Search

This paper critically engages with how life not worth living (LNWL) and cognate concepts are used in the field of beginning-of-life bioethics as the basis of arguments for morally requiring the application of preimplantation genetic diagnosis (PGD) and/or germline genome editing (GGE). It is argued that an objective conceptualization of LNWL is largely too unreliable in beginning-of-life cases for deriving decisive normative reasons that would constitute a moral duty on the part of intending parents. Subjective frameworks are found to be more suitable to determine LNWL, but they are not accessible in beginning-of-life cases because there is no subject yet. Conceptual and sociopolitical problems are additionally pointed out regarding the common usage of clear case exemplars. The paper concludes that a moral requirement for the usage of PGD and GGE cannot be derived from the conceptual base of LNWL, as strong reasons that can be reliably determined are required to limit reproductive freedom on moral grounds. Educated predictions on prospective well-being might still be useful regarding the determination of moral permissibility of PGD and/or GGE. It is suggested that due to the high significance of subjective experience in the normativity of beginning-of-life bioethics, the discipline is called to more actively realize the inclusion of people with disabilities. This regards for instance research design, citation practices, and language choices to increase the accessibility of societal debates on the reproductive ethics of genetic technologies. [ABSTRACT FROM AUTHOR]

This paper studies the optimal fiscal treatment of assisted reproductive technologies (ART) in an economy where individuals differ in their reproductive capacity (or fecundity) and in their wage. We find that the optimal ART tax policy varies with the postulated social welfare criterion. Utilitarianism redistributes only between individuals with unequal fecundity and wages but not between parents and childless individuals. To the opposite, ex post egalitarianism (which gives absolute priority to the worst‐off in realized terms) redistributes from individuals with children toward those without children, and from individuals with high fecundity toward those with low fecundity, so as to compensate for both the monetary cost of ART and the disutility from involuntary childlessness resulting from unsuccessful ART investments. Under asymmetric information and in order to solve for the incentive problem, utilitarianism recommends to either tax or subsidize ART investments of low‐fecundity‐low‐productivity individuals at the margin, depending on the degree of complementarity between fecundity and ART in the fertility technology. On the opposite, ex post egalitarianism always recommends marginal taxation of ART. [ABSTRACT FROM AUTHOR]

The article dwells upon topical demographic problems of infertility in the context of their national specifics and institutional features. The purpose of the study was to analyze the impact of infertility correction on the annual number of births in Russia through identifying reproductive disorders and expanding assisted reproduction programs as effective tools of the pronatal fertility policy. The material for the analysis is statistical data of the Russian Federal State Statistics Service, official information from the Russian Association of Human Reproduction published in the National Registers of Assisted Reproductive Technologies in 2000-2021, materials of the World Health Organization and international professional associations of reproductive health professionals, domestic and foreign themed publications. The paper casts light on the economic, psychological, medical, social, professional, financial and gender changes in society associated with the development of assisted reproduction as the most effective way to correct infertility. A currently prevailing global trend towards universal access to assisted reproduction programs as the realization of everyone's right to the highest level of health, regardless of income, marital status, gender identity, etc., is limited in some countries by cost-effectiveness and "threshold of utility" of in vitro fertilization in treating infertility. In Russia, the main concern is the programs involving "third parties" and reproductive donors, especially surrogacy, therefore, it is necessary to strengthen state regulation to make the assisted reproductive technologies most similar to the natural processes and traditional ethical standards. [ABSTRACT FROM AUTHOR]

