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English K, Frise C, Trinder J, Cauldwell M, Simpson M, Adamson D, Elton C, Burns G, Choudhary M, Nathanson M, Robert L, Moore J, O'Brien P, Pundir J. Best practice recommendations for medically assisted reproduction in patients with known cardiovascular disease or at high risk of cardiovascular disease. HUM FERTIL 2024; 27:2278295. [PMID: 38196173 DOI: 10.1080/14647273.2023.2278295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 01/11/2024]
Abstract
Increasing numbers of people are seeking assisted conception. In people with known cardiac disease or risk factors for cardiac disease, assisted conception may carry increased risks during treatment and any subsequent pregnancy. These risks should be assessed, considered and minimized prior to treatment.
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Affiliation(s)
- Kate English
- Department of Congenital Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Charlotte Frise
- Department of Obstetrics, Queen Charlotte's and Chelsea Hospital, London, UK
| | | | | | | | - Dawn Adamson
- Department of Cardiology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chris Elton
- Department of Anaesthesia, Leicester Royal Infirmary, Leicester, UK
| | | | - Meenakshi Choudhary
- Newcastle Fertility Centre at Life, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mike Nathanson
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Leema Robert
- Department of Clinical Genetics, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Jim Moore
- Department of Primary Care, NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | - Pat O'Brien
- Department of Obstetrics, University College London, London, UK
| | - Jyotsna Pundir
- Reproductive Medicine, St Bartholomew's Hospital, London, UK
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Skorupskaite K, Hardy M, Bhandari H, Yasmin E, Saab W, Seshadri S. Evidence based management of patients with endometriosis undergoing assisted conception: British fertility society policy and practice recommendations. HUM FERTIL 2024; 27:2288634. [PMID: 38226584 DOI: 10.1080/14647273.2023.2288634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 01/17/2024]
Abstract
Endometriosis is a chronic inflammatory condition in women of reproductive age, which can lead to infertility and pelvic pain. Endometriosis associated infertility is multifactorial in nature adversely affecting each step of the natural reproductive physiology and thereby processes and outcomes of Assisted Reproductive Technology (ART) cycles. These outcomes are further complicated by the subtype of endometriosis, being peritoneal, deep infiltrating and ovarian, which bear negative effects on ovarian reserve, response to stimulation, accessibility for oocyte retrieval, intraoperative safety and endometrial receptivity. There is still a lack of clear guidance about the role of surgery for ovarian endometriosis/endometriomas. This guideline evaluates the evidence of the impact of pelvic endometriosis and endometriomas on the outcome of ART and provides recommendations for management options before and during ART including intra-uterine insemination. Recommendations are made based on the current evidence for the management of patients with endometriosis across each step of ART with the primary aim of improving ART outcomes.
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Affiliation(s)
- Karolina Skorupskaite
- Edinburgh Fertility & Reproductive Endocrine Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Madeleine Hardy
- Leeds Centre for Reproductive Medicine at Leeds Teaching Hospitals NHS Trust, Seacroft Hospital, Leeds, UK
| | - Harish Bhandari
- Leeds Centre for Reproductive Medicine at Leeds Teaching Hospitals NHS Trust, Seacroft Hospital, Leeds, UK
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospital NHS Foundation Trust, London, UK
| | - Wael Saab
- The Centre for Reproductive & Genetic Health, London, UK
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Van Lierde A, Delagrange H, Russo FM, Van der Merwe J, Devlieger R, Lewi L. Are there differences between monochorionic twin placentas after spontaneous and assisted conception? Placenta 2022; 126:171-174. [PMID: 35842947 DOI: 10.1016/j.placenta.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION No data are available on the placental characteristics of monochorionic twin pregnancies conceived by in vitro fertilization (IVF). This study investigates the differences between placentas from monochorionic diamniotic (MCDA) twin pregnancies conceived spontaneously and those conceived after IVF. METHODS This is a retrospective analysis of placental data from a consecutive series of MCDA twin pregnancies followed from the first trimester. The following placental characteristics were compared between IVF versus spontaneous MCDA pregnancies: placental sharing and birth weight discordance relative to placental sharing, the placental angioarchitecture (number, type, and size of anastomoses), and the umbilical cord insertion types. RESULTS Of the 256 MCDA placentas included in this analysis, 32 (12%) were conceived through IVF and 224 (88%) spontaneously. MCDA twin placentas after IVF did not differ significantly from MCDA twin placentas after spontaneous conception regarding placental sharing, birthweight discordance relative to sharing discordance, and angioarchitecture. There was a trend toward more discordant cord insertions (combination eccentric and velamentous) in IVF (25%) than in spontaneously conceived placentas (12%) (P = 0.05). DISCUSSION No differences could be demonstrated between MCDA placentation after spontaneous conception and IVF. Any differences in pregnancy outcome between spontaneous and IVF conceived MCDA twins may not be related to differences in placental sharing, angioarchitecture and cord insertion type.
