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Principles of treatment
Published in Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh, An Atlas of ENDOMETRIOSIS, 2020
Caroline Overton, Colin Davis, Lindsay McMillan, Robert W Shaw, Charles Koh
Assisted reproduction appears to have an overall benefit for all stages of treatment. The treatment of choice will depend on the severity of endometriosis, the woman’s age, duration of infertility, past reproductive performance and the presence of other infertility factors such as tubal blockage or male factor infertility.
Psychological Impact of Infertility and Assisted Reproduction 1
Published in Rosa Maria Quatraro, Pietro Grussu, Handbook of Perinatal Clinical Psychology, 2020
The term assisted reproductive techniques (ART) encompasses all forms of treatment and all procedures brought to bear on human egg cells, sperm, or embryos with a view to bringing about pregnancy and the birth of a child. The procedures employed in assisted reproduction (medically induced pregnancy) are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), somewhat less frequently intrauterine insemination (IUI) after previous hormone stimulation for the woman. These procedures can be briefly described as follows. IVF: after previous hormone stimulation, oocytes are removed from the woman’s ovaries and fertilized by the (processed) sperm of the male partner in a Petri dish in the laboratory. After a number of days in the incubator, the fertilized oocytes are transferred to the uterus. ICSI: aspiration and back-transfer as with IVF, but here insemination is done via microinjection of one single sperm into an egg cell. IUI with previous hormone stimulation: the sperm is injected into the uterus with a catheter (after hormone stimulation in the female partner to enhance maturation of egg cells). Gamete donation (treatment with donor sperm or oocyte donation) can be combined with all three procedures. The psychosocial aspects of this particular kind of family planning require special consideration that goes beyond the concerns associated with ART procedures affecting couples only. Use can be made either of “freshly” obtained gametes (so-called “fresh” cycle) or of semen/egg cells that were initially frozen and later thawed (so-called “cryo” cycle).
Helping a woman afflicted with endometriosis to conceive
Published in Seema Chopra, Endometriosis, 2020
To address the need of assisted reproduction over expectant management in women with mild or minimal endometriosis, and no other detectable cause, surgical reduction of the disease followed by 3–6 cycles of Superovulation (SO) + IUI is likely to give the best chance of live birth without the need for IVF [5]. This was supported by the results of a randomized controlled trial that showed superovulation with gonadotropins and intrauterine insemination has an odds ratio of 5.6 (95% CI, 1.8–17.4) for live birth [5,24].
Disclosing Reproductive Genetic Carrier Status: What about the Donor?
Published in The American Journal of Bioethics, 2023
In their recent article, Dive, Holmes, and Newson (2023) argue that genetic information should be reported in accordance with the aims of reproductive genetic carrier screening (RGCS). Referring to the primary aim, only results with implications for reproductive decision-making should be disclosed. However, it is unclear whether this argument applies to RGCS in the context of donor conception, given that gamete donors occupy a unique position in assisted reproduction. One of the reasons for this unique position is that, while donors undergo screening for reproduction, they are not involved in reproductive decision-making. Therefore, according to the rule set forth by Dive and colleagues, because gamete donors do not participate in the primary aim of RGCS, information obtained from the screening should not be reported to them. In this commentary, it is argued that the arguments put forth by Dive and colleagues may not apply to the unique context of RGCS in donor conception. By examining these issues, I contribute to a more nuanced understanding of the ethical considerations involved in disclosing genetic information in the context of assisted reproduction.
Reproductive outcomes after laparoscopic surgery in infertile women affected by ovarian endometriomas, with or without in vitro fertilisation: results from the SAFE (surgery and ART for endometriomas) trial
Published in Journal of Obstetrics and Gynaecology, 2022
Helena Ban Frangež, Eda Vrtacnik Bokal, Martin Štimpfel, Teja Divjak Budihna, Ferdinando Antonio Gulino, Simone Garzon, Fabio Ghezzi, Ibrahim Alkatout, Georgios Gitas, Antonio Simone Laganà
Although endometriomas are common findings in infertile women, whether they should be surgically removed before an in vitro fertilisation (IVF) is a long-lasting debate, and current evidence does not offer a robust background to draw firm recommendations. On the one hand, surgical enucleation of endometriomas may facilitate subsequent oocyte retrieval after ovarian stimulation, reducing the possibility of follicular fluid contamination or infection and the risk of chemical peritonitis, and allows histological diagnosis of occult malignancy. On the other hand, surgery exposes the patients to the risk of potential complications, even when performed with a minimally invasive approach, and may cause iatrogenic reduction of ovarian reserve and consequently decrease the success rate of assisted reproduction technology (ART) (Nickkho-Amiry et al. 2018; Šalamun et al. 2018). In addition, women with endometrioma experience a progressive decline in serum anti-Müllerian hormone (AMH) levels, which is faster than that in healthy women (Kasapoglu et al. 2018): considering this element, endometriomas per se have a detrimental role on the ovarian reserve, even without surgery.
Accessibility and availability of assisted reproductive technology for people living with HIV in Europe: a thematic literature review
Published in AIDS Care, 2020
Mallory Bell, Megan Edelstein, Sadie Hurwitz, Rachel Irwin
The use of sperm washing in combination with IUI, IVF and ICSI effectively reduces the risk of transmission below the transmission rate of 0.1% as expected in unprotected, heterosexual intercourse (Zafer et al., 2016) and none of the reviewed literature presented a case of seroconversion with the use of sperm washing. Current literature supports the use of assisted reproduction in the form of IUI, IVF and ICSI when combined with sperm washing, where IUI is the most common (Marina et al., 1998; Ohl et al., 2003; van Leeuwen et al., 2005; Savasi, Mandia, Laoreti, & Cetin, 2012; Nicopoullos, Almeida, Ramsay, & Gilling-Smith, 2004). For example, a multicentre study collected data from eight centres located in six European countries that offered reproductive assistance to serodiscordant couples, in which the male is HIV-positive, found that of the 1036 couples that were treated, 499 women became pregnant at least once (Bujan et al., 2007). The study is regarded as the largest series published to date with sufficient case numbers, enabling them to “calculate the probability of contamination risk to be zero” (Bujan et al., 2007).