ABSTRACT
OBJECTIVE: To evaluate similarities and differences in clinical and laboratory practices among high-performing fertility clinics. DESIGN: Cross-sectional questionnaire study of selected programs. SETTING: Academic and private fertility practices performing in vitro fertilization (IVF). PATIENT(S): Not applicable. INTERVENTION(S): A comprehensive survey was conducted of 13 IVF programs performing at least 100 cycles a year and having high cumulative singleton delivery rates for 2 years. MAIN OUTCOME MEASURE(S): Clinical and laboratory IVF practices. RESULT(S): Although many areas of clinical practice varied among top programs, some commonalities were observed. All programs used a combination of follicle-stimulating hormone and luteinizing hormone for IVF stimulation, intramuscular progesterone in frozen embryo transfer cycles, ultrasound-guided embryo transfers, and a required semen analysis before starting the IVF cycle. Common laboratory practices included vitrification of embryos at the blastocyst stage, air quality control with positive air pressure and high-efficiency particulate air filtration, use of incubator gas filters, working on heated microscope stages, and incubating embryos in a low-oxygen environment, most often in benchtop incubators. CONCLUSION(S): Some areas of consistency in clinical and laboratory practices were noted among high-performing IVF programs that are likely contributing to their success. High-performing programs focused on singleton deliveries. As the field of IVF is rapidly evolving, it is imperative that we share best practices in an effort to improve outcomes from all clinics for the good of our patients.
Subject(s)
Fertilization in Vitro , Practice Patterns, Physicians'/statistics & numerical data , Pregnancy Rate , Adult , Cross-Sectional Studies , Female , Fertilization in Vitro/history , Fertilization in Vitro/statistics & numerical data , Fertilization in Vitro/trends , History, 21st Century , Humans , Infertility/epidemiology , Infertility/therapy , Male , Practice Patterns, Physicians'/trends , Pregnancy , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , Retrospective Studies , Treatment Outcome , United States/epidemiologyABSTRACT
RESEARCH QUESTION: What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018? DESIGN: Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. RESULTS: Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (freshâ¯+â¯FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. CONCLUSION: The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.
Subject(s)
Pregnancy Outcome/epidemiology , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , Adult , Female , History, 20th Century , History, 21st Century , Humans , Infant, Newborn , Infertility/epidemiology , Infertility/therapy , Latin America/epidemiology , Live Birth/epidemiology , Male , Multiple Birth Offspring/statistics & numerical data , Pregnancy , Pregnancy, Multiple/statistics & numerical data , Registries , Reproductive Techniques, Assisted/statistics & numerical data , Retrospective Studies , Treatment OutcomeABSTRACT
Demand for fertility preservation in women for oncologic, nononcologic, and personal reasons has increased dramatically. Meeting that demand is a major challenge, and we are rising to the challenge. Mature oocyte cryopreservation after ovarian stimulation and ovarian tissue cryopreservation are both methods endorsed by the American Society for Reproductive Medicine (formerly The American Fertility Society), and numerous papers confirmed their efficacy. In girls and women with leukemia or cancers who are at a high risk of ovarian metastasis and who may not be eligible for ovarian tissue transplantation, restoration of fertility can only be achieved by in vitro methods. Male fertility preservation has also become a pressing issue and is extensively reviewed in the present journal issue.
Subject(s)
Fertility Preservation , Cryopreservation/history , Cryopreservation/methods , Cryopreservation/trends , Female , Fertility Preservation/history , Fertility Preservation/methods , Fertility Preservation/trends , History, 21st Century , Humans , Male , Medical Oncology/history , Medical Oncology/methods , Medical Oncology/trends , Oocytes , Ovary , Reproductive Medicine/history , Reproductive Medicine/methods , Reproductive Medicine/trends , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , Semen Preservation/history , Semen Preservation/methods , Semen Preservation/trends , Sex Characteristics , TestisABSTRACT
This commentary highlights the publishing revolution achieved by Robert Edwards in founding Reproductive Biomedicine Online. It corrects some inaccuracies in the account given by Roger Gosden in his recently published book Let There Be Life: An Intimate Portrait of Robert Edwards and His IVF Revolution.