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Affiliation(s)
- Anette Van Lierde
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Hannelore Delagrange
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - Francesca Maria Russo
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | | | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium
| | - Liesbeth Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Department of Obstetrics and Gynecology, University Hospitals Leuven, Belgium.
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Elfituri A, Bakker W, Viswanatha R, Robinson E, Jan H, Ganapathy R. Maternal and perinatal outcomes of dichorionic diamniotic twins in women after spontaneous and assisted conception. Eur J Obstet Gynecol Reprod Biol 2021; 263:247-251. [PMID: 34242933 DOI: 10.1016/j.ejogrb.2021.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/10/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Twin pregnancies have been shown to be associated with numerous maternal and perinatal complications. Published data shows conflicting reports on whether assisted conception influences these risks. The purpose of this study was to assess the impact of mode of conception on maternal and perinatal outcomes of dichorionic diamniotic twin pregnancies. STUDY DESIGN This was a large retrospective study of 497 women with dichorionic diamniotic twins that were conceived spontaneously or with assisted conception in a single centre over a 10-year period. RESULTS This study showed no significant difference in mode of delivery (OR 1.40 95% CI 0.88 - 2.24), need for admission to neonatal unit (OR 1.56 95% CI 0.88-2.77), or preterm births between dichorionic twin pregnancies conceived following assisted conception when compared to spontaneously conceived dichorionic twin pregnancies. Women who conceived twins by assisted conception that did not have an elective caesarean section were more likely to go into spontaneous labour than have an induction of labour (OR 0.54 95% CI 0.3 - 0.99). They also had a higher chance of having an estimated blood loss of more than 1L than women who conceived naturally (OR 1.70 95% CI 1.06 - 2.73). CONCLUSIONS In the case of dichorionic twins, this study showed that assisted conception does not seem to be associated with adverse obstetric and perinatal outcomes when compared with spontaneous conception. These results should be considered reassuring to women undergoing assisted conception, and may assist clinicians when counselling patients for assisted conception treatment. Further research is needed to assess the impact of assisted conception on postpartum blood loss.
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Affiliation(s)
- Abdullatif Elfituri
- Obstetrics and Gynaecology Department, Epsom and St. Helier University Hospitals NHS Trust, Epsom, Surrey, UK
| | - Wouter Bakker
- Obstetrics and Gynaecology Department, Epsom and St. Helier University Hospitals NHS Trust, Epsom, Surrey, UK
| | - Radhika Viswanatha
- FRCOG, Consultant Fetal Medicine, Obstetrics and Gynaecology Department, Epsom and St. Helier University Hospitals NHS Trust, Epsom, Surrey, UK
| | | | - Haider Jan
- MRCOG, Gynaecology Consultant and Clinical Director, Obstetrics and Gynaecology Department, Epsom and St. Helier University Hospitals NHS Trust, Epsom, Surrey, UK
| | - Ramesh Ganapathy
- MRCOG, Consultant Fetal Medicine and Divisional Director, Obstetrics and Gynaecology Department, Epsom and St. Helier University Hospitals NHS Trust, Epsom, Surrey, UK.
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Schäfer S, Liu A, Campbell D, Nanan R. Analysis of maternal and perinatal determinants of allergic sensitization in childhood. Allergy Asthma Clin Immunol 2020; 16:71. [PMID: 32922456 PMCID: PMC7477859 DOI: 10.1186/s13223-020-00467-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/21/2020] [Indexed: 11/24/2022] Open
Abstract
Background Non-communicable diseases, such as allergies, are influenced by both genetic and epigenetic factors. Perinatal determinants conceivably modify the epigenetic makeup of the developing fetal immune system preventing or predisposing the development of allergies. The aim of this study therefore was to identify independent perinatal factors associated with allergic sensitization in childhood. Methods In a single center retrospective case-cohort study electronic obstetric medical records and available skin prick testing results of children were analyzed. For the analysis 286 skin prick test positive (sensitized) children [median (IQR): 3.47 (1.70–7.34) years] were compared with data from all remaining live births in the obstetric cohort (n = 66,583). Results Sensitized children more frequently had a mother born in Asia (19.1% vs. 10.2%; P < 10–6). Applying backward elimination logistic regression, seven out of 23 initially entered perinatal factors remained in the model. High maternal age (> 35 years; OR: 1.912; P < 0.001), male offspring sex (OR: 1.423; P < 0.01) and assisted conception (OR: 1.771; P < 0.05) increased the risk for allergic sensitization. In contrast, maternal smoking (OR: 0.469; P < 0.005), increasing parity (OR: 0.881; P < 0.05), maternal pre-pregnancy overweight (OR: 0.742; P < 0.005) and preterm birth (OR: 0.484; P < 0.05) decreased the risk for allergic sensitization. Conclusions In addition to supporting previous findings, this study is first to report an increased risk of allergic sensitization after assisted conception. Beyond this finding’s potential implementation in preventative strategies, exploration of this association could further pathophysiological understanding of allergic disease.
