Journal: Human fertility (Cambridge, England)
The objective was to determine the likelihood of conceiving spontaneously following cessation of IVF/ICSI; how long does it take and what factors are associated with conception? The design was an internet-based survey. All registered users of www.ivf-infertility.com received an electronic questionnaire addressing issues relating to the duration and cause of infertility, number of IVF/ICSI cycles and outcome, whether they conceived following cessation of IVF/ICSI and the time taken to conceive and outcome. Four hundred and eighty four patients responded of whom 403 met the study criteria. The overall cumulative live birth rate over a 6-year period following cessation of IVF/ICSI was 29%. Eighty-two percent of conceptions occurred within 2 years. Positive factors associated with spontaneous conception were unexplained infertility (p = 0.02), ovulation dysfunction (p = 0.01), infertility less than four years prior to IVF/ICSI (p = 0.045) and 2 years or less since discontinuation of IVF/ICSI (p < 0.001) and up to four attempts at IVF/ICSI (p = 0.02). In conclusion, 29% of couples conceived spontaneously over a 6-year period following the cessation of IVF/ICSI. The findings of this study can be used to counsel and reassure women following IVF/ICSI.
Before planning an assisted conception treatment cycle, a thorough assessment of the woman’s hormone profile and ovarian reserve is essential to aid the decision on the appropriate protocol for controlled ovarian hyperstimulation (COH). There is insufficient evidence to recommend the use of one type of gonadotrophins over another. There is no benefit of luteinising hormone (LH) supplementation in cycles stimulated with follicle stimulating hormone alone in an unselected population. There is some evidence to suggest a potential benefit of LH supplementation in patients with a history of poor ovarian response to stimulation and in those older than 35 years. The long gonadotrophin releasing hormone (GnRH) agonist protocol is the most widely used and is the preferred protocol in the unselected population of women undergoing COH for in vitro fertilisation or intra-cytoplasmic sperm injection. The GnRH antagonist protocol is best used for known or suspected high responders, including women with PCOS, as it reduces the risk of OHSS. There is a lack of robust evidence to suggest that the GnRH agonist protocol is better than the GnRH antagonist protocol in poor responders. The prolonged GnRH agonist protocol is advantageous in women who are undergoing COH due to pelvic endometriosis. Oral contraceptive pill pre-treatment adversely affects the IVF outcome in GnRH antagonist cycles, but not in GnRH agonist cycles.
This article explores the implications of reproductive mishaps for the life courses of women in eastern Cameroon. Based on 15 months of anthropological fieldwork in a Gbigbil village, it describes local ideas about the expected unfolding of physical and social life trajectories, and the ways in which reproductive losses jeopardize these anticipated pathways. The life history of one informant shows that repeated child death can create a paradoxical situation in which a woman feels, at the same time, physically old and socially young, and that decisions for the future are informed by these contradictory sensations. The particular dynamics brought about by reproductive loss, then, challenge common views of the life course as a predefined pathway through consecutive and clearly defined life stages. Instead, they reveal that reproductive biographies are contingent and unpredictable, and that life stages may be paradoxically congruent rather than mutually exclusive. This, in turn, affects the way in which women give direction to their precarious reproductive pathways.
Lifestyle habits of women undergoing in vitro fertilization (IVF) treatment are largely unknown. Therefore, this prospective study aimed to determine the prevalence of negative lifestyle habits in women undergoing IVF and determine if habits are related to the region in the United States and/or by mandated insurance coverage. A total of 12,811 ART patients were surveyed in infertility clinics throughout the US. They took an online questionnaire added to the patient portal of electronic medical record eIVF, a fertility-specific electronic health record. Of the women surveyed, 17-23% of patients drank alcohol, 2-7% smoked, 62-68% drank caffeine, < 1% used recreational drugs, and 47-62% exercised during their IVF treatment. There were a few statistically significant regional differences in health habits (p < 0.001) but there were no differences in health habits between women who resided in a state with mandated insurance coverage versus those without insurance coverage. This is the first prospective assessment of lifestyle habits across regions in the USA and by insurance coverage. The study concluded that women undergoing IVF engage in behaviors which may negatively impact their cycle. Women in certain parts of the US had significantly worse habits than other regions, but the availability of mandated insurance coverage did not impact health habits.