Subject(s)
Publishing , Reproductive Techniques, Assisted , Serial Publications , Fertilization in Vitro/history , Fertilization in Vitro/trends , Governing Board , History, 20th Century , History, 21st Century , Humans , Online Systems , Publishing/history , Publishing/organization & administration , Publishing/trends , Reproduction/physiology , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , Serial Publications/history , Serial Publications/trendsABSTRACT
OBJECTIVES: The aims of the study were to reviews the history of China's population policy since 2011, and draw lessons from the Chinese experience in response to infertility. METHODS: Data from the Chinese infertility status survey report (2009) and national statistical yearbooks (2009-2019) are used to assess the severity of infertility and reproductive centers shortage in China. Lessons from China was informed by a review of existing literature. RESULTS: The proportion of couples suffering from infertility in China increased to 12.5% (166.8 million in 2009) from just 6.89% (86.6 million in 1988) two decades earlier, while the number of reproductive centers was one for every 3.1 million citizens. The total costs per live birth for medically assisted reproduction in Chinese public fertility clinics was 30,000 yuan in 2012. Among infertile couples, unemployed patients accounted for the largest proportion (21.9% in 2014). Currently in China, health regulations permit oocyte donation only from infertility patients who have 20 or more mature oocytes, of which at least 15 must be kept for their own treatment. CONCLUSION: It is necessary to integrate the reproductive health care of infertile people into the national public health service. In addition to relieving their economic burden, national policies should guide and support enterprises to guarantee employee medical leave for infertility. Growing numbers of bereaved older women who have lost their only child make it imperative to reconsider liberalizing the regulation of oocyte donation in China.
Subject(s)
Family Planning Policy , Infertility/epidemiology , Reproductive Health Services/trends , Reproductive Health/trends , Reproductive Techniques, Assisted/statistics & numerical data , Adult , Asian People/history , Asian People/statistics & numerical data , China/epidemiology , Family Planning Policy/history , Female , Fertility Clinics/history , Fertility Clinics/legislation & jurisprudence , Fertility Clinics/statistics & numerical data , History, 21st Century , Humans , Infertility/ethnology , Infertility/history , Male , Oocyte Donation/history , Oocyte Donation/legislation & jurisprudence , Oocyte Donation/statistics & numerical data , Pregnancy , Reproductive Health/history , Reproductive Health/legislation & jurisprudence , Reproductive Health Services/history , Reproductive Health Services/legislation & jurisprudence , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/legislation & jurisprudenceABSTRACT
Following early studies showing no adverse effects, cleavage stage biopsy by zona drilling using acid Tyrode's solution, and removal of single blastomeres for preimplantation genetic testing (PGT) and identification of sex in couples at risk of X-linked disease, was performed by Handyside and colleagues in late 1989, and pregnancies reported in 1990. This method was later used for specific diagnosis of monogenic conditions, and a few years later also for chromosomal structural and/or numerical impairments, thereby establishing a valuable alternative option to prenatal diagnosis. This revolutionary approach in clinical embryology spread worldwide, and several other embryo biopsy strategies developed over three decades in a process that is still ongoing. The rationale of this narrative review is to outline the different biopsy approaches implemented across the years in the workflow of the IVF clinics that provided PGT: their establishment, the first clinical experiences, their downsides, evolution, improvement and standardization. The history ends with a glimpse of the future: minimally/non-invasive PGT and experimental embryo micromanipulation protocols. This grand theme review outlines a timeline of the evolution of embryo biopsy protocols, whose implementation is increasing worldwide together with the increasing application of PGT techniques in IVF. It represents a vade mecum especially for the past, present and upcoming operators and experts in this field to (re)live this history from its dawn to its most likely future.
