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Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care.
PloS One. 2017; 12(9):e0183131.INTRODUCTION: We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. METHODS: We recruited HIV-positive men and women on antiretroviral therapy (ART) ('index') from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner ('partner'), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. RESULTS: 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner's HIV status. Similarly, the partner's HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner's desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. CONCLUSIONS: Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.
Client uptake of safer conception strategies: implementation outcomes from the Sakh'umndeni Safer Conception Clinic in South Africa.
Journal of the International AIDS Society. 2017 Mar 08; 20(Suppl 1):43-51.INTRODUCTION: Implementation of safer conception services for HIV-affected couples within primary healthcare clinics in resource-limited settings remains limited. We review service utilization and safer conception strategy uptake during the first three years of Sakh'umndeni, which is a safer conception clinic in South Africa. METHODS: Sakh'umndeni is located at Witkoppen Health and Welfare Centre, a high-volume primary healthcare clinic in northern Johannesburg. Men and women desiring to conceive in less than or equal to six months and in relationships in which one or both partners are living with HIV are eligible for safer conception services. Clients receive a baseline health assessment and counselling around periconception HIV risk reduction strategies and choose which strategies they plan to use. Clients are followed-up monthly. We describe client service utilization and uptake and continuation of safer conception methods. Factors associated with male partner attendance are assessed using robust Poisson regression. RESULTS: Overall 440 individuals utilized the service including 157 couples in which both partners attended (55%) and 126 unaccompanied female partners. Over half of the couples (55%) represented were in serodiscordant/unknown status relationships. Higher economic status and HIV-negative status of the women increased male partner involvement, while HIV-negative status of the men decreased male involvement. Regarding safer conception strategies, uptake of antiretroviral therapy initiation (90%), vaginal self-insemination among partnerships with HIV-negative men (75%) and timed condomless intercourse strategies (48%) were variable, but generally high. Overall uptake of pre-exposure prophylaxis (PrEP) was 23% and was lower among HIV-negative men than women (7% vs. 44%, p < 0.001). Male medical circumcision (MMC) was used by 28% of HIV-negative men. Over 80% of clients took up at least one recommended safer conception strategy. Continuation of selected strategies over attempted conception attempts was >60%. CONCLUSIONS: Safer conception strategies are generally used by clients per recommendations. High uptake of strategies suggests that the proposed combination prevention methods are acceptable to clients and appropriate for scale-up; however, low uptake of PrEP and MMC among HIV-negative men needs improvement. Targeted community-based efforts to reach men unlinked to safer conception services are needed, alongside streamlined approaches for service scale-up within existing HIV and non-HIV service delivery platforms.
The effect of endometrial scratch injury on pregnancy outcome in women with previous intrauterine insemination failure: A randomized clinical trial.
Journal of Obstetrics and Gynaecology Research. 2017 Sep; 43(9):1421-1427.AIM: Endometrial scratch injury (ESI) has been recently proposed to enhance the implantation rate in assisted reproductive technology cycles. The present study was conducted to determine the effect of ESI on pregnancy rate in women with intrauterine insemination (IUI) failure. METHODS: This prospective randomized controlled study was carried out in Imam-Khomeini Hospital and Royan Institute, Tehran, during a 12-month period from January 2013 to January 2014. After assessment, 169 patients who had IUI failure twice or more (no chemical or clinical pregnancy) with normal uterine anatomy and hysterosalpingography, were enrolled. They were randomly assigned into two groups. In the experimental group, all patients underwent ESI at day 8 or 9 of stimulation phase in the present IUI cycle, whereas no intervention was performed on the control group. IUI outcome was then compared between the two groups. RESULTS: A total of 150 patients completed the IUI cycle during the study. The chemical pregnancy rate was 10.7% and 2.7% in the experimental and control groups, respectively, without significant difference (P = 0.09). Also no significant differences were detected in terms of clinical pregnancy and miscarriage rates between the two groups (P > 0.05). CONCLUSIONS: No significant beneficial effect of ESI on fertility outcome in patients with repeated IUI failure was detected when it was carried out on day 8 or 9 of the same IUI stimulation cycle. Also, however, no negative impact secondary to ESI was observed. Therefore, confirmation or refutation of this hypothesis requires further studies with a larger sample size. IRCT201507271141N19. (c) 2017 Japan Society of Obstetrics and Gynecology.
