Older first-time mothers and early postpartum depression: a prospective cohort study of women conceiving spontaneously or with assisted reproductive technologies.

OBJECTIVE: To evaluate whether older first-time mothers (≥37 years) have higher rates of postpartum depression compared with younger first-time mothers, controlling for mode of conception and known risk factors for postpartum depression. DESIGN: Prospective cohort study. SETTING: Assisted reproductive technology (ART) clinics in two large Australian cities and public and private antenatal clinics and/or classes in the vicinity of ART clinics. PATIENT(S): Nulliparous women who had conceived spontaneously (n = 295) or through ART (n = 297) in three age-groups: younger, 20 to 30 years (n = 173); middle, 31 to 36 years (n = 214); and older, ≥37 years (n = 189). INTERVENTION(S): Semistructured interviews and questionnaires. MAIN OUTCOME MEASURE(S): Major depressive disorder in the first 4 months after birth as assessed by structured diagnostic interview. RESULT(S): The study performed 592 complete pregnancy assessments and 541 postpartum assessments. The prevalence of major depressive disorder was 7.9%, at the lower end of community rates. Neither maternal age-group nor mode of conception was statistically significantly related to depression. CONCLUSION(S): Older first-time mothers, whether conceiving through ART or spontaneously, do not show increased vulnerability to postnatal depression.

Primate model of metaphase I oocyte in vitro maturation and the effects of a novel glutathione donor on maturation, fertilization, and blastocyst development.

OBJECTIVE: To assess the effect of glutathione ethyl ester (GSH-OEt) on the development of macaque metaphase (MI) oocytes as a model for human MI oocyte in vitro maturation (IVM). DESIGN: Prospective cohort study. SETTING: Nonhuman primate assisted reproductive technology program. ANIMAL(S): Twenty-three Macaca fascicularis females aged 6.5-12.5 years. INTERVENTION(S): Ovarian stimulation and maturation of MI oocytes in [1] human tubal fluid (HTF), [2] mCMRL-1066, [3] mCMRL-1066+GSH-OEt 3 mM, or [4] mCMRL-1066+GSH-OEt 5 mM. Oocytes were assessed for maturation after 4-6 hours (early) and 18-20 hours (late) of culture. Mature oocytes were inseminated or subjected to glutathione (GSH) assay. Zygotes were cultured to the blastocyst stage for total differential cell counts. MAIN OUTCOME MEASURE(S): Oocyte maturation rate, GSH content, pronuclear formation and blastocyst development, and cell number were compared between IVM treatment groups and sibling in vivo matured (IVO) MII oocytes. RESULT(S): Compared with HTF, mCMRL-1066 supported higher rates of normal fertilization and blastocyst development in early but not late maturing MI-MII oocytes. Five micromoles of GSH-OEt significantly increased blastocyst total cell and inner cell mass cell number in early MI-MII oocytes compared with IVO and IVM controls. GSH-OEt significantly increased oocyte GSH content and fertilization in late maturing oocytes but not blastocyst development. CONCLUSION(S): GSH-OEt positively affects the development of early and late maturing IVM oocytes.

Attitudes of couples with stored frozen embryos toward conditional embryo donation.

OBJECTIVE: To survey clients with stored frozen embryos regarding intention to donate embryos to other couples and attitudes toward conditional donation. DESIGN: Anonymous postal questionnaire. SETTING: A private IVF clinic in Sydney, Australia. PATIENT(S): Clients with embryos stored for 3 or more years. INTERVENTION(S): Patients completed a survey regarding attitudes to embryo donation and conditional embryo donation. Spontaneous written comments were also analyzed. MAIN OUTCOME MEASURE(S): Intentions regarding embryos, attitudes toward conditional donation, extent to which conditional donation would influence decision-making. RESULT(S): Of the clients surveyed, 99 women (35%) and 66 men (23%) responded. Only 4% indicated it was likely they would donate to other couples; 48% thought donors should be able to specify characteristics of recipients; and 41% indicated they would be more likely to donate if donation was conditional. A sense of ownership and responsibility for the well-being of the offspring underpinned reluctance to donate. Perceived control over the caretaking environment was seen as an advantage of conditional donation. Concerns were also raised about the need for donors to relinquish control and the potential for discrimination. CONCLUSION(S): An empirical understanding of the views of infertility patients regarding stored embryos is critical to informing public discourse, policy debates, and clinical practice as well as counseling, policy, and protocols on embryo donation.

Embryo donation for medical research: attitudes and concerns of potential donors.

BACKGROUND: The recent derivation of embryonic stem cell lines from human blastocysts and related implications for regenerative medicine has intensified a longstanding debate about the use of human embryos for research purposes. However, studies have shown that few couples with stored embryos opt to donate them for research. Herein, the attitudes and concerns of potential embryo donors to donation of surplus embryos for medical research were examined. METHODS: From a total of 509 couples who had stored frozen embryos and who had received a questionnaire about embryo donations for medical research, 152 women (30%) and 123 male partners (24%) responded. Embryos had been stored for a mean of 2.25 years (range 3 months to 12 years). RESULTS: Some 10% of respondents indicated it probable, and 34% possible, that they would donate their surplus embryos for research in the future. Women respondents whose embryos had been stored longer, and those committed to the practice of a religion, were more worried about their embryos. Respondents positively disposed to donation commented on their desire not to waste embryos, a desire to help infertile couples, and/or to advance scientific knowledge. Those with negative views commented on the embryo as a potential child and expressed concerns about a perceived lack of control over the type of research to be carried out. CONCLUSIONS: Findings indicate a need for tailored education and counselling about embryo donation for medical research.

Risk factors for strong regret and subsequent IVF request after having tubal ligation.

OBJECTIVES: To identify and describe pre-sterilisation characteristics most consistently associated with intensive post-sterilisation regret and subsequent request for IVF. DESIGN: Case control study. SETTING: Fertility clinic in a tertiary referral urban hospital, Sydney, Australia. SAMPLE CASES: Ninety-seven sterilised women who underwent evaluation for IVF during the period 1986-1996; CONTROLS: 101 sterilised women who remained satisfied with their tubal ligation. MAIN OUTCOME MEASURES: Variables known at the time of sterilisation including age, number of living children, history of abortion, underlying medical diseases, marital status, race, education, and timing of sterilisation. RESULTS: In the multivariate analysis of data, age at the time of sterilisation had the most pronounced effect on strong regret. Women younger than 30 years old at the time of sterilisation were more likely to request IVF treatment than women 30 to 34 years old. A concurrent caesarean section was associated with a threefold risk (95% CI, 1.05-10.03) relative to an interval procedure. A strong protective effect (OR = 0.07; 95% CI, 0.01-0.65) was found for women with more than two children compared to childless women. The overwhelming reason stated by women requesting IVF was change in marital status, and the desire to have a child with the new partner. CONCLUSIONS: Women with such characteristics who are considering tubal ligation need further caution and counselling.