Subject(s)
Embryo, Mammalian/pathology , Genetic Testing/history , Preimplantation Diagnosis/history , Preimplantation Diagnosis/trends , Biopsy/history , Biopsy/methods , Biopsy/trends , Embryo Research/history , Embryo, Mammalian/cytology , Female , Genetic Testing/methods , History, 20th Century , History, 21st Century , Humans , Male , Pregnancy , Preimplantation Diagnosis/methods , Prenatal Diagnosis/history , Prenatal Diagnosis/methods , Prenatal Diagnosis/trends , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trendsABSTRACT
Invited talks of old scientists are standard parts of international meetings, just like opening ceremonies, selection of committees and cocktail parties. Typically, senior scientists and emeritus professors prepare seemingly important and scientifically correct lectures about the great pioneers and past achievements of a given discipline. In fact, these speeches are usually meaningless and extremely boring. Kind of polite acknowledgments of the past contribution of the old guy who is already unable to provide any news to the audience. Farewells, just before the obituary. I am not sure I can make it more interesting, but at least give it a try by focusing on negative events: controversies, fiascos, and absurdities that have hampered the advancement - some of them up till today. I will make efforts to be sincere and sharp; I apologize for the biased and close to sarcastic tone in some statements. I will also talk a lot about the human field, as the two areas are strongly related, and in fact, the in vivo experiences and achievements in humans vastly surpass those in domestic species in most countries. I will not go back to historical ages, just start with my personal experiences since 1990, although it may still seem to be medieval for most of the audience.
Subject(s)
Reproductive Techniques, Assisted/veterinary , Vitrification , Animals , History, 20th Century , History, 21st Century , Humans , Reproductive Techniques, Assisted/economics , Reproductive Techniques, Assisted/historyABSTRACT
In vitro fertilization can be considered as causative factor of increasing rate of multiple pregnancies. Analysis of factors contributing to reduction in the percentage of multiple pregnancies may contribute to overall improvement of ART results. We compared annual reports from The Australian and New Zealand Assisted Reproduction Database and US National Summary Reports presented by The Centers for Disease Control and Prevention. The aim of this study was to analyze results of ART outcomes in two countries presenting opposite approach to ART, particularly to number of transferred embryos and number of eSETs (elective single embryo transfers). We found significant increase in total number of initiated cycles and transfers with significant shift toward frozen cycles and transfers in both countries. Percentage of eSET increased while average number of embryos transferred per one transfer decreased significantly in both countries without significant difference between countries. We also noticed significant decrease in the rate of multiple pregnancies and percentage of pregnancies resulting in triplets in Australia with New Zealand. Decreasing number of multiple pregnancies and higher percentage of transfers and pregnancies resulting in singleton live birth are the changes in ART politics found in our analysis. United States of America have more significant changes toward eSET, although Australia and New Zealand have significantly higher percentage of eSET from the beginning of analysis.
Subject(s)
Pregnancy Outcome/epidemiology , Reproductive Techniques, Assisted/statistics & numerical data , Adult , Australia/epidemiology , Female , History, 21st Century , Humans , Infant, Newborn , Live Birth/epidemiology , Male , New Zealand/epidemiology , Pregnancy , Pregnancy Rate/trends , Pregnancy, Multiple/statistics & numerical data , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , Single Embryo Transfer/statistics & numerical data , Treatment Outcome , United States/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Animals , Male , Female , History, Ancient , History, Medieval , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, 21st Century , Andrology/history , Reproduction/physiology , Infertility, Male/history , Reproductive Techniques, Assisted/historySubject(s)
Endocrinology , Faculty, Medical , Laboratory Personnel , Reproductive Techniques, Assisted , Endocrinology/history , Faculty, Medical/history , Female , History, 20th Century , History, 21st Century , Humans , Infertility/drug therapy , Kisspeptins/therapeutic use , Laboratory Personnel/history , Male , Pregnancy , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , United KingdomSubject(s)
Neonatology , Physicians , Reproductive Techniques, Assisted , Female , Fertility Preservation/history , Fetomaternal Transfusion/history , France , History, 20th Century , History, 21st Century , Humans , Infant, Newborn , Medical Laboratory Personnel/history , Neonatology/history , Physicians/history , Pregnancy , Reproductive Techniques, Assisted/historySubject(s)
Cryopreservation/methods , Embryo Culture Techniques/history , Embryo Culture Techniques/trends , Fertility Preservation/methods , Oocytes/cytology , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trends , Female , Fertilization in Vitro/methods , History, 20th Century , Humans , Italy , Pregnancy , Reproductive Techniques, Assisted/legislation & jurisprudence , VitrificationABSTRACT
In recent decades we have witnessed unprecedented progress in the field of the developmental biology of mammals. Building on 20th century discoveries, we have managed to increase our understanding of the molecular and cellular mechanisms governing early mammalian embryogenesis and link them to other biological questions, such as stem cells, regeneration, cancer, or tissue and organ formation. Consequently, it has also led to a creation of a completely new branch of reproductive medicine, i.e. assisted reproductive technology (ART). In this Special Issue of The International Journal of Developmental Biology (Int. J. Dev. Biol.) we wished to review state-of-the-art research regarding early mammalian development, from fertilization up to the implantation stage, and discuss its potential meaning for practical applications, including ART. As an introduction to the issue we present a compilation of short essays written by the most renowned scientists in the field, working both in basic and clinical research. The essays are dedicated to the greatest breakthroughs and challenges of 21st century developmental biology and reproductive medicine.