Prevalence and Correlates of Use of Safer Conception Methods in a Prospective Cohort of Ugandan HIV-Affected Couples with Fertility Intentions.
AIDS and Behavior. 2017 Aug; 21(8):2479-2487.We examined the prevalence and correlates of safer conception methods (SCM) use in HIV-affected couples with fertility intentions. A prospective cohort of 400 HIV clients in Uganda who had fertility intentions with their partner was surveyed every 6 months for 24 months. Logistic regression analysis was used to determine individual, relationship and provider level predictors of SCM use. Over one-third (35%) reported any use of timed unprotected intercourse (TUI) during the study; use of other SCM was rare. Baseline predictors of any TUI use included lower social support, greater perceived provider stigma of childbearing, greater SCM awareness, greater control over sexual decision making in the relationship, inconsistent condom use, and the belief that a desire for childbearing impedes condom use. These findings highlight the need for policy and provider training regarding integration of safer conception counselling into family planning and reproductive health services for people living with HIV.
Incidence Of Sexually Transmitted Diseases Amongst Potential Semen Donors In University Of Benin Teaching Hospital, Benin City, Nigeria.
Benin Journal of Postgraduate Medicine. 2008; 10(1):1-5.The incidence of Sexually Transmitted Diseases in Prospective Semen Donors where investigated using Standard Laboratory Procedures. 30 Prospective Semen Donors were screened for common STDs/STI at the Human Reproductive Research Programme /Invitro Fertilization Centre of the University of Benin Teaching Hospital. The incidence rates are Staphylococcus aureus (20%), followed by Chlamydia trachomatis (6.7%) while Klebsiellia spp, Treponema pallidum, Human Immunodeficiency Virus (HIV), Escherichia coli and Hepatitis B Virus were detected with incidence rate of 3.3% each respectively. Ten percent (10%) of the prospective semen donors had evidence of polymicrobial infection excluding HIV. The risk of sexually transmitted diseases or infection should be of great concern to couples undergoing therapeutic artificial donor insemination.
Fertility and Sterility. 2016 Mar; 105(3):607.We have come a long way in achieving, and preventing, pregnancy since 1966. Copyright (c) 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya.
AIDS Care. 2015; 27(1):10-6.In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination (TVI) of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. TVI, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis. We conducted five mixed and single-sex focus group discussions comprised of 33 HIV-serodiscordant couples and health-care providers in the Nyanza region of Kenya to assess the acceptability and feasibility of TVI as a safer method of conception. The transcribed data were analyzed using a grounded theory approach. We found that educating and counseling HIV-serodiscordant couples on TVI could make it an acceptable and feasible safer conception method when associated with frequent communication and home visits by health-care providers. The findings of this study indicate that implementation studies that integrate training and counseling of HIV-serodiscordant couples and health-care providers on TVI combined with consistent condom use are needed. Acknowledging and supporting the reproductive choice and needs of female positive, male negative HIV-serodiscordant couples who desire children should also include the use of assisted reproductive services at the same time as pharmaceutical options that prevent sexual HIV transmission.
Evaluating safer conception options for HIV-serodiscordant couples (HIV-infected female/HIV-uninfected male): a closer look at vaginal insemination.
Infectious Diseases In Obstetrics and Gynecology. 2012; 2012:587651.HIV serodiscordant couples represent at least half of all HIV-affected couples worldwide. Many of these couples have childbearing desires. Safer methods of conception may allow for pregnancy while minimizing the risk of sexual transmission of HIV. In serodiscordant partnerships with an HIV-infected female and HIV-uninfected male, vaginal insemination of a partner's semen during the fertile period coupled with 100% condom use may be the safest method of conception.
Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes.
