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Alorf F, Alani S, Steiner N, Dahan MH. How successful is intrauterine insemination after failed IVF? A study of 551 women. Reprod Biomed Online 2024; 48:103684. [PMID: 38271821 DOI: 10.1016/j.rbmo.2023.103684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/28/2023] [Accepted: 11/01/2023] [Indexed: 01/27/2024]
Abstract
RESEARCH QUESTION What is the success rate of intrauterine insemination (IUI) after failing IVF? DESIGN This retrospective cohort study evaluated the pregnancy outcomes of 551 patients who underwent a total of 992 IUI cycles at an academic fertility centre between October 2008 and April 2018. RESULTS The study participants (n = 551) had previously failed one to three fresh IVF cycles and any resultant embryo transfers, and subsequently underwent a total of 992 IUI cycles. When comparing demographics, women with ongoing pregnancies, clinical pregnancies and positive pregnancies were significantly younger (P = 0.037, P = 0.025 and P = 0.049, respectively) compared with women who did not conceive. The cumulative ongoing pregnancy rate for all IUI cycles was 7.44% per patient (41 pregnancies in 551 patients), and the ongoing pregnancy rate after the first IUI cycle was 4.72%. In single women who had previously failed six IUI cycles before undergoing IVF cycles with donor sperm, the cumulative ongoing pregnancy rate was 15.8% in donor sperm IUI cycles compared with 5.1% in women who used their partner's sperm for both IVF and IUI cycles, with an adjusted odds ratio of 6.1. Patient age, number of previous pregnancies, daily gonadotrophin dose for IVF, number of mature follicles at trigger, and number of failed IVF cycles failed to predict pregnancy outcomes. CONCLUSION Ongoing pregnancy following IUI after failed IVF occurs at a rate of approximately 5% per cycle, and this rate is higher if donor sperm is used for both IVF and IUI cycles. This can be considered with proper counselling in women aged <40 years, and may be discouraged in women aged ≥43 years.
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Affiliation(s)
- Faisel Alorf
- Obstetrics and Gynecology Department, McGill University, Montreal, Quebec, Canada.
| | - Sanah Alani
- Obstetrics and Gynecology Department, McGill University, Montreal, Quebec, Canada
| | - Naama Steiner
- Obstetrics and Gynaecology Department, Soroka Medical Centre, Beersheba, Israel
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, McGill University, Montreal, Quebec, Canada
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Esposito G, Parazzini F, Viganò P, Franchi M, Cipriani S, Fedele F, Corrao G, Somigliana E. Probability of second live birth after first natural and medically assisted reproduction-mediated live birth: A historical cohort study. Acta Obstet Gynecol Scand 2024; 103:121-128. [PMID: 37814141 PMCID: PMC10755134 DOI: 10.1111/aogs.14685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Evidence on the role of medically assisted reproduction (MAR) in achieving the desired number of children is very limited. The aim of the current investigation was to assess the probability and the mode of conception of a second live birth according to the mode of conception of the first one. MATERIAL AND METHODS This historical cohort study was based on administrative data from regional healthcare databases. Women hospitalized for childbirth in Lombardy between January 1, 2007 and December 31, 2017 were identified. The probability of a second live birth up to 2021 was estimated using the Kaplan-Meier method. We calculated this probability according to the mode of conception of the first birth, and the analysis was also performed in strata of maternal age at first birth. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between mode of conception at first live birth and the probability of having a second live birth. Mothers were right-censored if they moved out of the region, died, or did not have a second live birth by the end of follow-up. RESULTS We identified 431 333 women who had their first live birth after a natural conception and 16 837 who had their first live birth after MAR. The probability of having a second live birth was 58.6% and 32.1%, respectively in the two groups (HR = 0.68, 95% CI: 0.66-0.70). Considering solely women who naturally conceived their first live birth, the probability to have a second child with MAR was 1.1% and to have a second child naturally 59.3%. The corresponding values were 11.5% and 25.2% in the group of women with a first MAR-mediated live birth. CONCLUSIONS In our cohort, one woman out of 10 having a first MAR-mediated live birth underwent MAR programs again. Considering women who had a first natural live birth, this proportion was drastically reduced. In the field of MAR, more attention should be given to the capacity of a couple to achieve the number of desired children.
