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Liperis G, Makieva S, Serdarogullari M, Uraji J, Ali ZE, Pisaturo V, Cuevas-Saiz I, Scarica C, Sharma K, Fraire-Zamora JJ. Agree to disagree: reaching consensus amongst embryologists on the clinical management of low-quality blastocysts. Hum Reprod 2024; 39:1353-1356. [PMID: 38670550 DOI: 10.1093/humrep/deae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- George Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW, Australia
- Embryorigin Fertility Centre, Larnaca, Cyprus
| | - Sofia Makieva
- Kinderwunschzentrum, Klinik für Reproduktions-Endokrinologie, Universitätsspital Zürich, Zurich, Switzerland
| | - Munevver Serdarogullari
- Department of Histology and Embryology, Faculty of Medicine, Cyprus International University, Nicosia, Turkey
| | - Julia Uraji
- IVF Laboratory, TFP Düsseldorf GmbH, Düsseldorf, Germany
| | - Zoya Enakshi Ali
- Research & Development Department, Hertility Health Limited, London, UK
| | - Valerio Pisaturo
- Department of Maternal and Child Health and Urology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Catello Scarica
- European Hospital, New Fertility Group Centre for Reproductive Medicine, Rome, Italy
| | - Kashish Sharma
- HealthPlus Fertility Center, HealthPlus Network of Specialty Centers, Abu Dhabi, United Arab Emirates
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Alon I, Pinilla J. Assisted reproduction in Spain, outcome and socioeconomic determinants of access. Int J Equity Health 2021; 20:156. [PMID: 34229664 PMCID: PMC8259134 DOI: 10.1186/s12939-021-01438-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
RESEARCH QUESTION We analyzed two questions. First, the effectiveness of public Assisted Reproductive Technologies (ART) in Spain compared with private ones, measured by the time since initiating ART treatment until achieving pregnancy, accounting for age and socioeconomic factors. Second, socioeconomic determinants of access to ART, referring primarily to financial means derived by employment, income, and wealth. DESIGN We applied statistical models on data extracted from the national Spanish Fertility Survey from 2018. The first topic was analyzed by competing risk survival analysis conducted on a sample of 667 women who initiate ART treatment since 2000. The second, by a Bivariate Probit model conducted on a sample of 672 women older than 41 years who required ART services. RESULTS The first analysis raised that throughout the treatment, patients treated exclusively in private clinics had on average a higher cumulative incidence of becoming pregnant compared with patients who approached public clinics. The second analysis raised that both higher household equivalent income and higher education increase the likelihood of accessing ART in a private clinic and decrease the tendency of accessing public clinics or failing to access any service. Moreover, being single decreases the likelihood of accessing public clinics or ART services in general. CONCLUSIONS Long waiting periods could be the main reason for the lower incidence of getting pregnant in public healthcare, explaining why patients choose private over public care. We develop a broader discussion over the extent of Spanish public funding of ART, the unequal medical outcome, and potential options for optimization.
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Affiliation(s)
- Ido Alon
- Department of Development Economics, Research Group on Economics and Management of Innovation, Autonomous University of Madrid, Madrid, Spain
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, University of Las Palmas de Gran Canaria, Las Palmas, Spain
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Shao YH, Zhang XY, Buckett W, Ao A. Impact of in vitro fertilization-preimplantation genetic testing (IVF-PGT) funding policy on clinical outcome: An issue that stems beyond effectiveness of treatment. Eur J Obstet Gynecol Reprod Biol 2019; 235:1-5. [PMID: 30743159 DOI: 10.1016/j.ejogrb.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/10/2018] [Accepted: 01/01/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVE(S) The aim of this study was to compare the patient characteristics, type of genetic disease and inheritance, volume of activity, practice patterns and pregnancy outcomes, in private versus publically funded IVF pre-implantation genetic testing (PGT) for translocation (IVF-PGT-SR) and aneuploidy (PGT-A) periods. STUDY DESIGN This study retrospectively analyzed data during both privately funded period (PRP) and publically funded period (PUP) of assisted reproductive technology (ART) for a total of 275 patients. 83 patients underwent IVF-PGT-SR and 192 patients underwent IVF-PGT-A. Given that PGT-SR is a chromosomal abnormality hereditary in nature, whereas PGT-A is sporadic in addition to the contrasting funding policies, the two cohorts were analyzed separately. To achieve the proposed objective, the two groups under analysis were grouped in accordance with their respective coverage systems for infertility. RESULTS Among translocation patients, 94 normal/balanced embryos were obtained from 47 IVF-PGT cycles in PRP whereas 145 embryos were obtained from 92 IVF-PGT cycles in PUP. The average number of embryos transferred per embryo transfer cycle was significantly lower in PUP in comparison to PRP (1.13 vs. 1.74, p < 0.0001). 13 singletons and 2 sets of twins were conceived in PRP. 14 singletons were conceived in PUP. Regardless of funding period, there were more reciprocal translocation carriers (79.4% in PRP and 76.4% in PUP) and more male carriers (82.4% in PRP and 60% in PUP), of which the majority had abnormal sperm parameters. Among aneuploidy patients, on average 2.5 embryos in PRP and 1.4 embryos in PUP were transferred per ET cycle (p = 0.05). There was a 13.3% increase in number of IVF-PGT-A attempts per patient in PRP compared to PUP. Live birth rate per IVF-PGT-A was higher in PRP (29.7% vs. 15%, P = 0.02), which consisted of 48 singletons and 18 multiparous pregnancies in PRP and 9 singletons in PUP. CONCLUSION(S) Public coverage of ART is associated with a greater utilization ART, as well as a reduced number in embryo transfer (ET) per cycle, a lower proportion of cycles resulting in successful pregnancy and a lower multiple birth rate. Our study ultimately shines light on the effect of providers' and patients' monetary conscious on pregnancy outcome.
