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Preimplantation Genetic Testing and Reproductive Genetics from a Physician's Perspective
Published in Darren K. Griffin, Gary L. Harton, Preimplantation Genetic Testing, 2020
Genetic testing of gamete donors plays a substantial role in reproductive medicine. The effort is to exclude the transfer of serious genetic defects to the offspring of gamete donation recipients. Besides the medical point of view, a role is also played by legal regulation and the potential forensic consequences of giving birth to a child with a congenital defect.
Communicating About Technical Failures in Assisted Reproductive Technology
Published in Fritz Allhoff, Sandra L. Borden, Ethics and Error in Medicine, 2019
Rashmi Kudesia, Robert W. Rebar
The practice of clinical medicine requires detailed communication between members of the health-care team as well as between medical providers and patients. Though this dogma applies to all fields of medicine, different specialties and settings present unique medical, scientific, and ethical challenges. Recently, two highly publicized laboratory failures occurred within the field of reproductive medicine, resulting in the loss of thousands of cryopreserved eggs and embryos. Analysis of these events offers a window into the ethical sticking points of technological failures in the world of reproductive medicine. To fully understand and query these events, we begin by reviewing the science of assisted reproductive technologies (ARTs) and unique aspects to the clinical practice of reproductive medicine. We then consider the ethical issues posed by ARTs, the details of these two specific cases, and how they were handled. We summarize with a guide to planning and executing conversations around errors in reproductive medicine.
Optimizing embryo transfer technique for recurrent implantation failure management
Published in Efstratios M. Kolibianakis, Christos A. Venetis, Recurrent Implantation Failure, 2019
Many of the physicians in reproductive medicine have been trained in performing “blind” embryo transfer procedures. Roughly two distinct methods existed, the “clinical-touch” and the “fixed-distance” approaches, in order to deal with positioning of the catheter at the moment of push-out of the embryo(s). The clinical-touch method implied a sounding procedure until touching the uterine fundus, with subsequent withdrawal of the catheter by 1 cm and push-out. This approach was considered as potentially disadvantageous in the hands of some physicians, especially when using a firm catheter, as the touching could imply harm done to the endometrium lining, with bleeding and uterine contractions as the result. In contrast, the fixed-distance technique, with or without prior assessment of uterine sounding depth, and limiting the introduction of the catheter to ∼6 cm, with subsequent push-out, was proposed as the more atraumatic, and thereby more successful, way of working, in the hands of any physician.34
The importance of infertility duration and follicle size according to pregnancy success in women undergoing ovulation induction with gonadotropins and intrauterine insemination
Published in Journal of Obstetrics and Gynaecology, 2023
Meryem Kuru Pekcan, Aytekin Tokmak, Hasan Ulubasoglu, Mervenur Kement, Gülnur Özakşit
In the literature, some studies state that infertility duration is an indicator of pregnancy success in OI and IUI treatments (Wang et al.2019, Vargas-Tominaga et al.2020, Immediata et al.2020). Since there are many different factors in the aetiology of unexplained infertility, this is an expected result. Couples with shorter infertility duration are expected to be affected less from longer or less severe fertility factors than couples with longer infertility duration, therefore they are expected to get better results after the treatment. In unexplained infertility, up to three cycles of IUI with ovarian stimulation can be considered an effective treatment method, even in couples who cannot achieve pregnancy with await management for two years. Especially in young couples with an infertility period of less than three years, at least two cycles of IUI can avoid a significant amount of unnecessary IVF procedures (Ombelet et al.2020) n paralel with Osmanlıoğlu et al. study results (Osmanlıoğlu et al.2022), The American Society for Reproductive Medicine’s latest guidelines for unexplained infertility recommend that the best initial treatment for most couples is ovarian stimulation (typically three or four cycles) followed by oral medications and intrauterine insemination (OS-IUI) (Practice Committee of the American Society for Reproductive Medicine 2020).
Step-by-step decision-making process in third party assisted reproduction: a qualitative study
Published in Human Fertility, 2022
Zohreh Behjati Ardakani, Mehrdad Navabakhsh, Fahimeh Ranjbar, Mohammad Mehdi Akhondi, Alireza Mohseni Tabrizi
Biological motives for survival are unconscious and compulsory. The human beings’ inclination towards reproduction and child-rearing is an example of this instinct. People, knowing that they are mortal, try every means to maintain self-preservation and continue their existence, which is only possible through reproduction (Werner, 2001). The introduction of new assisted reproductive techniques has provided the ground for couples that cannot have children to overcome infertility. When a couple experiences a lack or defect in the uterus, gametes, or embryos, they can become parents only through third-party reproduction (Akhondi et al., 2007). The American Society for Reproductive Medicine defines third-party reproduction as the use of oocytes, sperm, or embryos that have been donated by a third person (donor) to enable an infertile individual or couple (intended recipient) to become parents. This also includes using a surrogate for fertility (Carsten, 2000; Tremayne, 2012).
The nexus between self-perception and behavioural responses of gestational surrogates’ risk experiences
Published in Human Fertility, 2022
Risks to commercial surrogates are worldwide concerned and debated. The policies and regulations of gestational surrogacy practice have been enhanced to protect the surrogate’s rights. For example, the European Society for Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ARSM) have single embryo transfer guidelines in practice that protect the gestational surrogates from the risk of multiple pregnancies (Maheshwari et al., 2011; Practice Committee of the American Society for Reproductive Medicine & the Practice Committee of the Society for Assisted Reproductive Technology, 2017; Shenfield et al., 2005). Some countries in which commercial surrogacy was widespread, like India and Thailand, have taken measures to completely ban these arrangements (Rao & Khan, 2017; Ray, 2018; Sattaburuth, 2015). Still, the issue prevails and is, perhaps, made worse for commercial surrogates involved in exploitative arrangements with incentives and shifting across the border (Hibino, 2020).