Previous studies have shown cord-blood DNA methylation differences in newborns conceived using assisted reproductive technologies (ART) compared to those conceived naturally. However, whether these ART-related DNA methylation differences vary with children's sex is unknown. We hypothesize that the DNA methylation differences in cord blood between ART-conceived and naturally conceived newborns also varies by the sex of the child, with distinct patterns of differential methylation present in males and females. We investigated sex differences in cord-blood DNA methylation variation according to conception by ART using the Illumina MethylationEPIC platform, comparing 456 ART-conceived versus 507 naturally-conceived girls, and 503 ART-conceived and 473 naturally-conceived boys. We identified 37 differentially methylated CpGs according to ART-conception among girls, and 70 differentially methylated CpGs according to ART-conception among boys, when we used a 1% false discovery rate to account for multiple testing. Ten CpGs were differentially methylated according to conception by ART in both sexes. Among the genes that were associated with these CpGs, we found the BRCA1; NBR2 gene (two CpGs) was hypermethylated in girls while the APC2 (two CpGs) and NECAB3;ACTL10, (four CpGs) related to cellular signaling were hypomethylated in boys. These findings confirm the presence of sex-specific epigenetic differences, illustrating the nuanced impact of ART on the fetal epigenome. There is a need for further explorations into the implications for sex-specific developmental trajectories and health outcomes in ART-conceived children. [ABSTRACT FROM AUTHOR]

Sperm DNA fragmentation (sDF) is a DNA damage able to predict natural conception. Thus, many laboratories added tests for the detection of sDF as an adjunct to routine semen analysis with specific indications. However, some points related to sDF are still open. The available tests are very different each from other, and a direct comparison, in terms of the prediction of reproductive outcomes, is mandatory. The proposed mechanisms responsible for sDF generation have not yielded treatments for men with high levels of sDF that have gained the general consent in clinical practice, thus requiring further research. Another relevant point is the biological meaning to attribute to sDF and, thus, what we can expect from tests detecting sDF for the diagnosis of male infertility. SDF can represent the "tip of iceberg" of a more extended and undetected sperm abnormality somehow impacting upon reproduction. Investigating the nature of such a sperm abnormality might provide novel insights into the link between sDF and reproduction. Finally, several studies reported an impact of native sDF on assisted reproduction technique outcomes. However, to fertilise the oocyte, selected spermatozoa are used where sDF, if present, associates with highly motile spermatozoa, which is the opposite situation to native semen, where most sDF associates with non-viable spermatozoa. Studies comparing the impact of sDF, as assessed in both native and selected spermatozoa, are needed. [ABSTRACT FROM AUTHOR]

Evidence suggests that one reason doctors provide certain interventions in assisted reproductive technologies (ART) is because of patient demand. This is particularly the case when it comes to unproven interventions such as 'add‐ons' to in vitro fertilisation (IVF) cycles, or providing IVF cycles that are highly unlikely to succeed. Doctors tend to accede to demands for such interventions because patients are willing to do and pay 'whatever it takes' to have a baby. However, there is uncertainty as to what moral weight should be placed on patient‐led demands in ART, including whether it is acceptable for such demands to be invoked as a justification for intervention. We address this issue in this paper. We start by elucidating what we mean by 'patient‐led demand' and synthesise some of the evidence for this phenomenon. We then argue that a doctor's professional role morality (PRM) yields special responsibilities, particularly in commercialised healthcare settings such as ART, because of the nature of professions as social institutions that are distinct from markets. We argue on this basis that, while there may be reasons (consistent with PRM) for doctors to accede to patient demand, this is not always the case. There is often a gap in justification between acceding to patient‐led demands and providing contested interventions, particularly in commercial settings. As a result, acceding to demand in such settings needs a strong justification to be consistent with PRM. [ABSTRACT FROM AUTHOR]