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Affiliation(s)
- Samuel Schäfer
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Discipline of Paediatrics and Child Health, Charles Perkins Centre-Nepean, Sydney Medical School-Nepean, The University of Sydney, Penrith, NSW Australia
| | - Anthony Liu
- Discipline of Paediatrics and Child Health, Charles Perkins Centre-Nepean, Sydney Medical School-Nepean, The University of Sydney, Penrith, NSW Australia
| | - Dianne Campbell
- Immunology and Allergy, The Children's Hospital at Westmead, Westmead, NSW Australia.,Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW Australia
| | - Ralph Nanan
- Discipline of Paediatrics and Child Health, Charles Perkins Centre-Nepean, Sydney Medical School-Nepean, The University of Sydney, Penrith, NSW Australia
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Bhide P, Srikantharajah A, Lanz D, Dodds J, Collins B, Zamora J, Chan D, Thangaratinam S, Khan KS. TILT: Time-Lapse Imaging Trial-a pragmatic, multi-centre, three-arm randomised controlled trial to assess the clinical effectiveness and safety of time-lapse imaging in in vitro fertilisation treatment. Trials 2020; 21:600. [PMID: 32611445 PMCID: PMC7329433 DOI: 10.1186/s13063-020-04537-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Subfertility is a common problem for which in vitro fertilisation (IVF) treatment is commonly recommended. Success rates following IVF are suboptimal and have remained static over the last few years. This imposes a considerable financial burden on overstretched healthcare resources. Time-lapse imaging (TLI) of developing embryos in IVF treatment is hypothesised to improve the success rates of treatment. This may be either by providing undisturbed culture conditions or by improving the predictive accuracy for optimal embryo selection from a cohort of available embryos. However, the current best evidence for its effectiveness is inconclusive. Methods The time-lapse imaging trial is a pragmatic, multi-centre, three-arm parallel-group randomised controlled trial using re-randomisation. The primary objective of the trial is to determine if the use of TLI or undisturbed culture in IVF treatment results in a higher live birth rate when compared to current standard methods of embryo incubation and assessment. Secondary outcomes include measures of clinical efficacy and safety. The trial will randomise 1575 participants to detect an increase in live birth from 26.5 to 35.25%. Discussion In the absence of high-quality evidence, there is no current national guidance, recommendation or policy for the use of TLI. The use of TLI is not consistently incorporated into standard IVF care. A large, pragmatic, multi-centre, trial will provide much needed definitive evidence regarding the effectiveness of TLI. If proven to be effective, its incorporation into standard care would translate into significant clinical and economic benefits. If not, it would allow allocation of resources to more effective interventions. Trial registration ISRCTN registry ISRCTN17792989. Prospectively registered on 18 April 2018
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Affiliation(s)
- Priya Bhide
- Barts Research Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK. .,Homerton Fertility Centre, Homerton University Hospital, London, UK.
| | | | - Doris Lanz
- Barts Research Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Julie Dodds
- Barts Research Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Bonnie Collins
- Centre for Reproductive Medicine, St Bartholomew's Hospital, London, UK
| | - Javier Zamora
- Barts Research Centre for Women's Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK.,Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), CIBER Epidemiology and Public Health, Madrid, Spain
| | - David Chan
- Assisted Reproductive Technology Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR
| | - Shakila Thangaratinam
- Institute of Metabolism and Systems Research, WHO Collaborating Centre for Women's Health, University of Birmingham, Birmingham, UK
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
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Bell JL, Hardy P, Greenland M, Juszczak E, Cole C, Maheshwari A, Bhattacharya S, Linsell L. E-Freeze - a randomised controlled trial evaluating the clinical and cost effectiveness of a policy of freezing embryos followed by thawed frozen embryo transfer compared with a policy of fresh embryo transfer, in women undergoing in vitro fertilisation: a statistical analysis plan. Trials 2020; 21:596. [PMID: 32605633 PMCID: PMC7329511 DOI: 10.1186/s13063-020-04441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/23/2020] [Indexed: 12/03/2022] Open
Abstract
Background The E-Freeze trial is a multi-centre randomised controlled trial of fresh versus frozen embryo transfer for women undergoing in vitro fertilisation. This paper describes the statistical analysis plan for the E-Freeze trial. Methods and design E-Freeze is a two-arm parallel-group, multi-centre, individually randomised controlled trial to determine if a policy of freezing embryos, followed by thawed frozen embryo transfer, results in a higher healthy baby rate when compared with the current policy of transferring fresh embryos. Couples undergoing their first, second or third cycle of in vitro fertilisation at fertility centres in the UK were randomised to either fresh or frozen embryo transfer. The primary outcome is a healthy baby, defined as a live singleton baby born at term with an appropriate weight for gestation. This paper describes the statistical analysis plan for the trial, including the analysis principles, definitions of outcomes, methods for primary analysis, pre-specified subgroup analysis and sensitivity analysis. This plan was finalised prior to completion of recruitment to the trial. Trial registration ISRCTN registry: ISRCTN61225414. Registered on 29 December 2015.
