An In Vivo Screening Model for Investigation of Pathophysiology of Human Implantation Failure

To improve current infertility treatments, it is important to understand the pathophysiology of implantation failure. However, many molecules are involved in the normal biological process of implantation and the roles of each molecule and the molecular mechanism are not fully understood. This review highlights the hemagglutinating virus of Japan (HVJ; Sendai virus) envelope (HVJ-E) vector, which uses inactivated viral particles as a local and transient gene transfer system to the murine uterus during the implantation period in order to investigate the molecular mechanism of implantation. In vivo screening in mice using the HVJ-E vector system suggests that signal transducer and activator of transcription-3 (Stat-3) could be a diagnostic and therapeutic target for women with a history of implantation failure. The HVJ-E vector system hardly induces complete defects in genes; however, it not only suppresses but also transiently overexpresses some genes in the murine uterus. These features may be useful in investigating the pathophysiology of implantation failure in women.

Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment

INTRODUCTION

This study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.

MATERIAL AND METHODS

A total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005-2007). Live birth rate after ART was 24.8% at baseline. Up to 5 years later (2010-2011) the same participants were sent individual postal questionnaires (n = 439).

RESULTS

Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow up. Of these, almost three of four (71.6%) had a live birth after ART and more than one of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nineteen (6.8%) women and 13 (7.1%) men had a child after adoption. Almost one of five (19.1%) women had no live birth at follow up.

CONCLUSION

The majority of women and men were living with children, resulting from a live birth after ART, spontaneous pregnancy and/or adoption up to 5 years later. However, almost one of five had no live birth at follow up.

Spontaneous pregnancies following discontinuation of IVF/ICSI treatment: an internet-based survey

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.

Spontaneous conceptions within two years of having a first infant with assisted conception

BACKGROUND

Australian data regarding spontaneous conceptions following a live birth conceived by assisted reproductive technologies (ART) have not yet been reported.

AIMS

This study aimed to determine the incidence of spontaneous conceptions within 18-24 months after women had a first infant conceived by ART (ARTC) or spontaneously conceived (SC). Factors associated with spontaneous pregnancies in women with ARTC first infants were investigated.

MATERIALS AND METHODS

Nulliparous women were recruited through ART clinics (n = 297) and maternity hospitals (n = 295) in Melbourne and Sydney, Australia. Participants were interviewed in pregnancy and when their first infants were aged 18-24 months. Information was collected on pregnancies since the first infant's birth. The outcome was any subsequent conception during this period.

RESULTS

Follow-up data were available for 198 women with SC first infants and 236 women with ARTC first infants, 94 (40%) of whom had further ART following the first birth. Spontaneous conceptions had occurred in 40% of women with SC first infants and 33% of women with ARTC first infants who had not had subsequent ART. Twenty-four per cent of pregnancies after the birth of SC first infants were unexpected, compared with 61% of subsequent pregnancies (without further treatment) after the birth of ARTC first infants (P < 0.001). Subsequent, spontaneous pregnancies in women with ARTC first infants were significantly associated with unexplained infertility and shorter partner relationship duration.

DISCUSSION

Discussion about contraception is recommended if women with ARTC first infants do not wish to have more children or wish to delay subsequent pregnancies.