Category Archives: Human Reproduction

BACKGROUND

Little is known concerning patient preferences for IVF treatments. The objective of this study was to elicit patient preferences for characteristics differentiating ovarian stimulation treatments.

METHODS

Women undergoing IVF were recruited from six clinics in Sweden between May 2010 and December 2010. Included patients completed a study questionnaire consisting of one contingent valuation (CV) question (with six different bids) and 16 conjoint analysis (CA) questions formulated as discrete choices between two hypothetical ovarian stimulation treatments (defined in terms of manufacturing method, method of administration, time required for administration, dose variability and hypothetical price). Patient preferences were derived using multinomial logit modelling.

RESULTS

The final study population consisted of 294 women (mean age of 35). Respondents were willing to pay 360 [95% confidence interval (CI): 340–390] to receive FSH derived from DNA technology instead of highly purified extract from urine from post-menopausal women, 300 (95% CI: 280–320) to administer the FSH using a prefilled injection pen instead of a conventional syringe, 30 (95% CI: 20–40) per saved minute required for administration and 530 (95% CI: 500–570) to reduce the dose variability from 10–20% to 1–2% (P< 0.001 for all estimates). The result from the CV was similar to the CA.

CONCLUSIONS

Women undergoing IVF place significant value on characteristics differentiating ovarian stimulation treatments. Product-specific aspects should be taken into account by decision-makers when discriminating between commercial gonadotrophins in clinical practice to align health-care decision-making with patient preferences and potentially improve the effectiveness of IVF interventions through enhanced patient satisfaction and treatment compliance. Preferences for treatment characteristics should also be considered in evaluations of ovarian stimulation products to capture their true value from a patient perspective.

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

BACKGROUND

Triggering ovulation by GnRH agonist (GnRHa) in GnRH antagonist IVF protocols coupled with adequate luteal phase support has recently been suggested as a means to prevent ovarian hyperstimulation syndrome (OHSS). Our objective was to examine the outcome of fresh embryo transfer (f-ET) after triggering ovulation by GnRHa and providing intensive luteal phase supplementation, compared with that of the next first frozen–thawed embryo transfer (ft-ET) after cycles with the same protocol and cryopreservation of all the embryos.

METHODS

We performed a cohort study at a university-based IVF clinic. The study population was patients at high risk for OHSS. A daily dose of 50 mg i.m. progesterone in oil and 6 mg of oral 17-β-estradiol initiated on oocyte retrieval day in the f-ET group (n= 70). In the ft-ET group (n= 40) the embryos were cryopreserved and transferred in the next cycle.

RESULTS

The live birth rate per f-ET was 27.1 versus 20% in the ft-ET groups [P = 0.4; rate ratio = 1.36 (0.65–2.81)]. The implantation, pregnancy and spontaneous abortion rates were comparable in both groups. None of the patients developed OHSS.

CONCLUSIONS

In this observational cohort study, we showed that triggering ovulation with GnRHa and intensive luteal phase support is a promising new modality to prevent OHSS without the cost of cycle cancellation, ET deferral and reduced clinical pregnancy rates. Confirmation of these findings by RCTs is now required.

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

BACKGROUND

Embryo donation, though less often performed than other assisted reproductive technology (ART), can represent an attractive option for couples who do not wish to discard their embryos remaining after IVF, and for those who cannot or should not conceive naturally. Clinicians and potential participants could benefit from information comparing outcomes of embryo donation with those of other ARTs, in various countries.

METHODS

We analyzed outcome information from ART treatment cycles using 2001–2008 data from national surveillance systems in the USA, Canada, the UK, Australia, New Zealand and Finland. We calculated the live birth rate (LBR) with relative risks, the average number of embryos transferred per cycle and the ratio between them (LBR per embryo transferred). We compared outcomes of embryo donation cycles with those for autologous IVF, frozen embryo transfer (FET) and oocyte donation (OD).

RESULTS

LBRs for embryo donation cycles were 14–33%, compared with 16–28% for autologous FET, 22–35% for autologous IVF and 15–52% for OD. In every country except Australia/New Zealand, and in all countries combined, the LBR for embryo donation approximated that for IVF, with no statistically significant differences in Finland and Canada. The average number of embryos transferred per cycle was 1.5–2.8. The LBR per embryo transferred was 11–12% for donor embryo cycles, compared with 8–11% for autologous FET, 12–15% for autologous IVF and 9–21% for OD.