This is a retrospective cohort study conducted in a national training centre for hysteroscopy between January 2012 and December 2014 to compare the clinical outcome of two doses of oestradiol valerate (4 mg and 10 mg daily) in the prevention of recurrence of adhesions after hysteroscopic adhesiolysis. A total of 176 women who suffered from Asherman syndrome with moderate to severe intrauterine adhesions were included: 91 subjects received a 10 mg daily dose of oestradiol and 85 subjects received a 4 mg daily dose of oestradiol in the postoperative period. Second look hysteroscopy was performed 4-6 weeks after the initial surgery. There was no difference in age and preoperative American Fertility Society (AFS) adhesion score between the two groups. The proportion of women in whom menstruation had returned to normal in the 10 mg group (49/91 = 53.8%) was significantly (p < 0.05) higher than that of subjects in the 4 mg group (35/85 = 41.2%). However, there was no difference in AFS scores at second look hysteroscopy between the two groups or in the conception rate and miscarriage rate between the two groups. The findings do not support the use of high-dose postoperative oestrogen therapy following hysteroscopic adhesiolysis.
Most people want and expect to have children but lack of awareness about the biological limits of fertility may reduce their chance of achieving their parenthood goals. We surveyed Australian university students' intentions and expectations for future parenthood, knowledge about fertility and preferred sources of fertility information. Male and female students (n = 1215) completed an anonymous 34-item online questionnaire. Fewer than 10% did not want children. Of those who wanted children, most (75%) wanted two or more. Although most participants wanted to have children within the biological limits of fertility they also expected to achieve many other life goals before becoming parents. Most underestimated the impact of female and male age on fertility (>75% and >95%, respectively). General practitioners and the Internet were the most preferred sources of fertility information. Almost all stated they would not feel uncomfortable if their general practitioner brought up the topic of future reproductive plans. To help women and men achieve their parenthood goals better education about fertility protection; proactive discussions with young people in primary care settings about reproductive life planning; and social policies and health promotion strategies that support becoming parents during the most fertile years are needed.
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.
Fertility preservation in the female poses several challenges due to the invasive nature of the techniques available to achieve it. The guideline aims to bring together the evidence available for the measures for fertility preservation and their outcome. The guideline addresses fertility preservation for medical reasons and includes both oncological and non-oncological causes. The techniques that the guideline considers are: (i) embryo and oocyte cryopreservation; (ii) ovarian tissue cryopreservation; (iii) GnRH agonist suppression and (iv) ovarian transposition. Although ovarian tissue cryopreservation is still considered experimental, the availability of this technique is gaining momentum as more live births from auto-transplanted tissue are reported. The guideline also highlights use of current treatment modalities for benign and malignant conditions that have a better fertility sparing profile. The guideline recommends a multidisciplinary approach in counselling women and girls about the risk to their fertility and available techniques. The role of psychological support in assisting women and girls with decision-making is highlighted. The guideline also highlights the risks associated with these techniques. Women need to be medically fit to undergo invasive procedures. Fertility preservation techniques are appropriate when treatment has curative intent. Fertility preservation is a subject of on-going research on outcomes of different techniques and at the time of publication, studies are still likely to emerge adding to the available literature.
Increasing numbers of donor-conceived individuals (and/or parents) are seeking individuals genetically related through donor conception. One route is through ‘direct-to-consumer’ (DTC) DNA testing, prompting calls for fertility services to alert donors and prospective parents to the increasing unsustainability of anonymity and secrecy. The complexity of interpreting DNA results in this context has also been discussed, including their lack of absolute certainty, as has the need for professional and peer support. This commentary highlights a different ‘threat’, from individuals learning of their donor-conception origins through the use of such tests by themselves or relatives for such purposes as genealogy or health checks. It illustrates the personal complexities faced by three older women and their families on learning not only of their genetic relationship to each other but also to 15 more donor-related siblings. DTC DNA services are a growing feature of modern life. This commentary raises ethical questions about their responsibilities towards those inadvertently learning of donor conception origins and the responsibilities of fertility services to inform prospective parents and donors of this new phenomenon. Considerations of how and when parents should tell their children of their donor-conception origins here instead become how and when children should inform their parents.
Current research surrounding infertility is focused primarily on women alone, thus removing men from the fertility equation. However, alternative research has indicated that, although men also experience infertility, there is a paucity of research on men. Therefore, very little is understood about the experiences of infertility from the male perspective. This study adopted a qualitative approach in an attempt to explore the infertility experience from the perspective of men. Fifteen men who had experienced infertility were interviewed to explore their experiences. Interpretative phenomenological analysis was used to analyse the data. Five superordinate themes were developed, and these included: (1) the influence of society on infertility; (2) feeling unacknowledged; (3) natural verses assisted conception; (4) emotional reactions; and (5) improving the infertility experience. The findings of this research indicated that men experience infertility as a mentally, physically and socially demanding condition. Comparisons to previous research have been made, and future research is proposed.