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Siristatidis C, Syristatidi K, Papapanou M. Updates in Assisted Reproduction. J Clin Med 2022; 11:jcm11113129. [PMID: 35683513 PMCID: PMC9180952 DOI: 10.3390/jcm11113129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 02/05/2023] Open
Abstract
There are multiple reasons for which the “updates in assisted reproduction” topic is and will be in the center of scientific attention—both clinical and laboratory—during the next decades. In this editorial, we present and discuss some of them.
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Affiliation(s)
- Charalampos Siristatidis
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion” University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece;
- Correspondence: ; Tel.: +30-693-2294-994
| | - Kalliopi Syristatidi
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews KY16 9TF, UK;
| | - Michail Papapanou
- Assisted Reproduction Unit, Second Department of Obstetrics and Gynecology, “Aretaieion” University Hospital, Medical School, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece;
- Obstetrics, Gynecology and Reproductive Medicine Working Group, Society of Junior Doctors, 15123 Athens, Greece
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Anifandis G, Sutovsky P, Turek PJ, Chavez SL, Kunej T, Messini CI, Schon SB, Mavroforou A, Adashi EY, Krawetz SA. Bioethics in human embryology: the double-edged sword of embryo research. Syst Biol Reprod Med 2022; 68:169-179. [PMID: 35380489 DOI: 10.1080/19396368.2022.2052771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There has been a significant increase in the use of assisted reproductive therapies (ARTs) over the past several decades, allowing many couples with infertility to conceive. Despite the achievements in this field, a mounting body of evidence concerning the epigenetic risks associated with ART interventions such as ovarian hormonal stimulation, intracytoplasmic sperm injection (ICSI), and in vitro culture (IVC) of oocytes and embryos has also emerged. Induced development of multiple follicles, the IVC media itself, and extended culture may alter the epigenome of both gametes and embryos, resulting in yet to be fully understood developmental, postnatal, and adult life health consequences. Investigators have attempted to decipher the molecular mechanisms mediating ART-induced epigenetic changes using either human samples or animal models with some success. As research in this field continues to expand, the ethical responsibilities of embryologists and researchers have become critically important. Here, we briefly discuss the ethical aspects of ART research, concentrating on the constraints arising from the perceived 'unnaturalness' of many of these procedures. Secondly, we focus on the bioethics and morality of human embryo research in general and how ethically acceptable model systems may be used to mimic early human embryogenesis. Lastly, we review the 14-day culture limit of human embryos and the notion that this rule could be considered of taken into account using new technologies and cues from animal models. The 'black box' of early post-implantation embryogenesis might be revealed using embryo models. As long as this distinct moral line has been drawn and closely followed, we should not fear scientific growth in embryo research. Although in vitro fertilization (IVF) is ethically acceptable, research with human embryos to improve its success raises serious ethical concerns that are in need of constant revisiting.Glossary index: Moral status: the ascription of obligations and rights to embryos on the basis of sentience; Sentience: the capacity of the developing embryo to experience feelings and sensations, such as the awareness of pain; Ectogenesis: the growth of the embryo in an artificial environment outside the mother's body.
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Affiliation(s)
- George Anifandis
- Department of Obstetrics and Gynecology, ART Unit, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Peter Sutovsky
- Division of Animal Sciences and the Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA
| | | | - Shawn L Chavez
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Departments of Obstetrics & Gynecology, Molecular & Medical Genetics, and Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Tanja Kunej
- Biotechnical Faculty, Department of Animal Science, University of Ljubljana, Domzale, Slovenia
| | - Christina I Messini
- Department of Obstetrics and Gynecology, ART Unit, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larisa, Greece
| | - Samantha B Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Anna Mavroforou
- School of Health Sciences, Faculty of Nursing, University of Thessaly, Larisa, Greece
| | - Eli Y Adashi
- Center for Prisoner Health and Human Rights, The Warren Alpert Medical School, Division of Biology and Medicine, Brown University, Providence, RI, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology, Molecular Medicine & Genetics, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, USA
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Revisiting selected ethical aspects of current clinical in vitro fertilization (IVF) practice. J Assist Reprod Genet 2022; 39:591-604. [PMID: 35190959 PMCID: PMC8995227 DOI: 10.1007/s10815-022-02439-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/16/2022] [Indexed: 12/19/2022] Open
Abstract
Ethical considerations are central to all medicine though, likely, nowhere more essential than in the practice of reproductive endocrinology and infertility. Through in vitro fertilization (IVF), this is the only field in medicine involved in creating human life. IVF has, indeed, so far led to close to 10 million births worldwide. Yet, relating to substantial changes in clinical practice of IVF, the medical literature has remained surprisingly quiet over the last two decades. Major changes especially since 2010, however, call for an updated commentary. Three key changes deserve special notice: Starting out as a strictly medical service, IVF in recent years, in efforts to expand female reproductive lifespans in a process given the term “planned” oocyte cryopreservation, increasingly became more socially motivated. The IVF field also increasingly underwent industrialization and commoditization by outside financial interests. Finally, at least partially driven by industrialization and commoditization, so-called add-ons, the term describing mostly unvalidated tests and procedures added to IVF since 2010, have been held responsible for worldwide declines in fresh, non-donor live birthrates after IVF, to levels not seen since the mid-1990s. We here, therefore, do not offer a review of bioethical considerations regarding IVF as a fertility treatment, but attempt to point out ethical issues that arose because of major recent changes in clinical IVF practice.
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