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4.
Am J Public Health ; 110(9): 1418-1420, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673116

RESUMO

Objectives. To measure trends in infertility treatment use between 2008 and 2017 in France using data from the national health insurance system.Methods. Between 2008 and 2017, we observed a representative national sample of nearly 1% of all women aged 20 to 49 years who were affiliated with the main health insurance scheme in France (more than 100 000 women observed each year). We exhaustively recorded all health care reimbursed to these women.Results. Among women aged 20 to 49 years, 1.25% were treated for infertility each year. Logistic regression analysis showed a significant interaction between age and year of treatment use (P < .001). Over the decade, infertility treatment use increased by 23.9% among women aged 34 years or older, whereas among women younger than 34 years there was a nonsignificant variation.Conclusions. Women aged 34 years or older were increasingly treated for infertility between 2008 and 2017.Public Health Implications. Treatment efficiency decreases strongly with a woman's age, presenting a challenge for medical infertility care.


Assuntos
Fatores Etários , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Técnicas de Reprodução Assistida/tendências , Adulto , Feminino , França/epidemiologia , Humanos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos
5.
Adv Exp Med Biol ; 1195: 177, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32468475

RESUMO

In recent years, popular culture has been graced with countless news announcing novel developments in genome editing. While many experiments are still in their early stages, genome editing seems very promising. Often betraying a sensationalist and triumphant tone, news coverage focuses on the potentials that these developments will have for the advancement of the human species, i.e., the eradication of disease, the extension of life, the improvement of the body and its appearance, etc. The future looks hopeful and unproblematic according to these accounts. On the opposite end of the spectrum, some may wonder whether these developments pose a potential worsening of the human condition: Are these developments safe? What are the ethical implications? Who will benefit from these developments? Given today's social divisions and cultural conflicts, these voices predict a rather unpromising future and warn against the pursue of innovation at any cost.


Assuntos
Arte , Edição de Genes/ética , Edição de Genes/tendências , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/tendências , Sistemas CRISPR-Cas , Humanos
6.
Urol Clin North Am ; 47(2): 257-270, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32272997

RESUMO

The male contribution to infertility has traditionally been overlooked, or at best oversimplified. In recent years efforts have been made to optimize diagnostic and therapeutic techniques to maximize fertility outcomes. A renewed focus on the male partner has resulted in an increased understanding of both genetic and epigenetic changes within the male germline. Furthermore, single-nucleotide polymorphisms, copy-number variants, DNA damage, sperm cryopreservation, obesity, and paternal age have recently been recognized as important factors that play a role in male fertility. Developing a deeper knowledge of these issues could potentially lead to improved success with assisted reproductive technology.


Assuntos
Epigênese Genética/genética , Fertilização In Vitro/tendências , Infertilidade Masculina/genética , Infertilidade Masculina/terapia , Obesidade/genética , Herança Paterna/genética , Fatores Etários , Criopreservação , Dano ao DNA/genética , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/métodos , Previsões , Humanos , Infertilidade Masculina/etiologia , Masculino , Mutação , Obesidade/complicações , Polimorfismo Genético/genética , Técnicas de Reprodução Assistida/efeitos adversos , Técnicas de Reprodução Assistida/tendências
7.
Fertil Steril ; 113(3): 500-509, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32111477

RESUMO

Since the birth of the first child conceived via in vitro fertilization 40 years ago, fertility treatments and assisted reproductive technology have allowed many couples to reach their reproductive goals. As of yet, no fertility options are available for men who cannot produce functional sperm, but many experimental therapies have demonstrated promising results in animal models. Both autologous (stem cell transplantation, de novo morphogenesis, and testicular tissue grafting) and outside-the-body (xenografting and in vitro spermatogenesis) approaches exist for restoring sperm production in infertile animals with varying degrees of success. Once safety profiles are established and an ideal patient population is chosen, some of these techniques may be ready for human experimentation in the near future, with likely clinical implementation within the next decade.