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8
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Maheshwari A, Bhattacharya S, Bowler U, Brison D, Child T, Cole C, Coomarasamy A, Cutting R, Harbottle S, Hardy P, Juszczak E, Khalaf Y, Kurinczuk JJ, Lavery S, Lewis-Jones C, Macklon N, Raine-Fenning NJ, Rajkohwa M, Scotland G, Troup S. Study protocol: E-freeze - freezing of embryos in assisted conception: a randomised controlled trial evaluating the clinical and cost effectiveness of a policy of freezing embryos followed by thawed frozen embryo transfer compared with a policy of fresh embryo transfer, in women undergoing in vitro fertilisation. Reprod Health 2019; 16:81. [PMID: 31196113 PMCID: PMC6567605 DOI: 10.1186/s12978-019-0737-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022] Open
Abstract
Background Infertility affects one in seven couples; many of these need in vitro fertilisation (IVF). IVF involves external hormones to stimulate a woman’s ovaries to produce eggs which are harvested surgically. Embryos, created in the laboratory by mixing eggs with sperm, are grown in culture for a few days before being replaced within the uterus (fresh embryo transfer). Spare embryos are usually frozen with a view to transfer at a later point in time – especially if the initial fresh transfer does not result in a pregnancy. Despite improvements in technology, IVF success rates remain low with an overall live birth rate of 25–30% per treatment. Additionally, there are concerns about health outcomes for mothers and babies conceived through IVF, particularly after fresh embryo transfer, including maternal ovarian hyperstimulation syndrome (OHSS) and preterm delivery. It is believed that high levels of hormones during ovarian stimulation could create a relatively hostile environment for embryo implantation whilst increasing the risk of OHSS. It has been suggested that freezing all embryos with the intention of thawing and replacing them within the uterus at a later stage (thawed frozen embryo transfer) instead of fresh embryo transfer, may lead to improved pregnancy rates and fewer complications. We aim to compare the clinical and cost effectiveness of fresh and thawed frozen embryo transfer, with the primary aim of identifying any difference in the chance of having a healthy baby. Methods E-Freeze is a pragmatic, multicentre two-arm parallel group randomised controlled trial where women aged ≥18 and < 42 years, with at least three good quality embryos are randomly allocated to receive either a fresh or thawed frozen embryo transfer. The primary outcome is a healthy baby, defined as a term, singleton, live birth with appropriate weight for gestation. Cost effectiveness will be calculated from a healthcare and societal perspective. Discussion E-Freeze will determine the relative benefits of fresh and thawed frozen embryo transfer in terms of improving the chance of having a healthy baby. The results of this pragmatic study have the potential to be directly transferred to clinical practice. Trial registration ISRCTN registry: ISRCTN61225414. Date assigned 29/12/2015.
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Abstract
This special issue adopts a comparative approach to the politics of reproduction in twentieth-century France and Britain. The articles investigate the flow of information, practices and tools across national boundaries and between groups of experts, activists and laypeople. Empirically grounded in medical, news media and feminist sources, as well as ethnographic fieldwork, they reveal the practical similarities that existed between countries with officially different political regimes as well as local differences within the two countries. Taken as a whole, the special issue shows that the border between France and Britain was more porous than is typically apparent from nationally-focused studies: ideas, people and devices travelled in both directions; communication strategies were always able to evade the rule of law; contraceptive practices were surprisingly similar in both countries; and religion loomed large in debates on both sides of the channel.
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Affiliation(s)
- Jesse Olszynko-Gryn
- Chancellor’s Fellow, School of Humanities (History), University of Strathclyde, Lord Hope Building, 141 St James Road, Glasgow G4 0LT, UK
| | - Caroline Rusterholz
- Wellcome Trust Research Fellow, Faculty of History, University of Cambridge, Alison Richard Building, 7 West Road, Cambridge CB3 9DT, UK
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10
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Abstract
Over 8 million babies have been born following IVF (in vitro fertilisation) and other artificial reproductive technology (ART) procedures since Louise Brown's birth 40 years ago. New innovations have added much complexity to both clinical and laboratory procedures over the last four decades. Translation of novel approaches from basic science into clinical practice continues unabated, widening the applicability of ART to new groups of people and helping improve both chances of healthy live birth and patient acceptability. However, the impact of ART on the health of both patients and their offspring continues to cause concern, and many ethical challenges created by new scientific developments in this field attract widely differing opinions. What is undeniable is that there will be a sustained global growth in utilisation of ART and that reproductive tourism will allow many people to access the treatment they desire notwithstanding national regulations that may forbid some approaches. The greatest challenge is to expand access to ART to those living in the less wealthy nations who are equally deserving of its benefits.