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Affiliation(s)
- Giovanna Esposito
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Fabio Parazzini
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Paola Viganò
- Infertility UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Matteo Franchi
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public HealthUniversity of Milano‐BicoccaMilanItaly
- National Center for Healthcare Research and PharmacoepidemiologyMilanItaly
| | - Sonia Cipriani
- Department of Woman, Newborn and ChildFondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Francesco Fedele
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public HealthUniversity of Milano‐BicoccaMilanItaly
- National Center for Healthcare Research and PharmacoepidemiologyMilanItaly
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Infertility UnitFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
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Kocourková J, Šťastná A, Burcin B. The influence of the increasing use of assisted reproduction technologies on the recent growth in fertility in Czechia. Sci Rep 2023; 13:10854. [PMID: 37407590 DOI: 10.1038/s41598-023-37071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
This study aims to enhance the understanding of how the increasing use of assisted reproductive technologies (ART) has contributed to the increase in the total fertility rate (TFR) and to further delaying childbearing. Moreover, it addresses the gap in the methodology concerning the quantification of the effect of ART on fertility postponement. Czechia is one of few countries that are able to serve for the study of the demographic impacts of ART. ART and non-ART fertility rates were calculated using unique data on all children born in Czechia. Excluding mothers who received cross-border reproductive care, the proportion of ART live births in Czechia has not exceeded 4%. However, without ART the TFR would have stood at just 1.65 instead of 1.71 in 2020. ART significantly contributed to a reduction in childlessness and to the increase in fertility rates at ages over 35. Applying the decomposition method, the contribution of the use of ART to delaying childbearing between 2013 and 2020 was 4%. The findings have important policy implications. ART has the potential to support fertility recovery in the context of delayed childbearing. The findings served to alleviate concerns about the contribution of ART to the further undesired delay of childbearing.
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Affiliation(s)
- Jiřina Kocourková
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
| | - Anna Šťastná
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia.
| | - Boris Burcin
- Department of Demography and Geodemography, Faculty of Science, Charles University, Prague, Czechia
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ElMokhallalati Y, van Eekelen R, Bhattacharya S, McLernon DJ. Treatment-independent live birth after in-vitro fertilisation: a retrospective cohort study of 2,133 women. Hum Reprod 2020; 34:1470-1478. [PMID: 31306480 DOI: 10.1093/humrep/dez099] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/29/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the chance of a treatment-independent live birth following IVF (including ICSI) treatment? SUMMARY ANSWER Over 5 years of follow-up, the treatment-independent live birth rate was 17% in unsuccessfully treated women and 15% in those who had a live birth after IVF. WHAT IS KNOWN ALREADY A limited number of studies have investigated the chance of treatment-independent conception following completion of IVF, but most of them have been based on surveys with poor response rates and limited sample sizes. STUDY DESIGN, SIZE, DURATION This is a population-based, retrospective cohort study of 2133 women who received IVF treatment between 1998 and 2011 at a single regional IVF Unit and were followed for a minimum of 1 year and maximum of 15 years after their last IVF or ICSI treatment cycle. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included all women, residing in the north-east of the UK, who attended the Aberdeen Fertility Clinic and received IVF treatment between 1998 and 2011. Clinical and diagnostic information of all women was linked with treatment and pregnancy outcome data. A total of 2133 women were divided into two groups: (i) those who achieved a live birth following successful IVF or ICSI treatment (n = 1060) and (ii) those in whom treatment was unsuccessful i.e. resulted in either no pregnancy or pregnancy loss (n = 1073). The two groups were followed from the date of the last embryo transfer until the first treatment-independent live birth or 31 December 2012, whichever came first. The primary outcome was the treatment-independent live birth rate at 1, 2.5, 5 and 10 years of follow-up. Cox regression was used to determine factors associated with treatment-independent live birth in each group. MAIN RESULTS AND THE ROLE OF CHANCE Within 5 years of follow-up, the treatment-independent live birth rate was 17% (95% CI, 15-19%) among women whose IVF or ICSI treatment was unsuccessful and 15% (95% CI, 12-17%) among women whose treatment resulted in live birth. In both groups, shorter duration of infertility, younger female age and IVF as compared to ICSI were associated with a