Simple Summary: Gynecological cancers affect many women of reproductive age, necessitating the development of fertility preservation methods to fulfill family planning. Consequently, providing treatment options that preserve fertility in women diagnosed with gynecological cancers has become a crucial component of care for survivors. This leads to improved quality of life, allowing survivors to become mothers even in the seemingly adverse circumstances posed by cancers. However, although there are guidelines on fertility preservation in the context of neoplasms, physicians do not routinely consider it and do not discuss these options with their patients. It is important for patients to be informed about the available options for fertility preservation and to be encouraged to make informed decisions in collaboration with their medical team. Standardized guideline recommendations for onco-fertility should be considered in the future. We explore possible methods that can be employed for obtaining a pregnancy after gynecologic cancer treatment, including more exotic ones like uterine transplant. (1) Background: Currently, an increasing number of women postpone pregnancy beyond the age of 35. Gynecological cancers affect a significant proportion of women of reproductive age, necessitating the development of fertility preservation methods to fulfill family planning. Consequently, providing treatment options that preserve fertility in women diagnosed with gynecological cancers has become a crucial component of care for survivors. (2) Methods: We conducted an extensive search of relevant scientific publications in PubMed and Embase databases and performed a narrative review, including high-quality peer-reviewed research on fertility after being treated for gynecologic cancers, reporting pregnancy rates, birth rates, and pregnancy outcomes in cancer survivors as well as therapeutic options which partially preserve fertility and methods for obtaining a pregnancy in survivors. (3) Discussion: The medicine practiced today is focused on both treating the neoplasm and preserving the quality of life of the patients, with fertility preservation being an important element of this quality. This leads to an improved quality of life, allowing these women to become mothers even in the seemingly adverse circumstances posed by such a pathology. However, although there are guidelines on female fertility preservation in the context of neoplasms, an analysis shows that physicians do not routinely consider it and do not discuss these options with their patients. (4) Conclusions: Advancements in medicine have led to a better understanding and management of gynecological neoplasms, resulting in increased survival rates. Once the battle against these neoplasms is won, the issue of preserving the quality of life for these women arises, with fertility preservation being an important aspect for women who have not yet fulfilled their family planning desires at the time of diagnosis. It is important for patients to be informed about the available options for fertility preservation and to be encouraged to make informed decisions in collaboration with their medical team. Standardized recommendations for onco-fertility into guidelines should be taken into consideration in the future. [ABSTRACT FROM AUTHOR]

The objective: to study the characteristics of the physical and sexual development of girls conceived with the help of assisted reproductive technologies (ART). Materials and methods. An examination of 16 teenage girls who were born with the help of ART was carried out. The average age of the girls was 12.0±0.45 (10–13) years. All girls underwent a clinical, functional, hormonal examinations, secondary sexual characteristics were evaluated according to the J. Tanner scale. Blood levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), dehydroepiandrosterone sulfate (DHEA-S), as well as estradiol (E2), testosterone, levels of thyroid hormones triiodothyronine (T3) and thyroxine (T4) were determined by the radioimmunoassay method on the microspectrophotometer “Stat fax” 303 PLUS USA in the first phase of the menstrual cycle. To study the functional activity of the liver, fasting glucose level and oral glucose tolerance test, insulin, alanine amino-transferase and aspartate aminotransferase levels were determined. In order to compare the concentration of hormones, 25 teenage girls of the appropriate age who were born from a spontaneous pregnancy and have a physiological course of the puberty period were additionally examined. Results. According to the ultrasound examination, the length of the right and left ovaries, as well as all echographic indicators, are significantly increased in girls who were born with the help of ART. A study of hormone levels in teenage girls conceived with ART revealed statistically higher levels of LH (5.05±1.17 mIU/ ml), DHEA-S (91.9±16.93 μg/dL), E2 (78.13±17.98 pg/ml), which indicates hyperandrogenism and hyperestrogenism of adrenal origin. At the same time, the fasting glucose level and its level after the oral glucose tolerance test were statistically lower than similar indicators in girls born from a spontaneous pregnancy and with the physiological course of puberty, but the fasting insulin level was higher (p<0.05). Conclusions. In girls who were born with the help of assisted reproductive technologies (ART), premature development of secondary sexual characteristics (late precocious puberty) and pronounced hair growth have been identified. Carbohydrate metabolism, enzymatic activity of the liver and functional activity of the kidneys in girls who were born with the help of ART do not differ from similar indicators of girls who were born from spontaneous pregnancy and with the physiological course of puberty. [ABSTRACT FROM AUTHOR]