Assuntos
Técnicas de Reprodução Assistida/tendências , Espermatogênese/fisiologia , Testículo/transplante , Pesquisa Médica Translacional/tendências , Animais , Criança , Criopreservação/métodos , Fertilização In Vitro , Humanos , Técnicas In Vitro , Infertilidade Masculina/patologia , Infertilidade Masculina/fisiopatologia , Infertilidade Masculina/terapia , Masculino , Espermatozoides
8.
Fertil Steril ; 113(3): 478-488, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32089255

RESUMO

The complexity of male reproductive impairment has hampered characterization of the underlying genetic causes of male infertility. However, in the last 20 years, more powerful and affordable tools to interrogate the genetic and epigenetic determinants of male infertility have accelerated the number of new discoveries in the characterization of male infertility. With this explosion of new data, integration in a systems-based approach-including complete phenotypic information-to male infertility is imperative. We briefly review the current understanding of genetic and epigenetic causes of male infertility and how findings may be translated into a practical component for the diagnosis and treatment of male infertility.


Assuntos
Big Data , Epigenômica/métodos , Infertilidade Masculina/genética , Técnicas de Reprodução Assistida/tendências , Análise Mutacional de DNA/métodos , Análise Mutacional de DNA/tendências , Epigênese Genética/fisiologia , Epigenômica/tendências , Sequenciamento de Nucleotídeos em Larga Escala/tendências , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/terapia , Masculino , Polimorfismo Genético , Análise de Sequência de DNA/tendências
9.
Bioethics ; 34(1): 16-32, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31877579

RESUMO

Potential applications of genome editing in assisted reproductive technology (ART) raise a vast array of strong opinions, emotional reactions and divergent perceptions. Acknowledging the need for caution and respecting such reactions, we observe that at least some are based on either a misunderstanding of the science or misconceptions about the content and flexibility of the existing legal frameworks. Combining medical, legal and ethical expertise, we present and discuss regulatory responses at the national, European and international levels. The discussion has an EU starting point and is meant as a contribution to the general international regulatory debate. Overall, this paper concludes that gene editing technologies should not be regulated autonomously. Rather, potential uses should be regulated under general, existing frameworks and where applicable by reference to sufficiently equivalent technologies and techniques already subject to specific regulation. To be clear, we do not argue for the hasty introduction of gene editing as a reproductive treatment option in the immediate future. We call for caution with regard to overreaching moratoria and prohibitions that will also affect basic research. We recommend flexible regulations that allow for further responsible research into the potential development of the technology. We call for an open and inclusive debate and argue that scientific communication should claim a more prominent role to counter the danger of widespread misinformation. A high level of transparency and accuracy should guide scientific communication while simultaneously global-scale responsibility and governance should be fostered by promoting cross-disciplinary thinking and multi-level stakeholder involvement in legal and regulatory processes.


Assuntos
Edição de Genes/ética , Edição de Genes/legislação & jurisprudência , Células Germinativas , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/legislação & jurisprudência , Difusão de Inovações , Pesquisas com Embriões/ética , União Europeia , Edição de Genes/tendências , Humanos , Direito Internacional , Técnicas de Reprodução Assistida/tendências
10.
Eur Child Adolesc Psychiatry ; 29(8): 1155-1164, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31686240

RESUMO

Evidence regarding the psychiatric morbidity of children born after Assisted Reproductive Techniques (ART) is inconsistent and limited. While normal mental well-being for ART children is usually reported, concerns are still being raised. Previous studies examine only some psychiatric disorders, but not all of them, ignore the impact of multiplicity, and limit the follow-up time to childhood. We examined all psychiatric diagnoses for singletons until their young adulthood. The aim was to study whether the risk of psychiatric disorders differs between ART and spontaneously conceived (SC) singletons until young adulthood. This retrospective Finnish population-based register study includes all ART and SC live-born children born in Finland during 1990-2013 and their hospital care in 1990-2014 (n = 1,425,975 of which 1,385,956, 97.2% were singletons). After excluding multiples, the final population included 17,610 ART and 1,368,346 SC singletons in 1990-2013 from the Finnish Medical Birth Registry. These data were linked to the Finnish Hospital Discharge Registry with the child's and mother's encrypted IDs. ART singletons had fewer psychiatric diagnoses (ART 10.2%, n = 1796, SC 12.0%, n = 164,408), but they received their diagnoses earlier (mean 8.3 years old, SD 5.0) than SC singletons (mean 10.5 years old, SD 5.7). After adjusting for confounding factors, ART singletons had an increased likelihood of getting a psychiatric diagnosis until young adulthood and the results were similar for boys (adjusted hazard ratios [aHR] = 1.16, 95% confidence interval (CI) 1.10-1.24) and girls (aHR = 1.25, 95% CI 1.16-1.35). We conclude that ART children receive their psychiatric diagnoses earlier than SC children, in particular during childhood and early adolescence. After adjusting for confounding factors ART children a slightly increased likelihood of any psychiatric diagnosis compared to SC controls.