higher chance of achieving treatment-independent live birth. Among unsuccessfully treated women, the chance of post-IVF live birth was reduced in those with tubal factor infertility. Three or more previous IVF or ICSI embryo transfers were associated with a lower chance of treatment-independent live birth among successfully treated women. LIMITATIONS, REASONS FOR CAUTION The study was conducted in a single fertility centre, which could compromise the generalizability of the findings. Moreover, data were unavailable on the women's use of contraception or active attempts to get pregnant, both of which could influence treatment-independent live birth rates. WIDER IMPLICATIONS OF THE FINDINGS This study provides a better understanding of the long-term prognosis for treatment-independent live birth after completion of IVF or ICSI treatment. The results will inform women of their chances of a treatment-independent live birth following failed or successful treatment and the factors that are associated with it. STUDY FUNDING/COMPETING INTEREST(S) This work was funded by a Chief Scientist Office Postdoctoral Training Fellowship in Health Services Research and Health of the Public Research (Ref PDF/12/06). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office. The authors have no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Yousuf ElMokhallalati
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Aberdeen, UK
| | - Rik van Eekelen
- Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands
| | - Siladitya Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen, UK
| | - David J McLernon
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen, UK
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Chua SJ, Danhof NA, Mochtar MH, van Wely M, McLernon DJ, Custers I, Lee E, Dreyer K, Cahill DJ, Gillett WR, Righarts A, Strandell A, Rantsi T, Schmidt L, Eijkemans MJC, Mol BWJ, van Eekelen R. Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis. Hum Reprod 2020; 35:1808-1820. [DOI: 10.1093/humrep/deaa129] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/30/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
STUDY QUESTION
What is the rate of natural conception leading to ongoing pregnancy or livebirth over 6–12 months for infertile women of age ≥35 years?
SUMMARY ANSWER
Natural conception rates were still clinically relevant in women aged 35 years and above and were significantly higher in women with unexplained infertility compared to those with other diagnoses.
WHAT IS KNOWN ALREADY
In recent years, increasing numbers of women have attempted to conceive at a later age, resulting in a commensurate increase in the need for ART. However, there is a lack of data on natural fertility outcomes (i.e. no interventions) in women with increasing age.
STUDY DESIGN, SIZE, DURATION
A systematic review with individual participant data (IPD) meta-analysis was carried out. PubMed, MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov were searched until 1 July 2018 including search terms ‘fertility service’, ‘waiting list’, ‘treatment-independent’ and ‘spontaneous conception’. Language restrictions were not imposed.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Inclusion criteria were studies (at least partly) reporting on infertile couples with female partner of age ≥35 years who attended fertility services, underwent fertility workup (e.g. history, semen analysis, tubal status and ovulation status) and were exposed to natural conception (e.g. independent of treatment such as IVF, ovulation induction and tubal surgery). Studies that exclusively studied only one infertility diagnosis, without including other women presenting to infertility services for other causes of infertility, were excluded. For studies that met the inclusion criteria, study authors were contacted to provide IPD, after which fertility outcomes for women of age ≥35 years were retrieved. Time to pregnancy or livebirth and the effect of increasing age on fertility outcomes after adjustment for other prognostic factors were analysed. Quality of studies was graded with the Newcastle–Ottawa Scale (non-randomised controlled trials (RCTs)) or the Cochrane Risk of Bias tool (for RCTs).
MAIN RESULTS AND THE ROLE OF CHANCE
We included nine studies (seven cohort studies and two RCTs) (n = 4379 women of at least age 35 years), with the observed composite primary outcome of ongoing pregnancy or livebirth occurring in 429 women (9.8%) over a median follow-up of 5 months (25th to 75th percentile: 2.5–8.5 months). Studies were of moderate to high quality. The probability of natural conception significantly decreased with any diagnosis of infertility, when compared with unexplained infertility. We found non-linear effects of female age and duration of infertility on ongoing pregnancy and tabulated the predicted probabilities for unexplained infertile women aged 35–42 years with either primary or secondary infertility and with a duration of infertility from 1 to 6 years. For a 35-year-old woman with 2 years of primary unexplained infertility, the predicted probability of natural conception leading to ongoing pregnancy or livebirth was 0.15 (95% CI 0.11–0.19) after 6 months and 0.24 (95% CI 0.17–0.30) after 12 months. For a 42-year-old woman, this decreased to 0.08 (95% CI 0.04–0.11) after 6 months and 0.13 (95% CI 0.07–0.18) after 12 months.