CONCLUSIONS

We found that transfer of donated embryos in these countries yields pregnancy outcomes comparable to those of autologous ART procedures. The variation in outcome rates among countries is not entirely explained by the number of embryos transferred. The relatively high success rates and low costs make embryo donation an attractive family building alternative.

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

BACKGROUND

Over the past 10 years, there has been a significant increase in the use of assisted reproductive technologies in Canada, however, little is known about the overall prevalence of infertility in the population. The purpose of the present study was to estimate the prevalence of current infertility in Canada according to three definitions of the risk of conception.

METHODS

Data from the infertility component of the 2009–2010 Canadian Community Health Survey were analyzed for married and common-law couples with a female partner aged 18–44. The three definitions of the risk of conception were derived sequentially starting with birth control use in the previous 12 months, adding reported sexual intercourse in the previous 12 months, then pregnancy intent. Prevalence and odds ratios of current infertility were estimated by selected characteristics.

RESULTS

Estimates of the prevalence of current infertility ranged from 11.5% (95% CI 10.2, 12.9) to 15.7% (95% CI 14.2, 17.4). Each estimate represented an increase in current infertility prevalence in Canada when compared with previous national estimates. Couples with lower parity (0 or 1 child) had significantly higher odds of experiencing current infertility when the female partner was aged 35–44 years versus 18–34 years. Lower odds of experiencing current infertility were observed for multiparous couples regardless of age group of the female partner, when compared with nulliparous couples.

CONCLUSIONS

The present study suggests that the prevalence of current infertility has increased since the last time it was measured in Canada, and is associated with the age of the female partner and parity.

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

BACKGOUND

Currently, there is no ideal agent to prevent adhesion formation. We have shown that sildenafil, a phosphodiesterase-5 (PDE-5) inhibitor, reduces post-operative adhesion formation by vasodilatation and increases fibrinolytic activity. Here, we evaluated whether tadalafil, a long-acting PDE-5 inhibitor, decreases post-operative adhesion reformation in rats.

MATERIALS AND METHODS

Standardized lesions were created in Wistar albino rats by cauterization of uterine horns and abrasion of adjacent peritonium. The extent and severity of adhesions were scored on the 14th post-operative day and adhesiolysis was performed at the second laparotomy. Animals were then assigned randomly into two groups. The study group (n = 11) received 10 mg/kg oral tadalafil by gavage 60 min before the second laparotomy and daily for 14 days afterwards. Controls (n = 11) received the same volume of tap water for 14 days by gavage. Animals were killed 15 days after adhesiolysis and adhesions were scored blind during the third laparotomy.

RESULTS

Basal adhesion scores at the time of the second laparotomy were comparable in the study and control groups. Scores for the extent of adhesion reformation in the study and control groups did not differ [median 1 (range 0–3) versus median 2 (range 1–3); P: 0.81] but tadalafil reduced the respective severity scores [median 0.5 (range 0–1) versus median 1 (range 0.5–1); P: 0.02] and total scores [median 2 (range 0–4) versus median 2.5 (range 1.5–4); P: 0.042].

CONCLUSIONS

Oral administration of tadalafil during the perioperative period reduces intra-abdominal adhesion reformation in rats.

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

BACKGROUND

In contrast to the uterine corpus, the vascular architecture of the human cervix has been the subject of only a few studies, mostly dealing with the ectocervical mucosal vessels. This study presents the vascular system of the cervical wall surrounding the endocervical canal visualized by the best currently available technique, corrosion casting combined with scanning electron microscopy.

METHODS

Uteri collected at autopsy (n= 20) were perfused via afferent vessels with fixative followed by Mercox resin and corroded after polymerization of the resin. The obtained vascular casts of the cervix visualizing all vessels including capillaries were examined in the scanning electron microscope.

RESULTS

The vascular system of the cervix was nearly completely replicated in only two (10%) of the samples. In the wall of the cervix, four distinct vascular zones surrounding the endocervical canal were observed: (i) the outer zone containing larger vessels, arteries and veins of 0.3–1 mm diameter; (ii) the zone containing arterioles and venules; (iii) the zone of endocervical mucosal capillaries showing a very high density, parallel arrangement and relatively few interconnections and (iv) the innermost, subepithelial zone containing small veins running along the endocervical canal.

CONCLUSIONS

Despite the loss of the delicate ectocervical mucosal vessels from the cast during the corrosion step, we have successfully visualized the majority of the cervical vasculature. The vascular pattern of the human cervix, especially that of the endocervical mucosa, may facilitate the adaptation of the cervical vasculature to the extensive remodeling of the cervix during parturition.

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