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Affiliation(s)
- G E Crawford
- The Royal Hospital for Women, Randwick, NSW, Australia.,School of Women's and Children's Health, The University of New South Wales, Randwick, NSW, Australia
| | - W L Ledger
- The Royal Hospital for Women, Randwick, NSW, Australia.,School of Women's and Children's Health, The University of New South Wales, Randwick, NSW, Australia
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Trifonova K, Slaveykov K, Mumdzhiev H, Dzhelebov D. Artificial Reproductive Technology - A Risk Factor for Retinopathy of Prematurity. Open Access Maced J Med Sci 2018; 6:2245-2249. [PMID: 30559896 PMCID: PMC6290440 DOI: 10.3889/oamjms.2018.448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/21/2018] [Accepted: 10/22/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND: Retinopathy of Prematurity (ROP) is a potentially blinding vasoproliferative disease in premature babies. The presentation and course of ROP are determined by a complex interaction of a series of risk factors, including artificial reproductive technology (ART). AIM: To analyse and combine the information relating ART as an independent risk factor for retinopathy of prematurity. METHODS AND MATERIAL: The article is systematic review and meta-analysis using RevMan 5. Pubmed, Scopus and Medline were searched for articles from 1990 to 2018. RESULTS: Studies suggest that ROP is observed more frequently in ART children. They are more likely to be premature and of low birth weight than those conceived naturally. Results vary from just a tendency to a five-fold increase in risk to develop ROP in ART babies. At the same time, they might develop ROP later, and more mature newborns might be affected. CONCLUSION: The data relating ART as a risk factor for ROP is inconclusive, but most studies show at least a tendency. The ART newborns need to be considered as a risk group for ROP and observed with greater suspicion. Even more mature ART newborns might need to be screened in order not to miss any significant pathology.
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Affiliation(s)
- Kalina Trifonova
- Trakijski Universitet, Meditsinski Fakultet, Ophthalmology, Stara Zagora, Bulgaria
| | - Kiril Slaveykov
- Trakijski Universitet, Meditsinski Fakultet, Stara Zagora, Bulgaria
| | - Hristo Mumdzhiev
- Trakijski Universitet, Meditsinski Fakultet, Stara Zagora, Bulgaria
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12
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Abstract
Biological parenthood is a central life-goal for many couples that can become blocked when they experience infertility. Many couples who undergo fertility treatment will face failure and consequently have to decide whether to continue with treatment. The present study used the qualitative methodology of Interpretative Phenomenological Analysis to examine self-regulatory approaches that underlie decision-making about continuing treatment. One-time, one-on-one, semi-structured, in-depth interviews were conducted with 16 individuals (eight heterosexual couples) after they had experienced at least one treatment failure and were considering whether to undergo another treatment. After treatment failure, individuals used several approaches to remain engaged with biological parenthood, including reframing treatment failure as a learning tool and emphasizing the importance of persistence in achieving success. The apparent decision to continue with treatment was considered non-negotiable and largely made by women in the partnership. Once the decision was made to pursue treatment, it was not discussed further. Given individuals' willingness to engage in treatment, patients should be offered additional support to consider wide psychosocial implications of continuing treatment.
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Affiliation(s)
| | - Jean Marie Place
- Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Jacky Boivin
- School of Psychology, Cardiff University, Cardiff, UK
| | - Sofia Gameiro
- School of Psychology, Cardiff University, Cardiff, UK
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13
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Crosby D, O'Brien Y, Glover L, Martyn F, Wingfield M. Influence of body mass index on the relationship between endometrial thickness and pregnancy outcome in single blastocyst frozen embryo transfer cycles. HUM FERTIL 2018; 23:32-37. [PMID: 30221570 DOI: 10.1080/14647273.2018.1504324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To date there is limited published data assessing whether body mass index (BMI) influences endometrial thickness (ET) and whether this impacts on pregnancy outcomes in single blastocyst FET cycles. The objective of this study, therefore, was to examine the relationship between BMI and ET on the outcome of single blastocyst FET cycles over a five-year period from 2012 until 2016. Patient age, BMI, endometrial pattern and ET prior to FET were recorded. Pregnancy outcomes included: implantation rate, clinical pregnancy rate and live birth rate. A total of 464 cycles met the inclusion criteria and the female age was 36.0 ± 3.0 years (mean ± SD). The mean ± SD BMI was 23.3 ± 3.1 kg/m2 and median ± SD ET was 8.1 ± 1.5 mm. BMI and ET were modestly correlated (Pearson r = 0.244) and there was an association between higher BMI category and higher median ET (7.2, 8.0, 8.3, 8.9 mm; p < 0.001). However, there was no association between ET and pregnancy outcome, either unadjusted, or adjusted for BMI, age, endometrial pattern or embryo quality. The data suggests that although ET increases with increasing BMI, there are no differences in cycle outcome. Importantly, this implies that an ET <8 mm may not jeopardize pregnancy outcome in women with lower BMI. The development of a norm referenced test for BMI and ET may prove to be a helpful adjunct in the clinical IVF setting.