LIMITATIONS, REASONS FOR CAUTION
In the studies selected, there were different study designs, recruitment strategies in different centres, protocols and countries and different methods of assessment of infertility. Data were limited for women above the age of 40 years.
WIDER IMPLICATIONS OF THE FINDINGS
Women attending fertility services should be encouraged to pursue natural conception while waiting for treatment to commence and after treatment if it is unsuccessful. Our results may aid in counselling women, and, in particular, for those with unexplained infertility.
STUDY FUNDING/COMPETING INTEREST(S)
S.J.C. received funding from the University of Adelaide Summer Research Scholarship. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437), B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. B.W.M. reports research support by Merck and Guerbet.
PROSPERO REGISTRATION NUMBER
CRD42018096552.
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Affiliation(s)
- S J Chua
- University of Adelaide, Adelaide, South Australia 5000, Australia
| | - N A Danhof
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - M H Mochtar
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - M van Wely
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - D J McLernon
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - I Custers
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - E Lee
- Western Ultrasound for Women, West Leederville, Western Australia 6007, Australia
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - D J Cahill
- Academic Unit of Obstetrics and Gynaecology, University of Bristol, St Michael’s Hospital, Bristol BS8 1TH, UK
| | - W R Gillett
- Women’s and Children’s Health, Dunedin School of Medicine, The University of Otago, Dunedin 9016, New Zealand
| | - A Righarts
- Women’s and Children’s Health, Dunedin School of Medicine, The University of Otago, Dunedin 9016, New Zealand
| | - A Strandell
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, 413 45 Göteborg, Sweden
| | - T Rantsi
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, FI-00029 HUS, Helsinki, Finland
| | - L Schmidt
- Department of Public Health, University of Copenhagen, 1014 Copenhagen K, Denmark
| | - M J C Eijkemans
- Department of Biostatistics and Research Support, Julius Centre, University Medical Centre, 3584 CX Utrecht, The Netherlands
| | - B W J Mol
- Discipline of Obstetrics and Gynaecology, Robinson Research Institute, University of Adelaide, South Australia 5006, Australia
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash Health and Monash University, Clayton 3800, Victoria, Australia
| | - R van Eekelen
- Department of Obstetrics and Gynaecology, Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Lim J, Kim JH, Chae YM. Evaluation for effectiveness of oriental medicine-based infertility treatment and spontaneous pregnancy rate of infertile patients using systematic review. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2019. [DOI: 10.5124/jkma.2019.62.12.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jiseun Lim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea
| | - Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Korea
- Institute of Health Promotion and Policy, Dankook University, Cheonan, Korea
| | - Yoo Mi Chae
- Department of Medical Education, College of Medicine, Dankook University, Cheonan, Korea
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Ling Y, Mee H, Nisa DS, Ni L. Live birth rates of assisted reproductive technology treatment and spontaneous conception among subfertile couples in Singapore: A follow-up study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2018. [DOI: 10.4103/2305-0500.241178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Seven out of 10 couples treated by IVF achieve parenthood following either treatment, natural conception or adoption. Reprod Biomed Online 2016; 33:560-567. [DOI: 10.1016/j.rbmo.2016.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
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Successful Treatment of Oligoasthenozoospermia Using Traditional Korean Medicine Resulting in Spontaneous Pregnancy: Two Case Reports. Explore (NY) 2016; 12:136-8. [DOI: 10.1016/j.explore.2015.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Indexed: 02/02/2023]
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The effects of traditional Korean medicine in infertile male patients with poor semen quality: A retrospective study. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Baird D, Bhattacharya S, Devroey P, Diedrich K, Evers J, Fauser B, Jouannet P, Pellicer A, Walters E, Crosignani P, Fraser L, Geraedts J, Gianaroli L, Glasier A, Liebaers I, Sunde A, Tapanainen J, Tarlatzis B, Van Steirteghem A, Veiga A. Failures (with some successes) of assisted reproduction and gamete donation programs. Hum Reprod Update 2013; 19:354-65. [DOI: 10.1093/humupd/dmt007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vacher Vitasse C, Rouget K, Hocké C. [The other side of the ART, or when the desire takes shape]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2012; 40:529-535. [PMID: 22325081 DOI: 10.1016/j.gyobfe.2011.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 08/01/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To study unconscious factors involved with the occurrence of spontaneous pregnancies in Assisted Reproductive Technologies process (ART). PATIENTS AND METHODS We wrote to 519 couples having received the benefit of an ART process in the years 2005-2007 in the center of ART of the CHU of Bordeaux. In the mail, they were asked whether a spontaneous pregnancy had occurred during the process and a psychoanalytical orientation talk was suggested to them. RESULTS Among 214 answers, 28 couples have declared a spontaneous pregnancy (so 13.1%). Twenty-six couples have been interviewed, 19 resulting from the questionnaire and seven registered in 2008 and having announced by their own the occurrence of a spontaneous pregnancy. Subjective factors directing the occurrence of a spontaneous pregnancy are found up to a significant degree. They are classified and studied by headings. DISCUSSION AND CONCLUSION Each heading is confronted with the data of the psychoanalytical literature. We find a correlation between the elements collected in the talks and those of the literature. The conclusion is in favor of unconscious factors playing a predominant part in the occurrence of spontaneous pregnancies for the unfertile subjects.
