Category Archives: Human Reproduction

BACKGROUND

The Internet has revolutionized fertility care since it became a popular source of information and support for infertile patients in the last decade. The aim of this scoping review is to map (i) the main categories of patient-focused Internet interventions within fertility care, (ii) the detailed composition of the interventions and (iii) how these interventions were evaluated.

METHODS

A literature search used various ‘Internet’ and ‘Infertility’ search terms to identify relevant studies published up to 1 September 2011. The selected studies had to include patients facing infertility and using an infertility-related Internet intervention. We charted data regarding categories of interventions, components of interventions and evaluation methodology. We categorized the stages of research using the UK's Medical Research Council framework for evaluating complex interventions.

RESULTS

We included 20 studies and identified 3 educational interventions, 2 self-help interventions, 1 human-supported therapeutic intervention, 9 online support groups and 2 counselling services. Information provision, support and mental health promotion were common aims. Few interactive online components were present in the online programmes. Three studies were in the pilot phase and 17 were in the evaluation phase.

CONCLUSIONS

Several categories of patient-focused Internet-based interventions in fertility care are primarily applied to provide support and education and promote mental health. The interventions could be improved by using more interactive and dynamic elements as their key components. Finally, more emphasis on methodological standards for complex interventions is needed to produce more rigorous evaluations. This review shows where further development or research into patient-focused Internet interventions in fertility-care practice may be warranted.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

BACKGROUND

Menarche is the first menstrual period of a girl at puberty. The timing of menarche is important for health in later life. Age at menarche is a complex trait and has a strong genetic component. This review summarizes the results of the genetic studies of age at menarche conducted to date, highlights existing problems in this area and outlines prospects of future studies on genetic factors for the trait.

METHODS

PubMed and Google Scholar were searched until May 2011 using the keywords: ‘menarche’, ‘puberty’ and ‘age at menarche’ in combination with the keywords ‘polymorphism’, ‘candidate gene’, ‘genome-wide association study’ and ‘linkage’.

RESULTS

Our search yielded 170 papers, 35 of which were selected for further analysis. Several large-scale genome-wide association studies along with a powerful meta-analysis of their aggregated data identified about 50 candidate genes for the trait. Some genes were replicated in different studies of Caucasians (e.g. LIN28B, TMEM38B) or in different ethnicities (e.g. SPOCK, RANK and RANKL). However, despite the large volume of results obtained, there is a huge gap in relevant data on ethnic groups other than Caucasians.

CONCLUSIONS

The reviewed studies laid a solid basis for future research on genetics of age at menarche. However, as yet specific genes for this trait have not been identified consistently in all ethnicities and types of studies. We suggest expanding the research to different ethnicities and propose several methodologies to increase the efficiency of studies in this area, including a systems approach, which combines existing high-throughput methods in a single pipeline.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

BACKGROUND

The subject of epigenetic risk of assisted reproduction treatment (ART), initiated by reports on an increase of children with the Beckwith–Wiedemann imprinting disorder, is very topical. Hence, there is a growing literature, including mouse studies.

METHODS

In order to gain information on transgenerational epigenetic inheritance and epigenetic effects induced by ART, literature databases were searched for papers on this topic using relevant keywords.

RESULTS

At the level of genomic imprinting involving CpG methylation, ART-induced epigenetic defects are convincingly observed in mice, especially for placenta, and seem more frequent than in humans. Data generally provide a warning as to the use of ovulation induction and in vitro culture. In human sperm from compromised spermatogenesis, sequence-specific DNA hypomethylation is observed repeatedly. Transmittance of sperm and oocyte DNA methylation defects is possible but, as deduced from the limited data available, largely prevented by selection of gametes for ART and/or non-viability of the resulting embryos. Some evidence indicates that subfertility itself is a risk factor for imprinting diseases. As in mouse, physiological effects from ART are observed in humans.

In the human, indications for a broader target for changes in CpG methylation than imprinted DNA sequences alone have been found. In the mouse, a broader range of CpG sequences has not yet been studied. Also, a multigeneration study of systematic ART on epigenetic parameters is lacking.