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Affiliation(s)
- David Crosby
- Merrion Fertility Clinic, Dublin, Ireland.,National Maternity Hospital, Dublin, Ireland
| | - Yvonne O'Brien
- Merrion Fertility Clinic, Dublin, Ireland.,National Maternity Hospital, Dublin, Ireland
| | | | - Fiona Martyn
- Merrion Fertility Clinic, Dublin, Ireland.,National Maternity Hospital, Dublin, Ireland
| | - Mary Wingfield
- Merrion Fertility Clinic, Dublin, Ireland.,National Maternity Hospital, Dublin, Ireland
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Hack KEA, Vereycken MEMS, Torrance HL, Koopman-Esseboom C, Derks JB. Perinatal outcome of monochorionic and dichorionic twins after spontaneous and assisted conception: a retrospective cohort study. Acta Obstet Gynecol Scand 2018; 97:717-726. [PMID: 29430623 PMCID: PMC5969062 DOI: 10.1111/aogs.13323] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/04/2018] [Indexed: 11/30/2022]
Abstract
Introduction The aim of this study was to compare pregnancy outcomes in twin pregnancies after assisted conception and spontaneous conception, according to chorionicity. Material and methods Retrospective cohort study of 1305 twin pregnancies between 1995 and 2015. All spontaneous (n = 731) and assisted conception conceived (n = 574) twin pregnancies with antenatal care and delivery in University Medical Center Utrecht, the Netherlands, a tertiary obstetric care center were studied according to chorionicity. Results Maternal age and incidence of nulliparity were higher among the assisted conception twins. Hypertensive disorders also appeared to be more frequent in assisted conception pregnancies, which could largely be explained by the higher proportion of elderly nulliparous women in this group. Spontaneously conceived twins were born earlier than twins after assisted conception, with subsequent lower birthweights and more admissions to a neonatal intensive care unit with increased neonatal morbidity. Monochorionic twins had worse pregnancy outcomes compared with dichorionic twins, irrespective of mode of conception; monochorionic twins conceived by assisted reproduction had more neonatal morbidity (mainly respiratory distress syndrome and necrotizing enterocolitis) and late neonatal deaths compared with spontaneously conceived monochorionic twins. Conclusions Spontaneously conceived twins have worse pregnancy outcome compared with twins after assisted conception, probably due to a lower incidence of monochorionicity in the assisted conception group. The already increased perinatal risks in monochorionic twins are even higher in monochorionic twins conceived after infertility treatments compared with spontaneously conceived monochorionic twins, which warrants extra attention to these high‐risk pregnancies.
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Affiliation(s)
- Karien E A Hack
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Obstetrics and Gynecology, Gelre Hospitals Apeldoorn, Apeldoorn, the Netherlands
| | - Marijn E M S Vereycken
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helen L Torrance
- Department of Fertility, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan B Derks
- Department of Obstetrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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15
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Athar S, Hamcho MA, Tellisi AK, Puttegowda R, Boama V. Effect of BMI on pregnancy rates following ovulation induction and assisted conception among women in Qatar experiencing infertility. Int J Gynaecol Obstet 2018; 141:389-390. [PMID: 29509955 DOI: 10.1002/ijgo.12479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/19/2017] [Accepted: 03/01/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Sufia Athar
- Department of Obstetrics and Gynecology, Al-Wakra Hospital, Hamad Medical Corporation, Al-Wakra, Qatar
| | - Mohammad A Hamcho
- Department of Obstetrics and Gynecology, Al-Wakra Hospital, Hamad Medical Corporation, Al-Wakra, Qatar
| | - Amna K Tellisi
- Department of Obstetrics and Gynecology, Al-Wakra Hospital, Hamad Medical Corporation, Al-Wakra, Qatar
| | - Rohini Puttegowda
- Department of Obstetrics and Gynecology, Al-Wakra Hospital, Hamad Medical Corporation, Al-Wakra, Qatar
| | - Vincent Boama
- Department of Obstetrics and Gynecology, Al-Wakra Hospital, Hamad Medical Corporation, Al-Wakra, Qatar.,Sidra Medical and Research Center, Doha, Qatar
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16
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Obajimi G, Ogunkinle B. ROUTINE SALINE INFUSION SONOHYSTEROGRAPHY PRIOR TO ASSISTED CONCEPTION: A REVIEW OF OUR INITIAL EXPERIENCE. Ann Ib Postgrad Med 2016; 14:99-102. [PMID: 28337095 PMCID: PMC5354628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Saline infusion sonohysterography has been employed to evaluate the uterine cavity prior to commencement of assisted conception.Intra-uterine lesions play an important role in the outcome of assisted conception procedures. A descriptive retrospective study of 760 patients who had saline infusion sonohysterography prior to assisted conception, between January 2008 and December, 2010. Forty-six percent of the patients had intra-uterine pathologies. Submucous fibroids accounted for almost half (48.57%) of the pathologies, followed by adhesions (28.57%) and endometrial polyps (22.86%). Complications arising from the procedure were minor and occurred in 26 patients (3.42%). Abdominal cramps, vaginal bleeding and vaginal discharge occurred in 14 (53.85%), 8 (30.77%) and 4 (15.38%) respectively. The average duration of the procedure was 6 minutes with a range of 4-9 minutes. Saline infusion sonohysterography is a reliable, cost effective and safe diagnostic tool in the evaluation of the uterine cavity prior to assisted conception.