Fertility and Sterility. 2010 Dec; 94(7):2796-9.In women with endometriosis, including those with endometriomas, 6 to 8 weeks of continuous use of oral contraception (OC) before assisted reproduction treatment (ART) maintains ART outcomes comparable with the outcomes of age-matched controls without endometriosis. In contrast, ART outcomes are markedly compromised in endometriosis patients who are not pretreated with OC. Ovarian responsiveness to stimulation was not altered by 6 to 8 weeks' use of pre-ART OC, including in poor responders with endometriomas. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Comparison of GnRH antagonist protocol with or without oral contraceptive pill pretreatment and GnRH agonist low-dose long protocol in low responders undergoing IVF/intracytoplasmic sperm injection.
Fertility and Sterility. 2009 Nov; 92(5)This prospective randomized study was performed to compare the efficacy of GnRH antagonist multiple-dose protocol (MDP) with or without oral contraceptive pill (OCP) pretreatment and GnRH agonist low-dose long protocol (LP) in 82 patients undergoing IVF/intracytoplasmic sperm injection (ICSI). GnRH antagonist MDP with OCP pretreatment was at least as effective as GnRH agonist low-dose LP in low responders, and can benefit the low responders by reducing the amount of FSH and the number of days of stimulation required for follicular maturation.
Oral contraceptive pretreatment and half dose of ganirelix does not excessively suppress LH and may be an excellent choice for scheduling IUI cycles.
Journal of Assisted Reproduction and Genetics. 2008 Aug; 25(8):417-20.PURPOSE: To assess the effects of using a reduced dose of ganirelix with oral contraceptive pretreatment in a pilot study of COH using pure FSH for intrauterine insemination (IUI) METHODS: Patients received oral contraceptive (OC; 30 microg ethinyl estradiol/150 microg desogestrel) for 14-21 days and rFSH (50-225 IU/day SC) was started on day 4 after OC discontinuation. Ganirelix acetate (125 microg/day) was started with a lead follicle diameter of 14 mm. RESULTS: Of the 25 subjects who started oral contraceptives, one was cancelled due to an excessive response, and one subject was not included in the analysis because she did not receive ganirelix until the lead follicle was 18 mm. Median (range) starting FSH dose was 100 (50-225), cumulative rFSH dose was 1000 (675-2175) IU over 10 (9-17) days. Duration of ganirelix acetate treatment was 4.0 (2-5) days. Seven subjects (30.4%) delivered ten babies (three pregnancies were twins). There were no biochemical pregnancies or miscarriages. Of the 16 subjects with measurement of LH on the day of HCG administration, only one was under 0.5 mIU/ml (0.4), and only one was over 10 mIU/ml (17.7), and that subject delivered twins. CONCLUSION: OC pretreatment afforded flexibility in scheduling while a reduced dose of ganirelix avoided excessive suppression of LH. The excellent results in this pilot study for IUI suggest this regimen could be further evaluated for scheduling IUI and IVF cycles.
Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in 899 families in Germany.
Reproductive Biomedicine Online. 2008 Sep; 17(3):403-9.There are only scarce data on the incidence of spontaneous pregnancy in infertility patients. Contraception after infertility treatment is another topic that has been neglected so far. Therefore, a questionnaire was sent to 1614 couples with a child conceived by intracytoplasmic sperm injection (ICSI) aged 4-6 years. A total of 899 couples responded (response rate 55.7%). A total of 10.9% of couples had used contraception. Of the couples that had actively tried to conceive, 20.0% had conceived spontaneously, resulting in a live-birth rate of 16.4%. 74.5% of these pregnancies were conceived within 2 years after delivery. A further 26.6% of couples conceived again by ICSI, with a live-birth rate of 20.9%. Maternal age was the only prognostic factor for spontaneous conception. Parents of multiples after ICSI did not have a higher chance of spontaneous conception than parents of singletons. Couples can be counselled that one out of five couples conceive spontaneously after successful ICSI. Even when assuming that none of the families that were lost to follow-up had conceived spontaneously, one out of eight couples would have conceived spontaneously. Therefore, it is important to counsel patients about the possibility of natural conception and necessity to use contraception despite their history of subfertility.