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[The physician's role in various clinical contexts. Physician counseling on in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:1144-53. [PMID: 22936482 DOI: 10.1007/s00103-012-1530-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The role of the physician in the context of in vitro fertilization and preimplantation genetic diagnosis has certain distinct characteristics. Involuntary childlessness by definition of the WHO is a disease with good treatment options. As it is not considered a medical emergency, the focus lies more on intensive information giving, education, and counseling. Because the diagnosis and treatment can be a medical and psychological strain for the couple, counseling should address both medical and psychological aspects. The physician needs to have detailed medical knowledge as well as good communication skills to be able to meet the specific needs of the couple. Moreover, the physician should point out the realistic success rates of treatment and should refer to alternatives, such as remaining childless, adoption, and sperm or egg donation. The concurrent inclusion of biological, psychological, social, and ethical aspects in terms of psychosomatic basic care (Psychosomatische Grundversorgung) seems to be useful. There is potential for conflicts, for example, due to the economic interests of the physician. On the other hand, the treatment can be a financial burden for the couple. Of importance are the physician's and the patient's moral concepts, especially concerning some aspects of therapy (sperm and egg donation, surrogacy). The expected welfare of the intended child should also be respected (e.g., higher risk of preterm birth in multiple pregnancies). Further possible conflicts in reproductive medicine arise because of the crossing of moral boundaries (oocyte donation for postmenopausal women, surrogacy, cloning of human beings). The framework of counseling is based on the guidelines of the German Medical Association (Bundesärztekammer) for assisted reproduction (2006). Preimplantation genetic diagnosis has special requirements from a medical and psychosocial point of view.
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Troude P, Bailly E, Guibert J, Bouyer J, de la Rochebrochard E. Spontaneous pregnancies among couples previously treated by in vitro fertilization. Fertil Steril 2012; 98:63-8. [DOI: 10.1016/j.fertnstert.2012.03.058] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/23/2012] [Accepted: 03/30/2012] [Indexed: 11/25/2022]
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Follow up of infertile patients after failed ART cycles: a preliminary report from Iran and Turkey. Eur J Obstet Gynecol Reprod Biol 2012; 161:38-41. [DOI: 10.1016/j.ejogrb.2011.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 08/06/2011] [Accepted: 11/12/2011] [Indexed: 11/23/2022]
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Caleshu C, Shiloh S, Price C, Sapp J, Biesecker B. Invasive prenatal testing decisions in pregnancy after infertility. Prenat Diagn 2010; 30:575-81. [PMID: 20509160 DOI: 10.1002/pd.2529] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study assessed decisional conflict about invasive prenatal testing among women pregnant after infertility. METHODS We surveyed 180 pregnant women with a history of infertility using a mixed methods cross-sectional design. Difficulty in deciding whether to have prenatal testing was measured using the Decisional Conflict Scale. RESULTS A minority of women (31%) chose to have invasive prenatal testing. Most participants (72%) reported low decisional conflict (score < 25; mean = 22.1; standard deviation = 23.2; range: 0-100). Half (53%) of the participants said that infertility made the testing decision easier. Qualitative data suggest that infertility makes the decision easier by clarifying relevant values and priorities. Most infertility characteristics studied were not significantly associated with decisional conflict. Variables associated with higher decisional conflict included infertility distress due to rejection of a childfree lifestyle, disagreement with others about testing, and choosing to have invasive testing after having had treatment for infertility. CONCLUSIONS For some women, infertility may make the invasive prenatal testing decision easier. Women with the greatest need for decisional support were those who have had treatment and choose invasive testing, who disagree with others about their testing choice, or who are particularly distressed about being childless.