Subject(s)
Developmental Biology/history , Reproductive Medicine/history , Animals , Cell Lineage , Developmental Biology/trends , Embryo Implantation , Embryonic Stem Cells , Fertilization , History, 20th Century , History, 21st Century , Humans , Reproductive Medicine/trends , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/trendsABSTRACT
To analyze the management of severe ovarian hyperstimulation syndrome based on aspects of its etiology and pathogenesis a systematic review of the literature was done. An evaluation of clinical trials, meta-analysis, case-reports and reviews assessing the management of different conditions related to ovarian hyperstimulation syndrome was made using the following data sources: MEDLINE Pubmed (from 1966 to July 2018) and the Cochrane Controlled Clinical Trials Register, Embase (up to July 2018). The role of intra-abdominal hypertension in the development of the severe forms of ovarian hyperstimulation syndrome and its complicated outcomes was assessed. The pathophysiology and clinic of intra-abdominal hypertension syndrome are almost identical to moderate and severe forms of ovarian hyperstimulation syndrome and associated organ dysfunction. The classic triad (respiratory disorders, reduction in venous return, and restriction of perfusion in internal organs) is present in severe ovarian hyperstimulation syndrome as well as in intra-abdominal hypertension syndrome. This review provides recommendations for the management of ovarian hyperstimulation syndrome and insight into the different medical complaints of this syndrome. The principles of therapy for intra-abdominal hypertension syndrome might be considered in the treatment of severe forms of ovarian hyperstimulation syndrome.
Subject(s)
Ovarian Hyperstimulation Syndrome , Female , History, 20th Century , History, 21st Century , Humans , Ovarian Hyperstimulation Syndrome/diagnosis , Ovarian Hyperstimulation Syndrome/epidemiology , Ovarian Hyperstimulation Syndrome/etiology , Ovarian Hyperstimulation Syndrome/therapy , Ovulation Induction/adverse effects , Ovulation Induction/methods , Pregnancy , Reproductive Techniques, Assisted/adverse effects , Reproductive Techniques, Assisted/history , Reproductive Techniques, Assisted/statistics & numerical data , Reproductive Techniques, Assisted/trends , Treatment OutcomeABSTRACT
Jean Purdy is almost forgotten as one of the British trio that introduced clinical IVF to the world. An unlikely pioneer, she qualified as a nurse but through indefatigable effort and unstinting loyalty to a programme that faced vitriolic opposition she became the clinical embryologist for the first IVF baby. In 1980, she helped to launch fertility services as the 'Technical Director' of Bourn Hall Clinic, near Cambridge. Although Robert Edwards and Patrick Steptoe generously credited her role in research and clinical care, a premature death in 1985 at age 39 robbed her of the reward of witnessing the blossoming of assisted reproductive technologies for patients around the world. This commentary seeks to recognize her contribution and bring her name to the attention of professionals in reproductive medicine and the patients they care for.
Subject(s)
Fertilization in Vitro/history , Reproductive Techniques, Assisted/history , England , History, 20th Century , HumansABSTRACT
Life is like riding a bicycle, to keep your balance you must keep moving. -Albert Einstein.