The significance of sperm DNA oxidation in embryo development and reproductive outcome in an oocyte donation program: A new model to study a male infertility prognostic factor.
Fertility and Sterility. 2008 May; 89(5):1191-1199.One byproduct resulting from free radical damage is the DNA hydroxylation also known as DNA oxidation. Our aim with this work was to determine the relevance of sperm DNA oxidation on embryo quality in oocyte donation cycles. We prospectively studied pairs of oocyte donation cycles, i.e., the same oocyte donors, donating to two recipients, where the only difference between the two treatments was the use of a different sperm sample. The setting was the University-affiliated private IVF setting. The patient(s) were infertile male partners from couples undergoing oocyte donation cycles (n = 38): 76 semen aliquots analyzed before and after semen processing by swim up. We measured sperm DNA oxidation by flow cytometry using the OxiDNA assay and correlated it with embryo quality parameters, implantation, and pregnancy outcome. A positive correlation was seen between embryo fragmentation and DNA oxidation of capacitated samples at 48 hours and 72 hours after fertilization. However, when we analyzed the differences in the IVF outcome parameters of the couples who shared the oocyte cohort (same donor) with the differences in the OxiDNA values, we observed increased and further relationships with cell embryo division 48 hours after fertilization. A negative association with blastocyst formation was also detected. Oxidative damage in the DNA is clearly increased in samples with lower sperm motility. An association between early and late embryo quality and sperm DNA oxidation supports the relevance of the hydroxylation of 8-oxoguanine as a biomarker of sperm quality reflecting the free radical damage in human sperm. (author's)
[Investigation and assisted reproduction in the treatment of male infertility] Investigacao e reproducao assistida no tratamento da infertilidade masculina.
Revista Brasileira de Ginecologia e Obstetricia. 2007 Feb; 29(2):103-112.Male infertility affects 10% of couples in the reproductive age worldwide and is treatable in many cases. In addition to other well-described etiologies, genetic causes of male infertility are now more commonly diagnosed. In men with prior vasectomy or varicocele, microsurgical reconstruction of the reproductive tract or varicocelectomy is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if no female fertility risk factors are present. If epididymal obstruction after vasectomy is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.
Reproductive Biomedicine Online. 2007 Sep; 15(3):310-315.Cervical mucus may cover the embryo transfer catheter during passage of the cervical canal, interfering with the correct placement of the embryo(s) into the uterine cavity. The effect of removal of cervical mucus prior to embryo transfer in IVF/intracytoplasmic sperm injection (ICSI) on live birth rate was studied. The study was set up as a single blind randomized controlled trial. Couples undergoing IVF/ICSI were randomly allocated to either removal of cervical mucus prior to embryo transfer, or a mock procedure. Randomization was done with stratification for age, cycle number and method of treatment. Primary outcome was live birth rate. A total of 317 couples were included and underwent 428 cycles, of which (he outcome of 3 cycles was unknown. Baseline characteristics of both groups were comparable. Live birth occurred in 52 of 220 (24%) cycles in the treatment group and 42 of 205 (21%) cycles in the control group (risk difference 3%, 95% confidence interval -5-11%). It is unlikely that removal of cervical mucus prior to embryo transfer has a significant effect on live birth rate. A small effect, however, cannot be excluded. (author's)
Journal of Pakistan Medical Association. 2007 Mar; 57(3):133-136.The objective was to determine the success rate of intrauterine insemination (IUI) in couples presenting with subfertility following controlled ovarian hyperstimulation (COH) by the use of cost effective intrauterine catheter (insertion tube). An experimental study was conducted at the Obstetric and Gynaecology Departments of Combined Military Hospital Kharian and PNS SHIFA Karachi in collaboration with the Department of Pathology from June 2002 to March 2005. A total of 89 couples were studied, out of which 28 couples presented with abnormal finding in the seminal fluid of husband whereas in 61 couples no identifiable cause could be detected. The mean age of women was 29 years and the duration of infertility was variable. All women had tubal patency confirmed before undergoing COH. IUI was performed at follicular maturity of 18-22 mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI, miscarriage rate and ongoing pregnancy rate. Prognostic factors associated with successful outcome in IUI, such as maternal age and motile sperm count was also observed. For cost effective measures, we used the sterilized disposable insertion tube of the 'Copper-T 380 A' device for insemination of reated sperms into the uterine cavity. Chi-square test was applied to assess the effectiveness of IUI in relation with these variables. A total of 205 insemination cycles were performed resulting in achievement of pregnancy in 31 patients. Miscarriage occurred in 3 patients. Out of these 31 women who conceived, 21 (67.7%, p=0.003) were aged < 35 years with higher pregnancy rate per cycle (21/90 = 23.3%). Intrauterine insemination may be regarded as valuable procedure for couples presenting at younger age with lesser duration of infertility and unexplained subfertility. (author's)
[Adolescents treated for cancer and fertility preservation. Psychological aspects] Les adolescents traites pour un cancer et la preservation de leur fertilite. Aspects psychologiques.
