertilization in Vitro/ethics , Humans , Infertility, Female/etiology , Pregnancy , Radiotherapy/adverse effectsABSTRACT
OBJECTIVES: An amendment to the French bioethics law allowing children conceived by gamete donation to know the identity of donors is proposed, while no study can assess the proportion of parents in France that disclose the nature of conception to their donor conceived offspring. The aim of our study was to know whether couples who wish to inform their offspring actually did it. PATIENTS AND METHODS: We sent a questionnaire to parents who had expressed an intention to disclose the nature of conception to their future offspring conceived by sperm donation. This allowed us to evaluate the number of couples who inform their offspring, and the couple and offspring feelings when information was given. RESULTS: Among 38 questionnaires sent, 20 couples answered. Fourteen informed their offspring about the nature of conception, most having lived serenely this moment. 47% of offspring have reacted with indifference. While 19 couples informed their friends or family, six couples did not inform their offspring, and two of them no longer want to disclose anymore. CONCLUSION: Careful thought before the beginning of assisted reproductive technology and support after birth are needed to help couples communicate information to their offspring. Without this communication, any policy of openness to know donor related data seems vain.
Subject(s)
Family Characteristics , Parent-Child Relations , Spermatozoa , Tissue and Organ Procurement , Truth Disclosure , Child , Child of Impaired Parents/psychology , Child of Impaired Parents/statistics & numerical data , Data Collection , Female , Humans , Infertility, Male , Male , Pregnancy , Social Environment , Surveys and Questionnaires , Tissue and Organ Procurement/ethics , Truth Disclosure/ethicsABSTRACT
Survival rates for cancers that occur in childhood and adolescence have improved over the last decades, and preservation of future fertility in these patients has become a relevant issue. Premature ovarian failure is a consequence of exposing women to chemotherapeutic drugs and ionizing radiation. Ovarian cryopreservation is an alternative to cryopreservation of embryos or oocytes for theses patients. Ovarian cryopreservation aims to reimplant ovarian tissue after complete remission into the pelvic cavity (orthotopique site) or a heterotopic site like the abdominal wall or the forearm. In vitro folliculogenesis, that aims at the maturation of ovarian cortex primordial follicles cryopreserved for a FIV, is still in an experimental research stage. In this review, the objective was to evaluate the real hopes of pregnancy after ovarian cryopreservation. Indeed, many teams offer ovarian cryopreservation at present time, although only two pregnancies have been achieved to date. In both cases, it can be discussed whether the fertilized oocyte originated from the transplant or from the native ovary. Furthermore, the potential for reintroduction of cancerous cells may limit this technique in cancers that are known to have a risk of ovarian dissemination. The hopes engendered by ovarian cryopreservation, but also its limits, must be explained to the patients before an ovarian surgery for cryopreservation.
Subject(s)
Cryopreservation , Infertility, Female/therapy , Organ Preservation , Ovarian Follicle/physiology , Ovary , Tissue Preservation/methods , Antineoplastic Agents/adverse effects , Female , Fertilization in Vitro , Humans , Infertility, Female/etiology , Ovary/transplantation , Pregnancy , Primary Ovarian Insufficiency/chemically induced , Radiation InjuriesABSTRACT
OBJECTIVE: An early ovarian failure and sterility, on patients often still young, may result from some of the anticancerous treatments. Ovarian cryopreservation is a research way for fertility restoration on patients who will have gonadotoxic treatment. The aim of our work was to study the cases of ovarian tissue preserved in our Department, enabling us to assess the clinical and ethical problems of this technique. PATIENTS AND METHODS: A retrospective study was conducted from January 2001 onwards up to October 2005, on 14 patients, whose ovarian cortex was frozen our the University Fertility Center (Hôpital de la Conception, Marseille, France). RESULTS: In our study, the patients' average age was 17+/-5.5 and the median was 14 years [13-24]. Eight patients were under 18 (11+/-3-years-old). The cryopreservation indications were especially haematological (N = 9). More than half of the patients (N = 8) had undergone a gonadotoxic treatment before ovarian cryopreservation. DISCUSSION AND CONCLUSION: Ovarian cryopreservation is still a recent technology in reproductive medicine. The future of ovarian tissue after thawing, with its different techniques of autograft, is still not consensual. Experimental research remains essential to improve the freezing protocols and ovarian transplant in human medicine.
Subject(s)
Cryopreservation/ethics , Ovary/physiology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infertility, Female/etiology , Infertility, Female/surgery , Leukemia/therapy , Neoplasms/therapy , Ovary/transplantation , Reproductive Techniques, Assisted , Retrospective StudiesABSTRACT
OBJECTIVE: Our aim was to analyse the results of a donor insemination program using ovarian stimulation, swim-up sperm preparation and intrauterine insemination proposed to women with a maximum age of 39. Incidence of several clinical and biological parameters on success rates was investigated. PATIENTS AND METHODS: Retrospective analysis of the results of 249 cycles performed in 106 couples during a four-year period is reported. RESULTS: Overall pregnancy rate of 28.1% and delivery rate of 22% per cycle were achieved, with a multiple pregnancy rate of 11.4%. Most of the pregnancies (84%) were obtained before the fourth insemination. Among the different parameters studied the total number of motile sperm inseminated was found to be the most important factor for success rate: pregnancy rate per cycle reached 40.4% if more than 1.5 million progressive sperm were inseminated vs. 24.7% if they were less than 1.5 million (P<0.05). DISCUSSION AND CONCLUSION: In precise conditions, outcome of inseminations with donor semen can reach satisfying pregnancy rates, being a valuable help for couples suffering of long-time infertility.
