Global fertility care with assisted reproductive technology

The elephant in the room: a study on the dialogue about sexuality during Assisted Reproductive Technology visits

Despite ongoing medical advancements in infertility treatment, the significant impact of sexuality on this journey often goes unaddressed. The present research aims to examine sexual conversations during ART visits, including who initiate the conversation and their content.This quali-quantitative study delves into analyzed video-recorded ART visits to explore how "sex" conversations are broached during healthcare interactions. Our findings reveal a strikingly low proportion of utterances related to sexuality, accounting for only 1.3% of the total 14,372 utterances analyzed. Sex utterances were mainly introduced by physicians (72%), while regarding those introduced by the couple, 64% were reported by men. From the qualitative analysis on the utterances emerged three distinct levels of communication about sex: explicit, almost explicit, and implicit. While physicians and males exhibit an almost balanced distribution across the 3 levels, female patients primarily respond to explicit and almost explicit communication initiated by physicians. The low percentage of sexual utterances underscores the rarity of these conversations during ART interactions, despite the clinical field where sexual health should deserve a crucial attention. Opening the door to conversations about sexuality could help to create a safe and supportive space for patients to talk about sex, with a potential impact on well-being and quality of care during the ART process.

Delayed time to pregnancy and associated factors among pregnant women attending antenatal care in bale zone administrative towns health facilities: multi-center cross-sectional study

BACKGROUND

The desire to conceive and become parents is a fundamental aspect of human life that carries immense personal, emotional, and societal significance. For many couples, achieving pregnancy represents a long-cherished dream, but the journey to parenthood is not always straightforward. The duration it takes to achieve the desired pregnancy can vary significantly among individuals and is influenced by many factors. This study explores the factors that influence the delayed time of pregnancy among women with naturally planned conception.

METHODS

An institutional-based cross-sectional study was conducted from May 1 to May 30, 2023, in public health facilities of Bale Zone administrative towns, Southeast Ethiopia. Using systematic random sampling, 388 women participated in the study and a pretested questionnaire was used to collect data. Bivariate logistic regression was done, and variables with p-values < 0.25 were exported to multivariable logistic regression, and a statistically significant association was declared at p-value < 0.05.

RESULTS

The study revealed delayed time to pregnancy was 18.6% with 95% (CI = 14.67-22.44%). Women's age ≥ 35, (AOR = 2.61; 95%, CI: 1.17-5.82), menstrual irregularity (AOR = 3.79; 95% CI: 1.98-7.25), and frequency of sexual intercourse/week (AOR = 2.15; 95% CI: 1.05-4.41) and women's sexual dysfunction before conception (AOR = 3.12, 95% CI: 1.62-6.01) were significantly associated factors with delayed time to pregnancy at p-value < 0.05.

CONCLUSION

The study revealed a substantial proportion of delayed time to pregnancy. This delayed time to pregnancy was associated with older maternal age, irregular menstrual cycles, coital activity per week, and the women's sexual dysfunction before pregnancy. Consequently, addressing delayed time to pregnancy requires a targeted approach, prioritizing initiatives such as raising awareness, fostering increased frequency of sexual activity per week, exploring interventions for women with irregular menstrual patterns, and challenges related to sexual dysfunction.

Anaesthesia considerations for assisted reproductive technology: a focused review

The global burden of infertility is significant and the evidence suggests it is increasing in prevalence worldwide. Assisted reproductive technologies (ARTs) are fertility related treatments used to achieve pregnancy which involve the manipulation of both oocytes and sperm. The specialty is rapidly growing and anaesthesia may be required for several stages in the ART cycle. Anaesthesiologists should appreciate the processes involved and how anaesthesia care can influence safe and effective treatment outcomes. In this review article we explain the key steps of the ART cycle and the role of anaesthesiologists in this process. We also highlight key patient considerations, the implications of remote site anaesthesia and the safety concerns with provision of sedation by non-anaesthesiologists. Finally we outline a typical anaesthetic technique used in our institution for transvaginal oocyte retrieval.

Sperm Preparation with Microfluidic Sperm Sorting Chip May Improve Intracytoplasmic Sperm Injection Outcomes Compared to Density Gradient Centrifugation

