Human Fertility (Hum Fertil)

Publications in this journal

• Article: An atlas of endometriosis (third edition).

  Christina Chi Ding, Rafet Gazvani
  Human Fertility 07/2009;
• Article: Infertility and assisted reproduction.

  Geraldine Hartshorne
  Human Fertility 07/2009;
• Article: Parent-child relationships and the psychological well-being of 18-year-old adolescents conceived by in vitro fertilisation.

  Susan Golombok, Lucy Owen, Lucy Blake, Clare Murray, Vasanti Jadva
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  ABSTRACT: This article presents the findings of the first study to have followed up children conceived by in vitro fertilisation (IVF) to late adolescence. As close as possible to their eighteenth birthday, standardised interviews and questionnaires were administered to 26 adolescents conceived by IVF and comparison groups of 27 adolescents adopted in infancy and 56 adolescents conceived naturally by previously infertile parents. IVF adolescents were found to have good relationships with their parents that did not differ from those of adopted and natural conception adolescents. At age 18, no young person was distressed about having been conceived by IVF. The findings of this study indicate that as test-tube babies approach adulthood, they are generally functioning well.
  Human Fertility 06/2009; 12(2):63-72.
• Article: Rare presentation of ectopic pregnancy following IVF-ET: live twin gestation in the same fallopian tube.

  Cem Somer Atabekoğlu, Murat Gözükuçük, Sinan Ozkavukçu, Murat Sönmezer
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  ABSTRACT: We report a case of a twin ectopic pregnancy (EP) after in vitro fertilization and embryo transfer (IVF-ET). A 24-year-old nulligravida presented with lower abdominal pain and vaginal bleeding 4 weeks after embryo transfer. Serum beta-HCG levels were 40 IU/mL, 90 IU/mL, and 1970 IU/mL on ET days 12, 14, and 23, respectively. Ultrasound examination revealed two ectopic gestational sacs with fetal heart beats in the left adnexa, without evidence of intrauterine pregnancy. At laparoscopy, one isthmic and another ampullary sac were detected in the left tube and left salpingectomy was performed. The patient was discharged healthy on postoperative day 2. Albeit extremely rare, ectopic pregnancies with abnormal presentation can be encountered following IVF-ET. Single embryo transfer may be advised to protect from ectopic pregnancies after IVF-ET.
  Human Fertility 06/2009; 12(2):122-4.
• Article: Regulating assisted reproduction in Italy: a 5-year assessment.

  Andrea Boggio, Gilberto Corbellini
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  ABSTRACT: In 2004, the Italian parliament comprehensively regulated medically assisted reproduction. Law 40/2004 has outlawed several techniques and tightly compressed the freedom of research in the area of human reproduction and regenerative medicine. This article analyses the post-2004 political, bioethical and legal debate on assisted reproduction in Italy. The analysis is grounded on empirical evidence on fertilisation outcomes released in 2007 and 2008 by the Italian government, on recent amendments related to the regulation of preimplantation genetic diagnosis and on the debates on the status of spare embryos as for their availability for scientific researches. The analysis shows that Law 40/2004 has failed to improve the access of infertile couples to assisted reproduction techniques and keeps supporting practices that the other jurisdictions have rejected because they are unwise from a clinical standpoint. Moreover, Law 40/2004 created severe limitations to scientific researches in the fields of medical embryology, gynaecology and regenerative medicine. With the political support of some Italian political parties and the Catholic Church, Law 40/2004 disregards the expectations of the majority of Italian citizens, international guidelines of good clinical practice, international codes of medical ethics, the interests of infertile couples and the social and economic relevance of biomedical research.
  Human Fertility 06/2009; 12(2):81-8.
• Article: Ultrasound tests of ovarian reserve; a systematic review of accuracy in predicting fertility outcomes.

