Understanding infertility
David J Cahill in Practical Patient Management in Reproductive Medicine, 2019
This chapter describes the definition of infertility and its frequency, how different factors affect the likelihood of infertility, the diagnostic categories and whether the incidence of infertility is rising or falling. Inability to conceive within 2 years should be regarded as subfertility until absolute infertility is confirmed. Confusingly, some epidemiological studies use live births rather than ability to conceive as the defining feature of infertility. One of the most significant factors influencing infertility is age. Couples may be concerned that they will only be offered expensive, high-technology infertility treatments, such as in vitro fertilisation. The increased media attention has made infertility less of a taboo, which means that friends and acquaintances are more open in talking about their own experiences of fertility problems giving rise to increased demand for interventions. The prevalence of infertility appears to be rising as several factors contribute to what is a rising burden of infertility on individuals, health services and the economy.
Risks of fertility treatments
Ruth Chambers in Fertility Problems, 2018
Multiple pregnancy is a common outcome from using fertility drugs due to the ovaries being stimulated to produce several eggs at a time, or more than one embryo being transferred to the uterus in In vitro fertilisation (IVF), or more than one egg being replaced in Gamete intra-fallopian transfer (GIFT). Two-thirds of triplets and higher order pregnancies are due to ovarian induction with clomiphene and gonadotrophin drugs. Clinics balance the risks of multiple pregnancy against gaining an acceptable pregnancy rate. The number of embryos that can be transferred after IVF is limited to three by the Human Fertilisation and Embryology Authority, and of course there is a further chance that a single embryo could sub-divide to give an identical set of twins or triplets. Fetal reduction may be carried out as a planned procedure to terminate the life of one or more fetuses in a multiple pregnancy.
Assisted Reproduction and Embryo Research
Marc Stauch, Kay Wheat in Text, Cases and Materials on Medical Law and Ethics, 2017
This chapter explores that specific solutions adopted by the law in relation to the key areas of licensed fertility treatment. It focuses on in vitro fertilisation treatment involving the creation of an embryo ex vivo to be implanted in a woman's uterus for gestation. The chapter considers the law on gamete and/or embryo donation as it bears in turn on the interests of the immediate parties to such an enterprise, namely the potential nurturing parents, the gamete donors, and any child who is born as a result. It attempts to the field of assisted reproduction, addresses the additional complexities that arise when third party gamete providers are introduced into the picture by procedures such as Artificial Insemination by Donor ('DI') and egg donation. The chapter also focuses on one area where third party involvement in reproduction has aroused particular controversy, namely, surrogacy, in which a woman makes use of her gestational capacity to carry a child for others.
Comparison of actual and ultrasound estimated second trimester gestational length in in-vitro fertilized pregnancies
Published in Acta Obstetricia et Gynecologica Scandinavica, 1993
Reynir T. Geirsson, Grethe Have
Objective. To compare actual and calculated gestational age in pregnancies conceived by in-vitro fertilisation. Methods. In 36 healthy women conceiving by in-vitro fertilisation an equation described for use in a Nordic population was used for calculating gestational age from the biparietal diameter and femur length at a routine 18–19 week scan. This was compared to actual gestational length estimated from the day between oocyte retrieval and embryo transfer. Results. The mean difference amounted to -0.86 days with a standard deviation of 2.86 days, a range of -5 to +6 days and a 95% confidence interval -0.11 to 1.83 (t=1.806, df = 35, p = 0.8). Correlation between the two methods was highly significant. Conclusion. The equation used allows prediction of term with sufficient accuracy for general use in our population.
Long-term health implications for children conceived by IVF/ICSI
Published in Human Fertility, 2009
Anna Judith Steel, Alastair Sutcliffe
In vitro fertilisation and intra-cytoplasmic sperm injection are well recognised techniques for assisted reproduction, helping over 85% of infertile couples conceive within a year, contributing to over 1% of the annual birth rate in the western world. There is currently limited data on the health of these children in later life as the techniques are relatively new. Certain trends have started to emerge with high order births proving to be responsible for a large proportion of premature and low-birth weight infants. The increased risk of perinatal morbidity and mortality associated with singleton births has been linked to the infertility of the couple rather than the techniques used. This theory has also been suggested to account for the increase in congenital malformations observed. No discrepancies in neurodevelopmental outcome of these children have been established and no detrimental psychological effects on the families have been reported. There has been an increase in childhood illness observed and the future fertility of these children is a major concern for many parents. Further follow up of these children is needed to fully establish the long-term health implications of in vitro fertilisation and intra-cytoplasmic sperm injection.
A narrative review of adjuvants in
Published in Journal of Obstetrics and Gynaecology, 2020
A review of studies published between January 1, 1984 and January 31, 2019 was performed with the aim of analysing the efficacy and adverse effects of commonly used adjuvants to in vitro fertilisation. The authors preferentially selected recent systematic reviews and randomised control trials (where available) from an electronic literature search. The review showed that low molecular weight heparin, corticosteroids and embryo glue may be of use in selected patient groups. Other adjuncts (such as growth hormone, assisted hatching, endometrial disruption and dehydroepiandrosterone) cannot currently be recommended as collated results showed no overall benefit to clinical pregnancy rates or live birth rates. There is a significant lack of robust evidence in this field, and areas in particular need of further research have been highlighted. In conclusion, caution should be exercised in prescribing adjuvants in in vitro fertilisation, either individually or in combination as further research is needed to ascertain their efficacy. Many adjuvants carry the risk of adverse effects which should also be considered. Patients should be clearly informed of the evidence, and where it is lacking, for these treatments. There is a need for further good quality trials to address the questions regarding best practice.
Related Knowledge Centers
- Intracytoplasmic Sperm Injection
- Assisted Reproductive Technology