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Affiliation(s)
- Colleen Caleshu
- Division of Medical Genetics, University of California, San Francisco, CA 94143-0794, USA.
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Lyerly AD, Steinhauser K, Voils C, Namey E, Alexander C, Bankowski B, Cook-Deegan R, Dodson WC, Gates E, Jungheim ES, McGovern PG, Myers ER, Osborn B, Schlaff W, Sugarman J, Tulsky JA, Walmer D, Faden RR, Wallach E. Fertility patients' views about frozen embryo disposition: results of a multi-institutional U.S. survey. Fertil Steril 2008; 93:499-509. [PMID: 19061998 DOI: 10.1016/j.fertnstert.2008.10.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 10/08/2008] [Accepted: 10/15/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe fertility patients' preferences for disposition of cryopreserved embryos and determine factors important to these preferences. DESIGN Cross-sectional survey conducted between June 2006 and July 2007. SETTING Nine geographically diverse U.S. fertility clinics. PATIENT(S) 1020 fertility patients with cryopreserved embryos. INTERVENTION(S) Self-administered questionnaire. MAIN OUTCOME MEASURE(S) Likelihood of selecting each of five conventional embryo disposition options: store for reproduction, thaw and discard, donate to another couple, freeze indefinitely, and donate for research; likelihood of selecting each of two alternative options identified in previous research: placement of embryos in the woman's body at an infertile time, or a disposal ceremony; importance of each of 26 considerations to disposition decisions; and views on the embryo's moral status. RESULT(S) We found that 54% of respondents with cryopreserved embryos were very likely to use them for reproduction, 21% were very likely to donate for research, 7% or fewer were very likely to choose any other option. Respondents who ascribed high importance to concerns about the health or well-being of the embryo, fetus, or future child were more likely to thaw and discard embryos or freeze them indefinitely. CONCLUSION(S) Fertility patients frequently prefer disposition options that are not available to them or find the available options unacceptable. Restructuring and standardizing the informed consent process and ensuring availability of all disposition options may benefit patients, facilitate disposition decisions, and address problems of long-term storage.
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Affiliation(s)
- Anne Drapkin Lyerly
- Department of Obstetrics and Gynecology, Duke University, Box 3040, Durham, North Carolina 27710, USA.
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de La Rochebrochard E, Quelen C, Peikrishvili R, Guibert J, Bouyer J. Long-term outcome of parenthood project during in vitro fertilization and after discontinuation of unsuccessful in vitro fertilization. Fertil Steril 2008; 92:149-56. [PMID: 18706550 DOI: 10.1016/j.fertnstert.2008.05.067] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 05/07/2008] [Accepted: 05/16/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the long-term outcome of patients who began IVF treatment by considering not only treatment outcome in the center but also the parenthood project outcome after discontinuation of unsuccessful IVF. DESIGN Retrospective cohort follow-up study. SETTING Two French IVF centers. PATIENT(S) Seven hundred twenty-four patients who began IVF treatment in 1998. INTERVENTION(S) Postal and phone contacts with unsuccessful IVF patients. MAIN OUTCOME MEASURE(S) Long-term outcome of parenthood project. RESULT(S) Of the 724 patients, a minimum of 53% and a maximum of 81% finally succeeded in their parenthood project during or after IVF treatment (depending on the hypotheses that the 204 patients not contacted either failed or succeeded in their parenthood project). An intermediate hypothesis gave an estimation of 66% of patients finally succeeding in having a child (40% during IVF treatment in the center and 26% after). Achievement of the parenthood project after IVF discontinuation was due mainly to adoption of a child (46%) or a birth following a spontaneous pregnancy (42%). CONCLUSION(S) Unsuccessful patients should not lose hope, because nearly half may subsequently succeed in having a child.