Subject(s)
Insemination, Artificial, Heterologous/methods , Adult , Female , Humans , Infertility, Male/therapy , Male , Pregnancy , Sperm Count , Sperm Motility , Treatment OutcomeABSTRACT
Homozygous beta-thalassemia is a severe, transfusion dependent anaemia that also causes infertility. Preimplantation genetic diagnosis is possible. Very few pregnancies are reported among such patients. They have a very high obstetrical risk and a pluridisciplinary follow is necessary.
Subject(s)
Pregnancy Complications, Hematologic , beta-Thalassemia/complications , Adult , Female , Humans , Infertility, Female/etiology , Pregnancy , Preimplantation Diagnosis , beta-Thalassemia/diagnosisABSTRACT
OBJECTIVE: To evaluate obstetric outcome of pregnancies and pediatric follow-up of children born after ICSI procedure. MATERIAL AND METHOD: Prospective study from october 1994 to September 1998 in medical assisted procreations center in La Conception hospital in Marseilles. Three hundred forty-two couples undergoing ICSI procedures. INTERVENTIONS: analysis of pregnancy rates, prematurity rates, obstetric outcome and frequency of congenital malformations. RESULTS: One hundred seventy-eight pregnancies have been obtained with 111 children. Multiple pregnancy rate arise 29.7%. The average term at birth in the singleton pregnancies (38.7 weeks) is higher than in the twins (35.7 weeks). The prematurity rate of delivery before 35 weeks of gestation is about 9.6%. Seven of 111 neonates was born with a congenital malformation, no cardiovascular one. One of boys presents a bilateral cryptorchidism with severe bilateral hypotrophy. CONCLUSIONS: Our results are similar with those of others teams. Congenital malformation rates is near rates reported in others studies. However, no bilateral cryptorchidism with bilateral severe hypotrophy has been yet reported in literature.
Subject(s)
Infant, Newborn , Pregnancy Outcome , Sperm Injections, Intracytoplasmic , Congenital Abnormalities/epidemiology , Embryo Transfer , Female , France/epidemiology , Gestational Age , Humans , Infant, Premature , Male , Pregnancy , Pregnancy, Multiple , Prospective Studies , TwinsABSTRACT
We analyzed retrospectively 936 intrauterine insemination (IUI) cycles with husband's sperm (384 couples). Superovulation and induction monitoring occurred in the majority of cases; IUI was timed 36-40 h after ovulatory hCG. The overall pregnancy rate per cycle (PR/C) was 11.4% (107/936). Data analysis demonstrated that PR/C decreased with infertility duration, woman's age (especially after 38 years old) and number of attempts (significantly after the 4 th cycle). Superovulation (in particular by antiestrogens) and induction monitoring seemed to provide an increase in cycle pregnancy rate. Highest PR/C were observed in dysovulation and male infertility groups. In cases of sperm defects, our data showed that 2 parameters had a significant influence on pregnancy outcome: the number of motile progressive inseminated spermatozoa (> 300,000) and the spermatozoa survival rate after 24 h (> 50%). As a conclusion, intrauterine insemination can be proposed as a satisfying treatment of infertility, if precise protocol is followed and its indications well-defined.
Subject(s)
Infertility/therapy , Insemination, Artificial, Homologous/methods , Pregnancy Outcome , Adult , Female , Humans , Infertility/etiology , Male , Pregnancy , Retrospective Studies , Sperm Motility , Time FactorsABSTRACT
In a series of 500 transfers of embryos obtained by in vitro fertilization, we examined the implantation rate of 1356 embryos transferred in utero. The average implantation rate per embryo was 15.1% and remained relatively constant, regardless of the number of transferred embryos per patient. The implantation rate per embryo, in relation to its morphology, was clearly lower when irregular blastomeres and fragments were present in the perivitelline area. Other embryos, regardless of their morphology, had an identical development potential. Analysis of the results of this series demonstrates the difficulty of determining the development potential of all the embryos on the basis of morphological criteria.
Subject(s)
Embryo Implantation/physiology , Embryo, Mammalian/anatomy & histology , Embryonic and Fetal Development , Fertilization in Vitro , Embryo, Mammalian/physiology , Embryonic and Fetal Development/physiology , Female , Humans , Male , Statistics as TopicABSTRACT
Epididymal sperm aspiration is a new treatment for vasal agenesis. In previous reports, epididymal spermatozoa resulted in pregnancy by utilizing in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT). We sought to investigate the efficacy of epididymal sperm aspiration in conjunction with IVF in patients with congenital absence of the vas deferens or with secondary extended obstruction of spermatic ducts. Fifty-eight attempts were performed in 23 patients (25-50 years). Eight patients (34.7%) had vasal agenesis and 14 (60.8%) presented with vasal secondary extended obstruction. The sperm count was adequate (greater than or equal 20 x 10(6)/ml) in 13.8% of sperm retrievals and sperm motility of 20% was obtained in 15.5% of sperm retrievals. Fourteen attempts at IVF were performed with epididymal sperm counts of 2-44 x 10(6)/ml and motilities of 0-45%. A mean of six mature oocytes (0-13) were inseminated in each case. Five embryo transfers were performed in five patients' wives (35.7%) and two couples had an early pregnancy loss (14.2%). Epididymal sperm aspiration is an advance in treating such patients, as an adequate number of mature spermatozoa can be obtained and used for IVF. However, spermatozoa directly aspirated from the proximal epididymis and with fertilizing capacity in vitro, gave a high rate of embryo degeneration (greater than 50%) after embryo transfer.