Gynecologie, Obstetrique and Fertilite. 2005 Sep; 33(9):627-631.Sperm preservation should be proposed to all the adolescents undergoing treatment for a cancer, because fertility is a major desire of young adults cured of a cancer. Proposing sperm preservation is among the oncologist's concerns about preventing sequels. However, this proposition can give rise to psychological problems as it concerns cancer and adolescence. For sperm collection to take place in a favourable climate with the adolescent's approval, their psychology and behaviour towards cancer should be well apprehended: they worry about their body, their appearance, their sexuality, their relations with their peers and their parents, their value, their narcissism, and their identity; but they can also be anxious, pessimistic about their future, disillusioned with parenthood, afraid of transmitting cancer, etc. Knowing these aspects helps one to understand and overcome any reluctance and to attenuate feelings of guilt and suffering in case of failure. Thus, a balance can be struck between over-respecting superficial opposition and imposing a decision that is not authentically theirs. In addition, closer relations nurtured between the sperm bank and oncohaematology departments, adolescent-friendly information material, and a better knowledge of adolescent psychology could also be helpful. (author's)
Human Reproduction. 2007 May; 22(5):1363-1372.The maximal number of live births (k) per donor was usually determined by cultural and social perspective. It was rarely decided on the basis of scientific evidence or discussed from mathematical or probabilistic viewpoint. To recommend a value for k, we propose three criteria to evaluate its impact on consanguinity and disease incidence due to artificial insemination by donor (AID). The first approach considers the optimization of k under the criterion of fixed tolerable number of consanguineous mating due to AID. The second approach optimizes k under fixed allowable average coefficient of inbreeding. This approach is particularly helpful when assessing the impact on the public, is of interest. The third criterion considers specific inheritance diseases. This approach is useful when evaluating the individual's risk of genetic diseases. When different diseases are considered, this criterion can be easily adopted. All these derivations are based on the assumption of shortage of gamete donors due togreat demand and insufficient supply. Our results indicate that strong degree of assortative mating, small population size and insufficient supply in gamete donors will lead to greater risk of consanguinity. Recommendations under other settings are also tabulated for reference. A web site for calculating the limit for live births per donor is available. (author's)
Developing World Bioethics. 2007 Aug; 7(2):104-111.Brazil has not yet approved legislation on assisted reproduction. For this reason, clinics, hospitals and semen banks active in the area follow Resolution 1358/92 of the Conselho Federal de Medicina, dated 30 September 1992. In respect to semen donation, the object of this article, the Resolution sets out that gamete donation shall be anonymous, that is, that the donor and recipients (and the children who might subsequently be born) shall not be informed of each other's identity. Thus, since recipients are unaware of the donor's identity, semen banks and the medical teams involved in assisted reproduction become the intermediaries in the process. The objective of this article is to show that, in practice, this represents disrespect for the ethical principles of autonomy, privacy and equality. The article also stresses that the problem is compounded by the racial question. In a country like Brazil, where racial classification is so flexible and goes side by side with racist attitudes, the intermediary role played by semen banks and medical teams is conditioned by their own criteria of racial classification, which are not always the same as those of donors and semen recipients. The data presented in this paper were taken from two semen banks located in the city of São Paulo (Brazil). At the time of my research, they were the only semen banks in the state of São Paulo and supplied semen to the capital (São Paulo city), the state of São Paulo, and to cities in other Brazilian states where semen banks were not available. (author's)