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Affiliation(s)
- G. Obajimi
- Department of Obstetrics & Gynaecology, University College Hospital, Ibadan
| | - B. Ogunkinle
- Department of Obstetrics & Gynaecology, The Bridge Clinic, Victoria Island, Lagos
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17
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Abstract
Poor ovarian response represents an increasingly common problem. This systematic review was aimed to identify the most effective treatment protocol for poor response. We searched MEDLINE, EMBASE, and The Cochrane Library from 1980 to October 2015. Study quality assessment and meta-analyses were performed according to the Cochrane recommendations. We found 61 trials including 4997 cycles employing 10 management strategies. Most common strategy was the use of gonadotropin-releasing hormone antagonist (GnRHant), and was compared with GnRH agonist protocol (17 trials; n = 1696) for pituitary down-regulation which showed no significant difference in the outcome. Luteinizing hormone supplementation (eight trials, n = 847) showed no difference in the outcome. Growth hormone supplementation (seven trials; n = 251) showed significant improvement in clinical pregnancy rate (CPR) and live birth rate (LBR) with an odds ratio (OR) of 2.13 (95% CI 1.06-4.28) and 2.96 (95% CI 1.17-7.52). Testosterone supplementation (three trials; n = 225) significantly improved CPR (OR 2.4; 95% CI 1.16-5.04) and LBR (OR 2.18; 95% CI 1.01-4.68). Aromatase inhibitors (four trials; n = 223) and dehydroepiandrosterone supplementation (two trials; n = 57) had no effect on outcome.
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Affiliation(s)
- Yadava Bapurao Jeve
- Leicester Fertility Centre, University Hospitals of Leicester, LE1 5WW, United Kingdom
| | - Harish Malappa Bhandari
- Department of Reproductive Medicine, Sub-specialty Trainee in Reproductive Medicine and Surgery, Newcastle Fertility Centre at Life, Newcastle upon Tyne, NE1 4EP, United Kingdom
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18
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Abstract
A possible mechanism for poor perinatal outcomes in singleton pregnancies conceived following assisted reproductive technologies (ART) and those conceived naturally following a period of infertility (>12 months) is thought to be placental dysfunction. This was investigated by measuring plasma concentrations of biochemical markers: (i) soluble fms-like tyrosine kinase1 (sFlt1); (ii) placental growth factor (PlGF); (iii) leptin; and (iv) plasminogen activator inhibitor 2 (PAI-2), serially at four antenatal time points. Baseline concentrations of each marker after delivery were also measured. The control group was naturally conceived singleton pregnancies with no history of infertility. Non-smoking, age-matched nulliparous women with no significant medical history were recruited to all groups. The ART group had significantly lower mean plasma concentrations of PlGF at all antenatal time points compared to the control group (p < 0.001). The subfertility (SF) group had significantly higher mean serum concentrations of leptin than the other groups at all time points (p < 0.001), even after correction for body mass index. There were no significant differences in sFlt1 and PAI-2 concentrations between the groups. Low plasma PlGF concentrations in the ART group might suggest abnormal placentation and/or abnormal function in ART pregnancies with relevance to pathogenesis of pregnancy complications in these women.