Background: In recent years, preimplantation genetic testing for aneuploidies (PGT-A) has become widespread in assisted reproduction. However, contrary to expectations, PGT-A does not significantly improve the clinical outcomes of assisted reproductive technologies. One of the underlying reasons is the discordance between the PGT-A results and the true chromosomal constitution of the blastocyst. In this case series, we re-examined the PGT-A results in trophectoderm (TE) re-biopsies and in the two isolated blastocyst compartments—the TE and the inner cell mass (ICM). Methods: This study enrolled 23 human blastocysts from 17 couples who were referred for assisted reproduction. The blastocysts were unsuitable for uterine transfer due to the chromosomal imbalance revealed by PGT-A using array comparative genomic hybridization (aCGH) (n = 11) or next-generation sequencing (NGS) (n = 12). The re-examination of the PGT results involved two steps: (1) a TE re-biopsy with subsequent aCGH and (2) blastocyst separation into the TE and the ICM with a subsequent cell-by-cell analysis of each isolated compartment by fluorescence in situ hybridization (FISH) with the DNA probes to chromosomes 13, 16, 18, 21, and 22 as well as to the PGT-A detected imbalanced chromosomes. Results: In 8 out of 23 cases, the PGT-A results were concordant with both the re-biopsy and the isolated TE and ICM analyses. The latter included the diagnoses of full non-mosaic aneuploidies (five cases of trisomies and two cases of monosomies). In one case, the results of PGT-A, aCGH on the TE re-biopsy, and FISH on the isolated TE showed Xp tetrasomy, which contrasted with the FISH results on the isolated ICM, where this chromosomal pathology was not detected. This case was classified as a confined mosaicism. In 4 out of 23 cases, the results were partially discordant. The latter included one case of trisomy 12, which was detected as non-mosaic by PGT-A and the re-biopsy and as mosaic by FISH on the isolated TE and ICM. This case was classified as a true mosaicism with a false negative PGT-A result. In 11 out of 23 cases, the re-examination results were not concordant with the PGT-A results. In one of these discordant cases, non-mosaic tetraploidy was detected by FISH in the isolated TE and ICM, whereas the PGT-A and the TE re-biopsy failed to detect any abnormality, which advocated for their false negative result. In two cases, the re-examination did not confirm full aneuploidies. In eight cases, full or partial mosaic aneuploidies as well as chaotic mosacism were not confirmed in the isolated TE nor the isolated ICM. Thus, in 47.8% of cases, the PGT-A results did not reflect the true chromosomal constitution of a blastocyst. Conclusions: The PGT results may have different prognostic value in the characterization of the chromosomal constitution of a blastocyst. The detected non-mosaic aneuploidies have the highest prognostic value. In stark contrast, most PGT-identified mosaic aneuploidies fail to characterize the true chromosomal constitution of a blastocyst. Once detected, a differential diagnosis is needed. [ABSTRACT FROM AUTHOR]

Male infertility has affected an increasingly large population over the past few decades, affecting over 186 million people globally. The advent of assisted reproductive technologies (ARTs) and artificial intelligence (AI) has changed the landscape of diagnosis and treatment of male infertility. Through an extensive literature review encompassing the PubMed, Google Scholar, and Scopus databases, various AI techniques such as machine learning (ML), artificial neural networks (ANNs), deep learning (DL), and natural language processing (NLP) were examined in the context of evaluating seminal quality, predicting fertility potential, and improving semen analysis. Research indicates that AI models can accurately estimate the quality of semen, diagnose problems with sperm, and provide guidance on reproductive health decisions. In addition, developments in smartphone-based semen analyzers and computer-assisted semen analysis (CASA) are indicative of initiatives to improve the price, portability, and accuracy of results. Future directions point to possible uses for AI in ultrasonography assessment, microsurgical testicular sperm extraction (microTESE), and home-based semen analysis. Overall, AI holds significant promise in revolutionizing the diagnosis and treatment of male infertility, offering standardized, objective, and efficient approaches to addressing this global health challenge. [ABSTRACT FROM AUTHOR]