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Affiliation(s)
- Yi-Hong Shao
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Xiao Yun Zhang
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill Univeristy, Montreal, Quebec, Canada
| | - William Buckett
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill Univeristy, Montreal, Quebec, Canada
| | - Asangla Ao
- MUHC Reproductive Centre, Department of Obstetrics and Gynecology, McGill Univeristy, Montreal, Quebec, Canada; Department of Human Genetics, McGill University, Montreal, Quebec, Canada.
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Karlström PO, Holte J, Hadziosmanovic N, Rodriguez-Wallberg KA, Olofsson JI. Does ovarian stimulation regimen affect IVF outcome? a two-centre, real-world retrospective study using predominantly cleavage-stage, single embryo transfer. Reprod Biomed Online 2017; 36:59-66. [PMID: 29233501 DOI: 10.1016/j.rbmo.2017.10.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 11/27/2022]
Abstract
In this study, ovarian stimulation using highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) for IVF were compared in two large assisted reproduction technique centres in Sweden. A total of 5902 women underwent 9631 oocyte retrievals leading to 8818 embryo transfers (7720 on day 2): single embryo transfers (74.2%); birth rate per embryo transfer (27.7%); multiple birth rate (5.0%); incidence of severe ovarian hyperstimulation syndrome (0.71%). Compared with ovarian stimulation with rFSH, women who received HP-HMG were older, had higher dosages of gonadotrophins administered, fewer oocytes retrieved and more embryos transferred. After multivariate analysis controlling for age and generalized estimating equation model, no differences were found in delivery outcomes per embryo transfers between HP-HMG and rFSH, independent of gonadotrophin releasing hormone analogue (GnRH) used. Logit curves for live birth rate suggested differences for various subgroups, most prominently for women with high oocyte yield or when high total doses were used. Differences were not significant, perhaps owing to skewed distributions of the FSH compounds versus age and other covariates. These 'real-life patients' had no differences in live birth rate between HP-HMG and rFSH overall or in subgroups of age, embryo score, ovarian sensitivity or use of GnRH analogue regimen.
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Affiliation(s)
- Per-Olof Karlström
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
| | - Jan Holte
- Carl von Linné Clinic, SE-751 83 Uppsala, Sweden
| | | | - Kenny A Rodriguez-Wallberg
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Jan I Olofsson
- Reproductive Medicine, Obstetrics and Gynecology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden; Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet/ Karolinska University Hospital, SE-171 76 Stockholm, Sweden.
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López-Lería B, Jimena P, Clavero A, Gonzalvo MC, Carrillo S, Serrano M, López-Regalado ML, Olvera C, Martínez L, Castilla JA. Embryologists' health: a nationwide online questionnaire. J Assist Reprod Genet 2014; 31:1587-97. [PMID: 25284212 DOI: 10.1007/s10815-014-0352-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/19/2014] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The present study evaluates health status and its relation with occupational characteristics and with burnout syndrome among embryologists. METHODS A cross-sectional design was used to conduct an online self-assessment survey, sent to all members of the Spanish Association of Clinical Embryologists. The questionnaire contained occupational questions and two standard instruments: 'Short Form-12 Health Survey' as a measure of physical (PCS-12) and mental (MCS-12) health and the Maslach Burnout Inventory-General Survey (MBI-GS) to evaluate the degree of burnout. RESULTS The PCS-12 obtained for the Spanish embryologists was higher than that for the reference population. However, the total MCS-12 was significantly lower than that observed in non-institutionalised males and females representative of the general Spanish population aged 35-44 years. In the linear regression model, the dependent variable PCS-12 was related indirectly with the variables number of hours worked per week, BMI, back pain, leg pain and visual discomfort. In the linear regression model, the dependent variable MCS-12 was indirectly related to the gender (male reference; female coefficient regression: -3.23), exhaustion and cynicism dimensions of the MBI-GS. A total of 87 (36.3%) embryologists presented a high score on at least one of the MBI-GS dimensions. CONCLUSION In this sample of Spanish embryologists, a norm measure (SF-12) showed their physical health to be better than the average for the general population, but that their mental health was poorer. A significant indirect relation was observed between mental health and burnout syndrome. Strategies to reduce occupational stress and problems should form part of the training provided for clinical embryologists.