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Ludwig AK, Katalinic A, Jendrysik J, Thyen U, Sutcliffe AG, Diedrich K, Ludwig M. Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in 899 families in Germany. Reprod Biomed Online 2008; 17:403-9. [DOI: 10.1016/s1472-6483(10)60225-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Qualitätssicherung in der assistierten Reproduktion auf der Grundlage einer qualifizierten Beratung. GYNAKOLOGISCHE ENDOKRINOLOGIE 2007. [DOI: 10.1007/s10304-007-0201-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The introduction of intracytoplasmic sperm injection (ICSI) in 1992 has dramatically changed the management of severe male infertility. In severe male infertility, live birth rates with ICSI are superior to those with other non-donor treatments. In non-male infertility, however, pregnancy rates are not better with ICSI than with in vitro fertilization (IVF). With obstructive or non-obstructive azoospermia, reasonable pregnancy rates are now possible with ICSI after recovery of sperm from the testes followed by ICSI. Genetic counselling is indicated for severe male infertility, whether or not ICSI is considered. ICSI is indicated in preimplantation genetic diagnosis (PGD) to avoid contamination by extraneous DNA in the case of PCR-based testing and to increase the number of embryos available for testing. In turn, PGD may be indicated in pregnancies that are at high risk of aneuploidy because of genetic factors associated with azoospermia. As with IVF, not all couples succeed, but 2% of couples with failed ICSI cycles will conceive without treatment. ICSI outcome studies indicate that there is a significant increase in prematurity, low birthweight, and perinatal mortality associated with single and multiple births, similar to the outcomes of conventional IVF. However, as evidenced in long-term follow-up studies, the higher rates of urogenital abnormalities and increased use of healthcare may be associated with paternal characteristics.
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Abstract
Subfertility is a statistical concept. When a pregnancy has not been achieved within a year of unprotected intercourse, the odds are that an underlying pathological mechanism is at play. Advanced female age, longer duration and primary infertility, are important prognostic factors, suggestive of low fecundity and indicating a need for further diagnosis and treatment. Many diagnostic tests only have screening value and the only gold standards are hysteroscopy and laparoscopy. Severely impaired semen quality should lead to andrological work-up. Postcoital test and endometrial biopsy are obsolete. Treatment should preferably be aetiological, such as in anovulation, and sometimes also in endometriosis and tubal infertility. Primary treatment of male infertility is not proven to be advantageous. Conception-enhancing techniques such as intrauterine insemination (IUI), in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI), have shown to be effective. As a rule, and where possible, IUI is preferred and only if four to six cycles have failed should IVF be offered.
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Affiliation(s)
- Petra De Sutter
- Infertility Clinic, Department of Obstetrics and Gynecology, University Hospital Ghent, 185 De Pintelaan, B-9000 Gent, Belgium.
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De Gennaro L, Balistreri S, Lenzi A, Lombardo F, Ferrara M, Gandini L. Psychosocial factors discriminate oligozoospermic from normozoospermic men. Fertil Steril 2003; 79 Suppl 3:1571-6. [PMID: 12801562 DOI: 10.1016/s0015-0282(03)00374-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the profile of psychosocial variables in a group of oligozoospermic and normozoospermic men for assessing the hypothesis of a relationship between impaired seminal status and psychosocial factors. DESIGN Double-blind investigation of the psychosocial differences between oligozoospermics and normozoospermics. SETTINGS Healthy volunteers in a clinical environment. PATIENT(S) Two hundred eighty men attending their first seminal examination. INTERVENTION(S) We selected 37 oligozoospermic patients on the basis of sperm concentration and 37 normozoospermic controls for comparison. OUTCOME MEASURE(S) Differences in alexithymia (difficulty identifying feelings, difficulty describing feelings, externally oriented thinking), personality traits (extroversion, neuroticism, psychoticism), and coping style toward stressors (task-oriented coping, emotion-oriented coping, avoidance-oriented coping) were assessed in the two groups. RESULT(S) Wilk's Lambda (.79) of the discriminant analysis showed a statistically significant difference between the two groups. The following variables met the inclusion criterion in the discriminant function: psychoticism and difficulty describing feeling. This analysis also showed a high probability of correct classification of oligozoospermic men on the basis of the psychosocial variables. CONCLUSION(S) The relationship between psychosocial variables and seminal status has been confirmed in a group of oligozoospermic and normozoospermic men.
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Affiliation(s)
- Luigi De Gennaro
- Department of Psychology, University of Rome "La Sapienza,", Rome, Italy.
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