  Ahmed Gibreel, Abha Maheshwari, Siladitya Bhattacharya, Neil P Johnson
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  ABSTRACT: We conducted a systematic review of studies evaluating the diagnostic accuracy of all the ultrasound based tests of ovarian reserve, including antral follicle count (AFC), ovarian volume and stromal blood flow in predicting fertility outcomes and, where appropriate, performed a meta-analysis to determine the predictive_value at each cut-off value described in the literature. Included in the analysis were 17 studies for AFC, six studies for ovarian volume and six studies for stromal blood flow. Meta-analyses showed that women with AFC less than four were 8.7 times more likely not to get pregnant after IVF (two studies; 95% CI, 2.4-31.7) than women with AFC four or more. The sensitivity and specificity of AFC to predict cycle cancellation was 66.7% and 94.7%, respectively. Women with an AFC of less than four were 37 times (two studies; 95% CI, 13.68-100.45) more likely to have their cycle cancelled than women with AFC of four o r more. Ovarian volume measurement, at a cut off value of 3 cm3, showed specificity for prediction of cycle cancellation and non-pregnancy of 92% (three studies, 95% CI, 89-94) and 93% (three studies, 95% CI, 87-97), respectively. The clinical value of Doppler studies for ovarian stromal blood flow was unclear.
  Human Fertility 06/2009; 12(2):95-106.
• Article: Fertility and endocrine effects of intra-abdominally misplaced intrauterine system for more than 2 years: a case report and review of the literature.

  George Botros, Nabil Haddad
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  ABSTRACT: This case report shows with documented evidence that a misplaced Mirena intrauterine system in the abdominal cavity had an endocrine and contraceptive effect causing amenorrhea and infertility for 2 years and 5 months. This had been proved by a negative hysteroscopy in November 2004 and an abdominal X-ray showing the device which was done in May 2007. Intraabdominal misplacement of the LNG-IUS has been reported in the literature with variable consequences and effects. In this case report, we reviewed the literature and assessed the fertility and endocrine consequences.
  Human Fertility 06/2009; 12(2):119-21.
• Article: The use of clinical ethics committees in infertility clinics.

  Lucy Frith
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  ABSTRACT: Clinical ethics committees (CECs) are increasingly used in UK health care (Slowther et al., 2004a). However, there has been little debate about their use in infertility units. Current HFEA guidance on CECs encourages their use in aiding ethical decision making but this is not required by the code of practice or obligated by law. It will be argued that the HFEA should strengthen its guidance on CECs by recommending that all infertility clinics should have a designated CEC (where possible) as a matter of good practice and such a recommendation should be formalised in the HFEA's Code of practice. The article will conclude with recommendations for a particular model of CECs in infertility units.
  Human Fertility 06/2009; 12(2):89-94.
• Article: Assessment of the contraceptive efficacy of the aqueous extract of Aegle marmelos Corr. leaves in male albino rats.

  Alka Chauhan, Meera Agarwal
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  ABSTRACT: The present study was conducted to evaluate the contraceptive effect of an aqueous extract from the leaves of Aegle marmelos (AMLAq) on the reproductive organs of male rats with an emphasis on reversibility. Adult male rats were treated daily with different doses of AMLAq, i.e., 150, 300 and 600 mg/kg bw/day for 60 days. The data presented in this study demonstrate that the weight of the reproductive organs was reduced significantly in all the treatment groups. AMLAq induced a significant decrease in the sperm motility and sperm density of the Cauda epididymis and testes. The reduction in fertility was 50%, 85% and 100%, respectively, in the treatment groups. The testosterone level also significantly declined. Biochemical analysis of the reproductive tissues for sialic acid, protein, glycogen, fructose, ascorbic acid, acid and alkaline phosphatase indicated a significant decrease whereas testicular cholesterol level significantly increased indicating alterations in the biochemical milieu of the genital organs. Fertility and other effects gradually returned to control levels 120 days after cessation of treatment. No clinical signs of side effects on general metabolism were detected throughout the treatment, and after withdrawal, body weight gain was similar in all groups together with no alterations in the weight of vital organs', hematological and serological parameters.
  Human Fertility 06/2009; 12(2):107-18.
• Article: Sex is over-rated: on the right to reproduce.