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Affiliation(s)
- B López-Lería
- Unidad de Reproducción, UGC laboratorio Clínico y UGC Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain,
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López-Regalado ML, Clavero A, Gonzalvo MC, Serrano M, Martínez L, Mozas J, Rodríguez-Serrano F, Fontes J, Castilla JA. Randomised clinical trial comparing elective single-embryo transfer followed by single-embryo cryotransfer versus double embryo transfer. Eur J Obstet Gynecol Reprod Biol 2014; 178:192-8. [DOI: 10.1016/j.ejogrb.2014.04.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 04/08/2014] [Indexed: 11/25/2022]
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Orozco I, Segura A, Prados F, Buxaderas R, Hernández J, Marqueta J, Cabello Y, de los Santos MJ, Vidal E, Herrero J, Zamora S, de Andrés M, Castilla JA. Evolución del método de fecundación in vitro en España: 1993-2010. Rev Int Androl 2013. [DOI: 10.1016/j.androl.2012.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cabello Y, Gómez-Palomares J, Castilla J, Hernández J, Marqueta J, Pareja A, Luceño F, Hernández E, Coroleu B. Impact of the Spanish Fertility Society guidelines on the number of embryos to transfer. Reprod Biomed Online 2010; 21:667-75. [DOI: 10.1016/j.rbmo.2010.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 05/25/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
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Luceño F, Castilla JA, Gómez-Palomares JL, Cabello Y, Hernández J, Marqueta J, Herrero J, Vidal E, Fernández-Shaw S, Coroleu B. Comparison of IVF cycles reported in a voluntary ART registry with a mandatory registry in Spain. Hum Reprod 2010; 25:3066-71. [PMID: 20943703 DOI: 10.1093/humrep/deq267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Monitoring assisted reproductive technology (ART) is essential to evaluate the performance of fertility treatment and its impact on birth rates. In Europe, there are two kinds of ART registers: voluntary and mandatory. The validity of register data is very important with respect to the quality of register-based observational studies. The aim of this paper is to determine the degree of agreement between voluntary and mandatory ART registers. METHODS The two sources for the data compared in this study (referring to 2005 and 2006) were FIVCAT.NET (an official compulsory Assisted Reproduction Registry within the Health Ministry of the Regional Government of Catalonia, to which all authorized clinics, both public and private, performing assisted reproduction in the region are obliged to report) and the register of the Spanish Fertility Society (SEF), to which data are provided on a voluntary basis. The SEF register data were divided into two groups: (i) data from clinics in Catalonia (SEF-CAT); (ii) data from the rest of Spain, excluding Catalonia (SEF-wCAT). The techniques compared were IVF cycle using patients' own eggs (IVF cycle) versus donor egg cycles. RESULTS For IVF cycles, the voluntary ART register reflected 77.2% of those on the official one, but the corresponding figure was only 34.4% with respect to donated eggs. The variables analysed in the IVF cycle (insemination technique used, patients' age, number of embryos transferred, pregnancy rates, multiple pregnancies and deliveries) were similar in the three groups studied. However, we observed significant differences in donor egg cycles with regard to the insemination technique used, pregnancy rates and multiple pregnancies between the voluntary and the official register. CONCLUSIONS Data from the voluntary ART register for IVF cycles are valid, but those for donor egg cycles are not. Further study is necessary to determine the reasons for this difference.
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Affiliation(s)
- F Luceño
- Centro de Reproducción Humana, Granada, Spain
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Woodruff TK. The Oncofertility Consortium--addressing fertility in young people with cancer. Nat Rev Clin Oncol 2010; 7:466-75. [PMID: 20498666 DOI: 10.1038/nrclinonc.2010.81] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The number of young cancer survivors is increasing owing to advances in cancer therapeutics, but many face infertility as a result of their treatment. Technologies that already exist for cancer patients concerned about their future fertility include sperm banking for men and hormonal intervention followed by in vitro fertilization and embryo cryopreservation for women. However, logistical barriers to timely patient referral and coordination of care between specialties can limit patient access to all the available options. Moreover, there are few alternatives for young women and girls who cannot delay their cancer treatment, or who are unable to undergo hormonal intervention. The Oncofertility Consortium is a network of researchers, physicians and scholars who are advancing fertility preservation options for young cancer patients. Research into the societal, ethical, and legal implications is also an important part of the work performed by the Oncofertility Consortium, which is providing new perspectives on patient decision-making about how to access these emerging reproductive technologies. Experts in the fields of oncology, reproductive medicine, the social sciences, law, education, and the humanities are working together to develop next-generation reproductive interventions and promote communication between scholars, clinicians, patients, and the public to ensure that young cancer patients are equipped with the most appropriate information and options for having a family in the future.
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Affiliation(s)
- Teresa K Woodruff
- Northwestern University Feinberg School of Medicine, Department of Obstetrics and Gynecology, Division of Fertility Preservation, 303 East Superior Street, Lurie 10-119, Chicago, IL 60211, USA.
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