Human Reproduction. 2007; 22:902-903.We greatly appreciate the valuable comment by Dr Zahedi on our article entitled 'Public opinion regarding oocyte donation in Turkey: first data from a secular population among the Islamic world'. During the preparation of our manuscript, we consulted with Dr Azimaraghi from Iran and also with Dr Schenker JG from Israel (who has several publications on the issue) regarding the status of third-party reproduction in the Islamic world. We realized that although oocyte donation is practised in Iran, most of the professionals were not fully aware of the details of the regulations. For this reason, the information presented by Dr Zahedi is extremely important. As far as I know, Iran is the only country in the Islamic world where third-party reproductive treatment is allowed. Sperm donation is not permitted in any Islamic country so far. Interestingly, egg donation is permitted in less than one-third of 39 European countries practising assisted reproductive treatment, but sperm donation is allowed in 24 of 39 countries. Because culture is patriarchal based especially in eastern societies including the Persian culture, lineage and genetics is believed to be transmitted via sperm. This common belief in the population probably influences the law-makers to ban sperm donation while permitting oocyte donation. (excerpt)
Human Reproduction. 2007 Mar; 22(3):902.We have read the article written by Isikoglu et al. published in January 2006 issue of this journal with interest. We would like to mention some points about the situation of gamete donation in Iran that authors have also pointed out in the discussion. Based on the decree (Fatwa) by the spiritual leader of Iran, donor technologies are permitted and could be effectively used. According to this Fatwa, oocyte donation is not in and by itself forbidden, and also, it is not prohibited to fertilize a woman's oocyte with a sperm donor in and by itself, but the opposite gender should avoid touching or seeing the woman or man. Owing to this Fatwa, 'the Act of Embryo Donation to Infertile Couples' was ratified by the parliament in 2003. Nevertheless, it needs to be remembered that although the consensus of physicians and religious leaders has paved the way for progress of third-party-assisted reproduction in Iran, there are numerous ethical, legal, psychological and socio-cultural issues that could have important influences on application of these technologies in practice. The issues of new forms of kinship, the importance of safeguarding lineage, welfare of the resulting child and inheritance would be challenging concerns. Some aspects of the issue were discussed at the Conference of Gamete and Embryo Donation in Infertility Treatment. (excerpt)
Fertility issues: the perceptions and experiences of young men recently diagnosed and treated for cancer.
Journal of Adolescent Health. 2007 Jan; 40(1):69-75.The purpose was to explore fertility issues for young men who had been diagnosed and treated for cancer and to examine communication problems surrounding these fertility issues. Narrative interviews were conducted with 21 young men previously treated for cancer in the United Kingdom. Eighteen talked about fertility issues at some length. A qualitative interpretive approach was taken, combining thematic analysis with constant comparison. Communication about sperm storage was sometimes difficult and embarrassing. Young men wanted the opportunity to bank their sperm but decisions were often rushed. Some would have appreciated counseling and were unprepared for the process of sperm banking and criticized facilities. Uncertainty about fertility status caused worries for the future. More still needs to be done to help young men with cancer to address issues of fertility. All adolescents and young men treated for cancer should be offered sperm banking if their fertility may be affected. They should be offered counseling at every stage by professionals who feel comfortable talking about the subject. Interactive, educational CD-ROMs or websites may be useful. Physical facilities for sperm banking should be improved. (author's)
The relationship between total motile sperm count and pregnancy rate after intrauterine insemination.