Assuntos
Transtornos Mentais/etnologia , Técnicas de Reprodução Assistida/tendências , Criança , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Sistema de Registros , Estudos Retrospectivos
13.
Fertil Steril ; 112(6): 1136-1143.e4, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31843090

RESUMO

OBJECTIVE: To study social and demographic differentiation of assisted reproduction technology (ART) use at the population level in the United States. DESIGN: Population-based study. SETTING: Not applicable. PATIENT(S): Women 15-49 years old in the American Community Survey and National Vital Statistics Birth Certificate data from 2010-2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Birth rate after ART by major sociodemographic categories and likelihood of having an ART birth. RESULT(S): Net of education, age, period, and marital status, the incidence rates of ART births are lower for black women (0.57 times; 95% CI, 0.52-0.62) and Hispanic women (0.67 times; 95% CI, 0.57-0.62) relative to white women's rates; for Asian women, the incidence rates are 1.21 times that of white women's rates. Further, the incidence rates of ART births are higher for women with more than a 4-year degree (2.08 times; 95% CI, 1.90-2.27) relative to women with a 4-year degree, and are lower for women with less education. Women who are married have an incidence rate of ART that is 5.72 times (95% CI, 5.37-6.09) that of unmarried women. The incidence rates for 2013-2016 are statistically significantly higher than for 2010 by a factor of 1.16 (95% CI, 1.02-1.31), 1.16 (95% CI, 1.03-1.31), 1.27 (95% CI, 1.12-1.43), and 1.51 (95% CI, 1.43-1.82), respectively. The educational differences in ART exist across all age groups from 20 to 49, but are the largest among the 35-39 and 40-44 age groups. CONCLUSION(S): Large differences in the risk of an ART birth and the proportion of births and the total fertility rate due to ART exist across period, age, race, education, and marital status groups in the United States. Current measures of ART births may disguise an unmet need for ART.


Assuntos
Disparidades em Assistência à Saúde/tendências , Infertilidade/terapia , Técnicas de Reprodução Assistida/tendências , Determinantes Sociais da Saúde/tendências , Fatores Socioeconômicos , Adolescente , Adulto , Fatores Etários , Grupos de Populações Continentais , Escolaridade , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Infertilidade/etnologia , Infertilidade/fisiopatologia , Nascimento Vivo , Estado Civil , Pessoa de Meia-Idade , Gravidez , Determinantes Sociais da Saúde/etnologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
14.
Best Pract Res Clin Endocrinol Metab ; 33(6): 101369, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31837981

RESUMO

Infertility consists by definition in" failure to achieve a clinical pregnancy after 12 months or more of regular unprotected intercourse" while the term subfertility means a delay to achieve pregnancy. Several factors can contribute to infertility or subfertility in patients with systemic autoimmune diseases. The association of systemic autoimmune conditions with endometriosis, celiac disease and thyroid autoimmunity that are well known causes of infertility and/or subfertility need to be taken in consideration when difficulties in the onset of pregnancy is reported. The majority of the used antirheumatic drugs do not interfere with fertility. However, the use of cyclophosphamide, limited to severe disease, can provoke premature ovarian failure; to preserve fertility a preventive treatment is available. Nonsteroidal anti-inflammatory drugs can cause temporary infertility and corticosteroids are associated to a prolonged time to pregnancy in some rheumatic diseases. Data on the association of antiphospholipid antibodies (aPL) with infertility are still debated but in general an increased rate of aPL is described patients undergoing medically assisted reproductive techniques. In systemic lupus erythematosus aPL and other autoantibodies (i.e. anti-oocytes) can contribute to the infertility of some patients. Subfertility, rather than infertility, is observed in patients with rheumatoid arthritis; the particular physical conditions of these women can also account for this. Physicians should not forget the patients' age, that is mandatory in order to preserve their chance to have children.