  Daniela Cutas
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  ABSTRACT: In this article, I will show what is respected most in human reproduction and parenting is not a right to reproduce in the way in which this right is explicitly proposed. The only way in which people can become, and function as, parents without having to submit themselves to anyone else's judgements and decisions, is by having reproductive sex. Whatever one's intentions, social status, standard of living, income, etc., so long as assistance is not required, that person's reproductive decisions will not be interfered with in any way, at least not until neglect or abuse of their offspring becomes known. Moreover, none of the features that are said to back the right to reproduce (such as bodily integrity or personal autonomy) can justify one's unquestioned access to the relationship with another unable to consent (the child). This indicates that the discourse in terms of the right to reproduce as is currently used so as to justify non-interference with natural reproduction and parenting coupled with the regulation of assisted forms of reproduction and parenting, is at best self-deluding and that all it protects is people's freedom to have reproductive sex and handle the consequences.
  Human Fertility 04/2009; 12(1):45-52.
• Article: Oxidative stress-mediated essential polyunsaturated fatty acid alterations in female infertility.

  Savita S Mehendale, Anitha S Kilari Bams, Chaya S Deshmukh, Bharati S Dhorepatil, Vandana N Nimbargi, Sadhana R Joshi
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  ABSTRACT: Prostaglandins are exclusively synthesized in vivo from cell membrane essential fatty acids and together are known to regulate many aspects of reproductive processes. The objective of the study was to examine whether disturbances in fatty acid profile as a result of increased oxidative stress could be one of the causes of female infertility. Forty-five infertile and 30 control women were enrolled via the Department of Obstetrics and Gynecology of Bharati Medical College Hospital, Pune, India. Essential polyunsaturated fatty acids, malondialdehyde (MDA; oxidative stress-marker) levels and antioxidants (vitamins E and C) were measured in both groups. Results show that plasma eicosapentaenoic acid and erythrocyte docosahexaenoic acid levels were reduced (p < 0.05) in infertile women as compared to controls. Likewise, levels of MDA, a peroxidative product of essential fatty acids, were increased (p < 0.05) and vitamin E concentrations were decreased (p < 0.05) in infertile women, suggesting that increased oxidative stress and consequent altered essential polyunsaturated fatty acids are associated with infertility. Our study indicates, for the first time, the cause and effect relationship between oxidative stress and membrane essential polyunsaturated fatty acids in infertile women. These data have important implications for the supplementation of a combination of omega-3 fatty acids and antioxidants in the successful management of female infertility.
  Human Fertility 04/2009; 12(1):28-33.
• Article: Social and psychological consequences of infertility and assisted reproduction - what are the research priorities?

  Lone Schmidt
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  ABSTRACT: The lifetime prevalence of infertility in representative population-based studies from industrialised countries is 17-28%, and on average, 56% of individuals affected seek medical advice. Infertility, as well as being a medical condition, has a social dimension; it is a poorly-controlled, chronic stressor with severe long-lasting negative social and psychological consequences. Although infertility can lead to severe strain in a couples' relationship, it can also have a potentially positive effect. Appraisal-oriented coping strategies including emotional coping are associated with reduced stress in infertility. Long-term studies of involuntary childless women following unsuccessful treatment show that although most adjust well psychologically, their childlessness is a major theme of their lives. Most studies are based on cross-sectional studies among couples seeking fertility treatment and focus on individual characteristics, for example, stress level, anxiety and symptoms of depression. There is a lack of studies investigating the impact of infertility and its treatment on social relations and of studies which have used the couple as the unit of analysis. More large-scale, long-term prospective cohort studies which address the social as well as psychological consequences of infertility are needed.
  Human Fertility 04/2009; 12(1):14-20.
• Article: Medical adjuncts in IVF: evidence for clinical practice.

