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Multiple pregnancy and infertility
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Mary and her husband had been trying to conceive for 3 years, and after undergoing extensive investigations that led to a diagnosis of unexplained infertility, they were advised that IVF would be their best option. They did not feel quite ready to accept that this was the path for them, and as Mary was only 29 years of age, they believed that they could afford to wait a little longer before, as they saw it, ‘giving up’ on their natural fertility. After a further few months Mary duly conceived naturally, only for her immense joy to be crushed when it was discovered that the pregnancy was ectopic. After surgery to remove her left Fallopian tube, Mary was devastated to be told that her remaining tube was damaged to the extent that natural conception was highly unlikely, and that if she underwent IVF, removal of the remaining tube first would be best to avoid the risk of further ectopic pregnancies. Mary’s emotional recovery took many months as she was consumed by distress about what she had lost. Her self-esteem plummeted and she felt an overwhelming sense of failure. She described her feelings as veering between anger and profound grief. Her anger was directed both at herself and her ‘failed’ body, and at her doctor, who had delivered the news in a way that she found cold, uncaring and too matter-of-fact. She grieved both for her lost pregnancy and for her own fertility.
Principles of Pathophysiology of Infertility Assessment and Treatment*
Published in Asim Kurjak, Ultrasound and Infertility, 2020
Joseph G. Schenker, Aby Lewin, Menashe Ben-David
Prerequisites for treatment are the patient having no contraindication for pregnancy, the presence of a uterus hospitable to pregnancy, ovaries with either spontaneous or inducible ovulation, and fertile sperm. The patient’s age is also important, and an age over 40 to 42 years is in most centers a criterion for exclusion from IVF treatment as a result of poor success rate in IVF. Regular menstrual pattern is not a prerequisite, since the regularity of menstruation and the presence or absence of spontaneous ovulation did not affect IVF results. The majority of IVF patients have a mechanical factor of infertility due to various causes: (1) absent tubes due to successive ectopic pregnancies or removal of one or both tubes during surgery for ovarian cyst or surgical treatment of pelvic inflammatory disease; (2) severe damage to the fallopian tubes in which surgery has poor prognosis; and (3) history of failed tubal corrective surgery or patent tubes after such an operation but no conception.
Regulation of Reproduction by Dopamine
Published in Nira Ben-Jonathan, Dopamine, 2020
In vitro fertilization (IVF) is the process of fertilizing an egg by sperm outside the body. In 1978, Louise Brown was the first child born after her mother received a natural cycle IVF treatment. In recognition of this accomplishment, Dr. Robert Edwards, the developer of this technique, was awarded the Nobel Prize in Physiology and Medicine in 2010. Since the 1980s, IVF has been practiced worldwide. In 2018 alone, over 8 million children were born using IVF and other assisted reproduction techniques. Patients as old as 65 have benefited from IVF.
Does male fertility-related quality of life differ when undergoing evaluation by reproductive urologist versus reproductive endocrinologist?
Published in Human Fertility, 2023
Rachel Danis, Intira Sriprasert, William Petok, Jesse Stone, Richard Paulson, Mary Samplaski
We found that RU evaluated men who earned lower incomes than those evaluated by a RE (43.1% versus 70.8% of men earned >$100,000, respectively, p = 0.002). These men were also less like to be in couples pursuing IVF (54.0% versus 70.9%, p = 0.03). Taken together these findings relate to financial access to care. The mean cost of IVF in the US is $30,274 (Dupree, 2016; Smith et al., 2011), and patients with household incomes >$150,000/year are more likely to utilise IVF (Smith et al., 2011). Male factor specific data show that 47% of men report financial strain from infertility, and 46% report treatment options limited by cost (Dupree, 2016; Elliott et al., 2016). Despite infertility being defined as a disease by the World Health Organisation and ASRM, private health insurance plans rarely cover treatment for infertility (Dupree et al., 2016; House of Representatives, Congress (2010); Practice Committee of the American Society for Reproductive Medicine, 2020; Zegers-Hochschild et al., 2009). Only 15 states have laws mandating infertility coverage, and only 8/15 have male coverage (Dupree, 2016; Dupree et al., 2016). It is possible that some men will see a RU to optimize male factor issues in order to avoid the need for costly IVF. The stress associated with the male factor and the cost of IVF may have also contributed to the lower FertiQoL scores seen in males evaluated by a RU versus RE.
Follitropin Alpha for assisted reproduction: an analysis based on a non-interventional study in Greece
Published in Current Medical Research and Opinion, 2022
Vassilis Fragoulakis, Andreas Mantis, Nikolaos Christoforidis, Dimitrios Dovas, Spyros Deftereos, Tryfwnas Lainas, Evripidis Mantoudis, Thanos Paraschos, Dimitris Sakellariou, Evangelos Makrakis
Within the regression framework, as expected, the total dose of Gonal-f was the most important factor for the drugs cost per patient. The estimation of mean total cost of IVF therapy per patient in this local setting was in line with the corresponding costs found in other countries. More specifically, the estimated costs per IVF cycle (in 2014 USD) are in the U.S.A at $12,513, UK at $5244, Australia at $5645, Brazil at $3000, Canada at $8500, Germany at $4,418–$4,977, India at $600–$1000 (92). As it can be observed, the estimated costs of IVF vary among different countries36. However, the high cost of IVF is the main obstacle that prevents couples from benefiting from this technology37. This indicates that the IVF procedure in Greece represents one of the least costly and thus an attractive option in Europe for those suffering of infertility38. It must be mentioned at this point, that the clinic cost was based on literature and represents a rough estimation of the actual cost and probably would be slightly changed, if new evidence came into view.
Higher baseline alanine aminotransferase level is associated with lower live birth rate after freeze-thawed embryo transfer
Published in Gynecological Endocrinology, 2022
Shuping Zhang, Hongyi Xu, Juan Chen, Ying Zhang, Zhifeng Sun, Lijuan Luo, Xiaoning Wang, Xing Jiang, Chenglong Jiang, Kai Deng, Changjun Zhang
Assisted reproductive technology (ART) is the most effective means to treat infertility [1]. ART enables infertile couples to have children with a success rate of up to 65% [1, 2], and the number of people born with ART has exceeded 8 million [3, 4]. In vitro fertilization-embryo transfer (IVF-ET) involves the pharmacological induction of ovulation, retrieval of oocytes, fertilization of eggs with sperm to produce embryos, in vitro culture of embryos for 2–5 days, and transfer of the embryo(s) into the uterus [5]. The remaining embryos are frozen for later use if pregnancy is not achieved during the fresh cycle or if additional children are desired. The first report describing live births after freeze-thawed embryo transfer (FET) was published in 1984 [6]. Technological advances in embryo vitrification, cryopreservation and thawing technologies have led to FET being increasingly used as an ART [7].