Assuntos
Doenças Autoimunes/complicações , Infertilidade Feminina/etiologia , Insuficiência Ovariana Primária/etiologia , Anticorpos Antifosfolipídeos/sangue , Autoanticorpos/efeitos adversos , Autoanticorpos/sangue , Doenças Autoimunes/terapia , Autoimunidade/fisiologia , Criança , Endometriose/complicações , Endometriose/imunologia , Endometriose/terapia , Feminino , Humanos , Recém-Nascido , Infertilidade Feminina/imunologia , Infertilidade Feminina/terapia , Gravidez , Insuficiência Ovariana Primária/imunologia , Insuficiência Ovariana Primária/terapia , Técnicas de Reprodução Assistida/tendências , Glândula Tireoide/imunologia
15.
J Assist Reprod Genet ; 36(12): 2447-2457, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786731

RESUMO

PURPOSE: To provide a global scale report on a representative sample of the clinical embryology community depicting the practice of discarding supernumerary IVF embryos. METHODS: A web-based questionnaire titled "Anonymous questionnaire on embryo disposal practices" was designed in order to ensure anonymous participation of practicing clinical embryologists around the world. RESULTS: During a data collection period of 8 months, 703 filled-in questionnaires from 65 countries were acquired. According to the data acquired, the majority of practitioners, dispose of embryos by placing them directly in a trash can strictly dedicated for embryo disposal for both fresh and frozen cycles (39% and 36.7% respectively). Moreover, 66.4% of practitioners discard the embryos separately-case by case-at different time points during the day. Over half of embryologists (54%) wait until day 6 to discard the surplus embryos, while 65.5% do not implement a specially allocated incubator space as a designated waiting area prior to disposal. The majority of 63.1% reported that this is a witnessed procedure. The vast majority of embryologists (93%) do not employ different protocols for different groups of patients. Nonetheless, 17.8% reported the request to perform a ceremony for these embryos. Assessing the embryologists' perspective, 59.5% of participants stated that the embryology practice would benefit from a universally accepted and practiced protocol. CONCLUSION(S): This study uniquely provides insight into global embryo disposal practices and trends. Results highlight the divergence between reported practices, while indicating the significance on standardization of practice, with embryologists acknowledging the need for a universally accepted protocol implementation.


Assuntos
Tomada de Decisões , Destinação do Embrião , Fertilização In Vitro/tendências , Técnicas de Reprodução Assistida/tendências , Humanos , Inquéritos e Questionários
18.
CRISPR J ; 2(5): 304-315, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31599685

RESUMO

Germline genome editing (GGE) holds the potential to mitigate or even eliminate human heritable genetic disease, but also carries genuine risks if not appropriately regulated and performed. It also raises fears in some quarters of apocalyptic scenarios of designer babies that could radically change human reproduction. Clinical need and the availability of alternatives are key considerations in the ensuing ethical debate. Writing from the perspective of a fertility clinic, we offer a realistic projection of the demand for GGE. We lay out a framework proposing that GGE, hereditary genetic disorders, and in vitro fertilization are fundamentally entwined concepts. We note that the need for GGE to cure heritable genetic disease is typically grossly overestimated, mainly due to the underappreciated role of preimplantation genetic testing. However, we might still find applications for GGE in the correction of chromosomal abnormalities in early embryos, but techniques for that purpose do not yet exist.