  Luciano G Nardo, Ingrid Granne, Jane Stewart
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  ABSTRACT: The cross-talk between the embryo and the endometrium, leading to implantation, is a complex, dynamic and highly controlled phenomenon. Over the last decade, a large amount of translational and clinical research has been carried out in an attempt to increase the likelihood of pregnancy in in vitro fertilisation (IVF). The purpose of this article was to review the literature on the effectiveness of adjuvant therapy in IVF and to provide fertility professionals with evidence-based guidance and recommendations. Clinicians who decide to prescribe therapies for which the evidence base is weak, should make patients aware of this lack of knowledge and potential adverse effects. There is a need for good clinical trials in many of the areas surrounding medical adjuncts in IVF to resolve the empirical/evidence divide.
  Human Fertility 04/2009; 12(1):1-13.
• Article: Long-term health implications for children conceived by IVF/ICSI.

  Anna Judith Steel, Alastair Sutcliffe
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  ABSTRACT: 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.
  Human Fertility 04/2009; 12(1):21-7.
• Article: Vascular endothelial growth factor and its soluble receptor in patients with polycystic ovary syndrome undergoing IVF.

  Paolo Giovanni Artini, Maria Ruggiero, Maria Rosaria Parisen Toldin, Patrizia Monteleone, Massimiliano Monti, Vito Cela, Andrea Riccardo Genazzani
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  ABSTRACT: We aimed to examine the behaviour of the angiogenetic factor vascular endothelial growth factor (VEGF) and its soluble receptor (sVEGFR-1) in polycystic ovary patients undergoing In vitro fertilisation (IVF) compared with respect to normally ovulating controls. Levels of VEGF and sVEGFR-1 were compared in follicular fluid and serum, both on the day of human choriogonadotropin (hCG) administration and on the day of oocyte retrieval (OR), in controls and polycystic ovarian syndrome (PCOS) patients undergoing IVF cycles. The bioactivity of VEGF (VEGF/sVEGFR-1 ratio) in the two groups was calculated. Thirty PCOS patients and 20 controls referring to the IVF Centre of the University of Pisa (Italy) were enrolled. In each patient, blood samples were collected on the day of hCG and on the day of OR administration, and follicular fluid samples. VEGF and sVEGFR-1 were measured by Enzyme Linked Immuno Sorbant Assay (ELISA). Serum VEGF bioactivity markedly increased in both groups after hCG administration. Serum and follicular fluid VEGF bioactivity was greater in PCOS patients than in controls on the day of OR. The increase in VEGF bioactivity in PCOS patients undergoing IVF was not only because of increasing levels of VEGF but also to decreasing levels of its soluble receptor. We believe that additional studies will clarify their role in the pathogenesis of ovarian hyperstimulation syndrome, which most often occurs in patients with PCOS.
  Human Fertility 04/2009; 12(1):40-4.
• Article: The premenstrual syndromes: PMS and PMDD.

  Sarah Hetrick
  Human Fertility 04/2009; 12(1):57.
• Article: Report on the donation of supernumerary embryos from fresh IVF and ICSI treatment cycles for human stem cell research.

  S Brett, M Livie, G Thomas, A McConnell, M Rajkhowa
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  ABSTRACT: Research involving human embryos promises exciting therapeutic advances but raises ethical and moral dilemmas for scientists and potential donors. The aim of this study is to report the proportion of couples donating supernumerary fresh embryos for development of stem cell lines from a single centre and the characteristics of those who donate. Couples undergoing assisted conception treatment in a teaching hospital received research information between January 2005 and July 2006. Counselling and consenting was performed by a dedicated research nurse. Demographic data was collected for couples who enrolled in the study. To determine the proportion of couples willing to donate surplus embryos for stem cell derivation and to examine the characteristics of those who consent to donate. Of 508 couples, 353 (69%) expressed an interest in research on their treatment consent forms. Sixty-six percent of those interested in research and 87% of counselled couples consented to donation. The demographic characteristics of those who agreed to donate were similar to those of all couples attending the unit. Approximately half of couples consented to donate under the described system in our centre. Detailed information provision helps the majority of those counselled to proceed to donation.
  Human Fertility 04/2009; 12(1):34-9.
• Article: Who am I?

  Alexina McWhinnie
  Human Fertility 01/2009; 11(4):265.