Pakistan Journal of Medical Sciences. 2006 Jul-Sep; 22(3):223-227.The objective was to determine the relationship between the total motile sperm count and the success of IUI treatment cycles with postwashed husband spermatozoa in couples with infertility in a large patient population. Design: Retrospective descriptive study. Setting: Academic University Hospital-based infertility center. Patients: Eight hundred twenty four infertile couples undergoing 824 cycles of IUI. Main outcome measure(s): To assess the significance of prognostic factors including a woman's age, duration of infertility, diagnoses, use of ovulation induction and sperm parameters for predicting the outcomes of clinical pregnancy after the first cycle of IUI. The pregnancy rate per cycle was 18.2% (150/824). Postwashed semen parameters including total motile sperm count > 10 × 10/6,motility > 50%. There was a trend toward an increased success rate with increased total motile Sperm count. Our finding suggest that a final postwashed total motile sperm count used for IUI may be considered predictive of the success for pregnancy. (author's)
Intrauterine insemination: pregnancy rate and its associated factors in a university hospital in Iran.
Middle East Fertility Society Journal. 2006; 11(1):59-63.The objective was to determine pregnancy rate and its associated factors in Intrauterine Insemination (IUI) in a University ART center in Tehran, Iran. Are retrospective descriptive study was conducted on all available records of infertile patients (200 cases) who had undergone IUI treatment for their infertility problems in Mirza Koochak Khan ART center, between 1999 and 2000. The necessary data were collected and then analyzed with Chi-square test with a significant level of 0.05. 200 infertile couples did 575 IUI cycles. Pregnancy rate was 19.5% per couple and 6.8% per cycle (39 cases). The pregnancy rate in couples with secondary infertility was significantly higher than those with primary infertility (47.4% vs. 8.4%, P<0.0001) and patients with more than 60% normal sperm morphology (NSM) had higher pregnancy rate than those with less than 60% NSM (24.3% vs. 7.7%, P=0.0052). Pregnancy rate tended to increase when the number of large follicles increase at time of IUI (From 6.7% in 1-2 oocytes to 15.7% in > 5 oocytes, P=0.0095). As the numbers of IUI treatment cycles increased, the success rate per cycles decreased. There was a significant difference in pregnancy rate according to kind of drug used for ovarian stimulation. Pregnancy rate was 11.5% with HMG, compared to 7.2% with clomiphene citrate and HMG (P=0.052). Pregnancy rate with twice IUI per cycle was significantly higher than those who had one IUI per cycle (24.1% versus 11.8%, P<0.05). The highest pregnancy rate was seen in 21-30 years old patients (46.5%) and the lowest in women with more than 36 years of age, while no pregnancy occurred in patients less than 20 years of age. The frequency of twin pregnancy and low birth weight infants was 25.6% (10 subjects) and 14.3% (7 subjects) respectively. It seems that IUI provides better results in patients with secondary infertility, with >60% NSM and with >5 large follicles at the time of treatment. Pregnancy rate does not increase with increasing the number of treatment cycles and ovarian stimulation with HMG is associated with relatively higher pregnancy rate. (author's)
Acta Obstetricia et Gynecologica Scandinavica. 2006 Jul; 85(8):993-996.Infertile Hungarian couples were surveyed with regard to their opinion of preconception gender selection by the separation of X- and Y-bearing sperm populations. Self-completion of a questionnaire. Group 1: subjects presenting for infertility examination; Group 2: presenting for homologous intrauterine insemination. As concerns the gender of the firstborn, 13.8% of those in Group 1 preferred a boy and 10.3% a girl, while 75.9% had no preference. The male preference was higher in Group 2: 33.3% preferred a boy and 7.4% a girl while 59.3% had no preference (x/2, p < 0.05). In the event of a wish for more offspring, 91% in Group 1 and 94% in Group 2 did not have a wish for only one particular gender. In Group 2, 30.8% were willing to pay the extra costs for a gender selection procedure as compared with only 10.8% of the couples in Group 1 (x/2, p < 0.05). If the National Health Fund fully covered the costs, 53.4% in Group 1 and 38.5% in Group 2 would request the procedure for nonmedical reasons, while 94.6% and 97.4% of them, respectively would so for medical reasons. Our findings revealed a trend to preference for firstborn males, although couples wishing more than one offspring prefer equal numbers of male and female children. The utilization of preconception gender selection, therefore, would not seem to appreciably affect the natural male/female ratio. Genetic indications exert significant effects on the decision regarding sex selection procedures. (author's)