Assuntos
Fertilização In Vitro/tendências , Edição de Genes/ética , Engenharia Genética/ética , Feminino , Fertilização In Vitro/ética , Engenharia Genética/tendências , Testes Genéticos , Células Germinativas/transplante , Humanos , Gravidez , Diagnóstico Pré-Implantação/ética , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/tendências
19.
Fertil Steril ; 112(5): 908-921, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31594631

RESUMO

OBJECTIVE: To systematically review reproductive outcomes of assisted reproductive technology (ART) treatment in women transplanted with frozen-thawed ovarian tissue. DESIGN: Systematic review in accordance with guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). SETTING: Not applicable. PATIENT(S): Women undergoing ovarian tissue transplantation (OTT) and subsequent ART. INTERVENTION(S): Literature search in PubMed and Scopus databases. MAIN OUTCOME MEASURE(S): Time from OTT to initiation of ART, stimulation protocol, and conventional ART outcome measures. RESULT(S): Twenty studies (including 15 case reports), specifying ART treatments and outcomes of 40 women undergoing OTT were identified. Multiple stimulation protocols were applied, with the modified natural cycle as the most frequently used. In total, 195 ART cycles were performed (4.0 cycles per patient) resulting in 1.5 follicles and 1.0 mature oocyte retrieved per cycle. Empty follicle rates ranged from 23% to 35% in the three largest cohort studies. Twenty-five women (62.5%) had one or more pregnancies, of which 28.6% were lost, resulting in a total of 20 live births (22 children). Overall the pregnancy rates varied from 3.9% to 19.3% and live-birth rates from 3.9% to 14.0% per cycle in the three cohort studies. Fertility treatment was initiated shortly after OTT in some centers, while others awaited natural conception before embarking on ART treatment. CONCLUSION(S): The reported pregnancy and live-birth rates for women undergoing OTT and ART were considerably lower than those of the general in vitro fertilization (IVF) population, corresponding to patients with poor ovarian reserve. In general, ART outcomes are underreported, and there is a lack of consensus regarding the timing of ART in relation to OTT and the type of ovarian stimulation protocol.


Assuntos
Criopreservação/métodos , Nascimento Vivo/epidemiologia , Reserva Ovariana/fisiologia , Ovário/fisiologia , Ovário/transplante , Indução da Ovulação/métodos , Estudos de Coortes , Feminino , Humanos , Indução da Ovulação/tendências , Gravidez , Técnicas de Reprodução Assistida/tendências
20.
Fertil Steril ; 112(5): 858-865, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31594633

RESUMO

OBJECTIVE: To investigate assisted reproductive technology (ART) outcomes in a female-to-male transgender cohort and compare the results with those of a matched cisgender cohort. DESIGN: Matched retrospective cohort study. SETTING: In vitro fertilization clinic. PATIENT(S): Female-to-male transgender patients (n = 26) who sought care from 2010 to 2018. A cisgender cohort (n = 130) was matched during the same time period by age, body mass index, and antimüllerian hormone levels. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Cycle outcomes, including oocyte yield, number of mature oocytes, total gonadotropin dose, and peak E2 levels. RESULT(S): The mean number of oocytes retrieved in the transgender group was 19.9 ± 8.7 compared with 15.9 ± 9.6 in the cisgender group. Peak E2 levels were the same between the two groups. The total dose of gonadotropins used was higher in the transgender group compared with the cisgender group (3,892 IU vs. 2,599 IU). Of the 26 patients, 16 performed oocyte banking only. Seven couples had fresh or frozen transfers, with all achieving live births. CONCLUSION(S): This is the first study of this size investigating ART outcomes in female-to-male transgender patients. The findings may serve to reassure transgender patients and their care providers that outcomes can be excellent even if testosterone therapy has already been initiated. Further investigation needs to be performed on the generalizability of these findings, and whether similar results can be achieved without stopping testosterone therapy.


Assuntos
Preservação da Fertilidade/métodos , Indução da Ovulação/métodos , Medicina Reprodutiva/métodos , Pessoas Transgênero , Adolescente , Adulto , Estudos de Coortes , Feminino , Preservação da Fertilidade/tendências , Humanos , Masculino , Indução da Ovulação/tendências , Medicina Reprodutiva/tendências , Técnicas de Reprodução Assistida/tendências , Estudos Retrospectivos , Adulto Jovem
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