Does sperm preparation using the FERTILE PLUS™ Sperm Sorting Chip improve fertilization rates, blastocyst formation, utilization, and euploidy rates in patients undergoing intracytoplasmic sperm injection (ICSI), compared with density gradient centrifugation (DGC)? A single-cohort, retrospective data review including data from 53 couples who underwent ICSI cycles within a 12-month period. For each couple, the two closest, consecutive cycles were identified, where one used the standard technique of sperm preparation (DGC) and the subsequent used FERTILE PLUS™, therefore, couples acted as their own controls. Paired samples t-test was used to compare means for the outcomes (fertilization, blastocyst formation, utilization, and euploidy rates). Binary logistic regression analysis assessed the relationship between female age, the presence of male factor infertility, and euploidy rates. Blastocyst, utilization, and euploidy rates were significantly higher for cycles using FERTILE PLUS™ compared to DGC (76% vs 56%, p = 0.002; 60% vs 41%, p = 0.005, and 40% vs 20%, p = 0.001, respectively). Although there was an increase in fertilization rates for cycles using FERTILE PLUS™, this was not significant (72% vs 68%, p = 0.449). The euploidy rates of females ≤ 35 years were significantly increased when the FERTILE PLUS™ sperm preparation method was used, compared to the older age group (OR 2.31, p = 0.007). No significant association was found between the presence or absence of male factor infertility and euploidy rates between the two cycles. This study provides tentative evidence that the FERTILE PLUS™ microfluidic sorting device for sperm selection can improve blastocyst formation, utilization, and euploidy rates following ICSI in comparison to the DGC method.

Pregnancies through oocyte donation. A mini review of pathways involved in placental dysfunction

Pregnancies resulting from assisted reproductive techniques (ART) are increasingly prevalent worldwide. While most pregnancies conceived through in-vitro fertilization (IVF) progress without complications, mounting evidence suggests that these pregnancies are at a heightened risk of adverse perinatal outcomes. Specifically, IVF pregnancies involving oocyte donation have garnered attention due to numerous reports indicating an elevated risk profile for pregnancy-related complications within this subgroup of patients. The precise mechanisms contributing to this increased risk of complications remain incompletely understood. Nonetheless, it is likely that they are mediated by an abnormal immune response at the fetal-maternal interface. Additionally, these outcomes may be influenced by baseline patient characteristics, such as the etiology of infertility, absence of corpus luteum, and variations in endometrial preparation protocols, among other factors. This review aims to succinctly summarize the most widely accepted mechanisms that potentially contribute to the onset of placental dysfunction in pregnancies conceived through oocyte donation.

Infertility and Risk of Autism Spectrum Disorder in Children

Importance

Previous studies on the risk of childhood autism spectrum disorder (ASD) following fertility treatment did not account for the infertility itself or the mediating effect of obstetrical and neonatal factors.

Objective

To assess the association between infertility and its treatments on the risk of ASD and the mediating effect of selected adverse pregnancy outcomes on that association.

Design, Setting, and Participants

This was a population-based cohort study in Ontario, Canada. Participants were all singleton and multifetal live births at 24 or more weeks' gestation from 2006 to 2018. Data were analyzed from October 2022 to October 2023.

Exposures

The exposure was mode of conception, namely, (1) unassisted conception, (2) infertility without fertility treatment (ie, subfertility), (3) ovulation induction (OI) or intrauterine insemination (IUI), or (4) in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Main Outcome and Measures

The study outcome was a diagnosis of ASD at age 18 months or older. Cox regression models generated hazard ratios (HR) adjusted for maternal and infant characteristics. Mediation analysis further accounted for the separate effect of (1) preeclampsia, (2) cesarean birth, (3) multifetal pregnancy, (4) preterm birth at less than 37 weeks, and (5) severe neonatal morbidity.

Results

A total of 1 370 152 children (703 407 male [51.3%]) were included: 1 185 024 (86.5%) with unassisted conception, 141 180 (10.3%) with parental subfertility, 20 429 (1.5%) following OI or IUI, and 23 519 (1.7%) following IVF or ICSI. Individuals with subfertility or fertility treatment were older and resided in higher-income areas; the mean (SD) age of each group was as follows: 30.1 (5.2) years in the unassisted conception group, 33.3 (4.7) years in the subfertility group, 33.1 (4.4) years in the OI or IUI group, and 35.8 (4.9) years in the IVF or ICSI group. The incidence rate of ASD was 1.93 per 1000 person-years among children in the unassisted conception group. Relative to the latter, the adjusted HR for ASD was 1.20 (95% CI, 1.15-1.25) in the subfertility group, 1.21 (95% CI, 1.09-1.34) following OI or IUI, and 1.16 (95% CI, 1.04-1.28) after IVF or ICSI. Obstetrical and neonatal factors appeared to mediate a sizeable proportion of the aforementioned association between mode of conception and ASD risk. For example, following IVF or ICSI, the proportion mediated by cesarean birth was 29%, multifetal pregnancy was 78%, preterm birth was 50%, and severe neonatal morbidity was 25%.

Conclusions and Relevance

In this cohort study, a slightly higher risk of ASD was observed in children born to individuals with infertility, which appears partly mediated by certain obstetrical and neonatal factors. To optimize child neurodevelopment, strategies should further explore these other factors in individuals with infertility, even among those not receiving fertility treatment.