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Affiliation(s)
- Jolly Joy
- a Department of Obstetrics and Gynaecology , Queen's University Belfast , Belfast , UK and
| | - Lee Armstrong
- b Regional Regulatory Peptide Laboratory , Royal Victoria Hospital , Belfast , UK
| | - Joy Ardill
- b Regional Regulatory Peptide Laboratory , Royal Victoria Hospital , Belfast , UK
| | - Neil Mcclure
- a Department of Obstetrics and Gynaecology , Queen's University Belfast , Belfast , UK and
| | - Inez Cooke
- a Department of Obstetrics and Gynaecology , Queen's University Belfast , Belfast , UK and
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19
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Vinturache A, Stephenson N, McDonald S, Wu M, Bayrampour H, Tough S. Health-related quality of life in pregnancy and postpartum among women with assisted conception in Canada. Fertil Steril 2015; 104:188-95.e1. [PMID: 25956365 DOI: 10.1016/j.fertnstert.2015.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the effects of mode of conception (spontaneous vs. assisted) on health-related quality of life (HRQoL) throughout pregnancy and in the postpartum period. DESIGN Secondary analysis of data from the All Our Babies cohort. SETTING Not applicable. PATIENT(S) A total of 243 women with assisted conception and 3,309 women with spontaneous conception. INTERVENTION(S) Short Form 12 (SF-12) health survey administered by means of questionnaires at <25 weeks, 34-36 weeks of gestation, and 4 months postpartum. MAIN OUTCOME MEASURE(S) Changes in the SF-12 Physical (PCS) and Mental (MCS) Component Summary scores from pregnancy to postpartum. RESULT(S) The PCS scores were lower during pregnancy and at <25 weeks and 34-36 weeks of gestation among women with assisted conception, but were equivalent to those of women with spontaneous conception by 4 months postpartum. The MCS scores were higher at <25 weeks among women with assisted conception, but by 34-36 weeks of gestation and at 4 months postpartum they were similar regardless of the method of conception. Analysis of covariance showed no significant differences for the changes in PCS and MCS scores from pregnancy to postpartum between assisted and spontaneous conception groups, after adjusting for covariates. CONCLUSION(S) Women with assisted conception may report lower physical and better mental health during pregnancy than women with spontaneous conception. At 4 months postpartum, there were no differences in self-reported HRQoL between modes of conception. Women with assisted conception may benefit from support and reassurance that perception of suboptimal health may improve over pregnancy and into the postpartum period.
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Affiliation(s)
- Angela Vinturache
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Nikki Stephenson
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Muci Wu
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hamideh Bayrampour
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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20
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Griffith R. Parents of children conceived through assisted conception. Br J Nurs 2015; 24:302-303. [PMID: 25757591 DOI: 10.12968/bjon.2015.24.5.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Parental responsibility allows parents to exercise rights over their children and to make decisions on behalf of the child that are in the best interests of the welfare of the child. It is a crucial part of being a parent. In recognition of the changing demographic of the family resulting in more cohabiting couples and step families the law relating to parental responsibility was changed in 2003 and 2005. With the development of more effective assisted conception techniques and increased use of 'do-it-yourself ' insemination using semen purchased over the Internet it was necessary to amend the rules relating to parenthood as a result of assisted conception. This article considers the amendments relating to the recognition of parenthood introduced by the Human Fertilisation and Embryology Act 2008.
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Affiliation(s)
- Richard Griffith
- Senior Lecturer in Health Law, College of Human and Health Sciences, Swansea University
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21
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Younger M, Hollins-Martin C, Choucri L. Individualised care for women with assisted conception pregnancies and midwifery practice implications: An analysis of the existing research and current practice. Midwifery 2014; 31:265-70. [PMID: 25066895 DOI: 10.1016/j.midw.2014.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 03/29/2014] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE the aim is to explore the psychosocial needs of women who are pregnant after assisted conception, specifically in vitro Fertilisation and whether their needs are being addressed within the current maternity care service. DESIGN critical review of the literature using a narrative approach. FINDINGS AND KEY CONCLUSIONS 15 papers were identified. These included both qualitative and quantitative studies, literature reviews and surveys. The findings of this limited narrative review imply that women who undergo assistive reproductive techniques to achieve pregnancy have higher levels of anxiety in pregnancy and may have some difficulties in the transition to parenthood leading to perinatal morbidity. It appears that for this group of women it is important that their history in achieving pregnancy is known to the care providers, to enable the alleviation of some of the anxieties they face. Various aspects of antenatal care have been identified as possible areas which if addressed may reduce these levels of anxiety leading to a reduction in perinatal morbidity. IMPLICATIONS FOR PRACTICE currently, there is insufficient evidence to suggest that providing specialist midwifery care reduces morbidity in these women. However, maternity service providers should consider offering additional antenatal and postnatal services to meet the needs of this group in advance of further research in this area.
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Affiliation(s)
- Mimi Younger
- University of Salford, The Crescent, Salford, Lancashire M5 4WT, UK.
| | | | - Lesley Choucri
- University of Salford, The Crescent, Salford, Lancashire M5 4WT, UK.
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22
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Ghandi S, Ahmadi R, Fazel M. Heterotopic pregnancy following induction of ovulation with clomiphene citrate. Iran J Reprod Med 2011; 9:319-21. [PMID: 26396583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 04/30/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Although heterotopic gestation is common in assisted reproductive techniques, it is very rare in natural conception and clomiphene induced pregnancy. Diagnosis and appropriate intervention of heterotopic pregnancy requires a high index of suspicious. CASE In this paper a case of heterotopic pregnancy in a 30-year old woman with hemoperitoneum from ruptured tubal pregnancy with live intrauterine gestation at 9 weeks of gestation is reported. CONCLUSION This case suggests that a heterotopic pregnancy must always be considered particularly after the induction of ovulation by clomiphene citrate or assisted reproductive technology. Every clinician treating women of reproductive age should keep this diagnosis in mind. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.
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