CONCLUSIONS

The field of epigenetic inheritance within the lifespan of an individual and between generations (via mitosis and meiosis, respectively) is growing, driven by the expansion of chromatin research. ART can induce epigenetic variation that might be transmitted to the next generation.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

BACKGROUND

The aim of this meta-analysis was to evaluate the role of androgens or androgen-modulating agents on the probability of pregnancy achievement in poor responders undergoing IVF.

METHODS

Medline, EMBASE, CENTRAL, Scopus and Web of Science databases were searched for the identification of randomized controlled trials evaluating the administration of testosterone, dehydroepiandrosterone (DHEA), aromatase inhibitors, recombinant luteinizing hormone (rLH) and recombinant human chorionic gonadotrophin (rhCG) before or during ovarian stimulation of poor responders.

RESULTS

In two trials involving 163 patients, pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy [risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%] and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. No significant differences in clinical pregnancy and live birth rates were observed between patients who received DHEA and those who did not. Similarly, (i) the use of aromatase inhibitors, (ii) addition of rLH and (iii) addition of rhCG in poor responders stimulated with rFSH for IVF were not associated with increased clinical pregnancy rates. In the only eligible study that provided data, live birth rate was increased in patients who received rLH when compared with those who did not (RD: +19%, 95% CI:+1 to +36%).

CONCLUSIONS

Based on the limited available evidence, transdermal testosterone pretreatment seems to increase clinical pregnancy and live birth rates in poor responders undergoing ovarian stimulation for IVF. There is insufficient data to support a beneficial role of rLH, hCG, DHEA or letrozole administration in the probability of pregnancy in poor responders undergoing ovarian stimulation for IVF.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

25-02-2012 22:19

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Journy in to life HUMAN REPRODUCTION - Video

From Wednesday's Globe and Mail Published Tuesday, Feb. 21, 2012 7:30PM EST Last updated Tuesday, Feb. 21, 2012 11:04PM EST

Children who are conceived with an egg or sperm donor should have the right to know their biological origins. The quest for this knowledge is really a quest to know themselves. In the same way governments once moved toward eliminating the presumption of anonymity from adoption rules, they must now reform laws around egg and sperm donation, and acknowledge the importance of this issue to donor-conceived offspring. Any changes, however, should not be applied retroactively.

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Currently in Canada, the law guiding this complex aspect of assisted human reproduction is unclear. Provincial fertility clinics collect the medical history of egg and sperm donors, but under federal legislation, donors are not required to give up confidentiality.

This leaves donor-conceived offspring in the dark, forced to fight expensive and time-consuming legal battles when they become adults and inevitably start to ask questions about their life narrative. One such battle is under way in British Columbia, where the government is appealing a lower court ruling that found a woman named Olivia Pratton, conceived in 1982 at a Vancouver fertility clinic, had the legal right to know the identity of the sperm donor. The government argued this month in court that it has no constitutional obligation to include donor-conceived offspring in the Adoption Act, and accord them the same rights to know their biological parentage.

Research shows that depriving children of the ability to access their genetic backgrounds can cause them psychological harm. Much less likely, they could inadvertently end up in a romantic relationship with a half-sibling. The experience of hiding the truth from adoptive children has shown how destructive family secrets can be.

Other countries have already moved forward; in Australia, the U.K., and Sweden, all egg and sperm donors must now agree to disclose their identities. There are national registries to ensure that donor-conceived offspring can access the information when they come of age, even if clinics close and records are lost.

In Canada, the regulatory framework is complicated by the fact that the Supreme Court of Canada struck down parts of the Assisted Human Reproductive Act in 2010, ruling it is up to the provinces to regulate fertility clinics. It left in place a ban on paying donors, and other elements in the act, including those governing the use of human embryos in stem-cell research. But there are regulatory voids.

It is time for Ottawa to work with the provinces to bring clarity to this important aspect of assisted reproduction, and ensure that the best interests of all donor-conceived offspring are taken into account.

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The interests of children conceived through egg and sperm donation must be protected