Background: In Egypt, where research into the underlying cytogenetic and molecular causes of infertility is scarce, unexplained infertility presents a substantial clinical and emotional difficulty for many couples. This study attempts to fill a gap in knowledge on the chromosomal disorders that cause infertility in Egyptian couples. Methods: In order to compile research on cytogenetic and molecular anomalies in Egyptian couples with unexplained infertility, an extensive database search was performed. Translocations, inversions, and aneuploidies were the primary focus of this study. Studies discussing the diagnostic utility of chromosomal analysis and molecular markers were considered and critically appraised up to April 2023 for this review. Results: The results suggest that cytogenetic and molecular abnormalities are responsible for a significant proportion of unexplained infertility in Egypt. Disruption of gametogenesis, abnormal embryonic development, and problems with genomic imprinting have all been linked to chromosomal abnormalities, which are typically missed in routine infertility examinations. Improved understanding of the causes of infertility and the potential for individualized therapies has resulted from the development of genetic testing. Conclusions: There is a strong correlation between cytogenetic and molecular abnormalities and unexplained infertility in Egypt. It becomes clear that karyotypic and molecular chromosomal examination are essential parts of the diagnostic process for afflicted couples. This analysis highlights the need for improved diagnosis techniques and the creation of individualized treatments. The ethical implications of genetic testing and Assisted reproductive technology are substantial, calling for a careful weighing of technology advantages and moral issues. New genetic and chromosomal therapies show promise in reducing infertility problems, and they fit in with current trends in ethics, medicine, and scientific inquiry. Future Directions: Future research in reproductive genetics should aim to improve diagnosis accuracy and provide therapies that are targeted to individual genetic profiles. There is a need for both ethical norms and instructional initiatives to help couples make informed choices about genetic testing and reproductive treatments. [ABSTRACT FROM AUTHOR]

As global demographics shift toward increasing paternal age, the realm of assisted reproductive technologies (ARTs), particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), faces new challenges and opportunities. This study provides a comprehensive exploration of the implications of advanced paternal age on ART outcomes. Background research highlights the social, cultural, and economic factors driving men toward later fatherhood, with a focus on the impact of delayed paternity on reproductive outcomes. Methods involve a thorough review of existing literature, centering on changes in testicular function, semen quality, and genetic and epigenetic shifts associated with advancing age. Study results point to intricate associations between the father's age and ART outcomes, with older age being linked to diminished semen quality, potential genetic risks, and varied impacts on embryo quality, implantation rates, and birth outcomes. The conclusions drawn from the current study suggest that while advanced paternal age presents certain risks and challenges, understanding and mitigating these through strategies such as sperm cryopreservation, lifestyle modifications, and preimplantation genetic testing can optimize ART outcomes. Future research directions are identified to further comprehend the epigenetic mechanisms and long-term effects of the older father on offspring health. This study underscores the need for a comprehensive approach in navigating the intricacies of delayed fatherhood within the context of ART, aiming for the best possible outcomes for couples and their children. [ABSTRACT FROM AUTHOR]

Infertility affects approximately 15% of couples trying to conceive. Male-related causes account for roughly 50% of cases, with obesity emerging as a possible significant factor. Obesity, defined as a body mass index of 30.0 or higher, has become a widespread epidemic associated with numerous health issues, including a decrease of fertility. This review discusses the relationship between obesity and male infertility, particularly focusing on sperm quality and function. An overview of the literature suggests that obesity may influence the male reproductive system via disruptions in hormonal profiles, oxidative stress, and inflammation, leading to changes in sperm parameters. Several studies have discussed if obesity causes a decrease in sperm concentration, motility, and normal morphology, so far without a consensus being reached. However, available evidence suggests an impairment of sperm function in obese men, due to an increase in DNA damage and oxidative stress, impaired mitochondrial function and acrosome reaction in response to progesterone. Finally, the relationship between obesity and assisted reproductive technologies outcomes remains debatable, with conflicting evidence regarding the influence on fertilisation, pregnancy, and live birth rates. Therefore, the actual impact of obesity on human spermatozoa still needs to be clarified, due to the multiple factors potentially in play. This review focuses on the potential impact of male obesity on sperm quality and function – a long-debated topic. The adverse effects of obesity on sperm parameters can significantly impair male and couple fertility, resulting in an increased necessity for fertility assistance among obese men. Furthermore, although more definitive research is needed, these individuals often experience poorer outcomes in assisted reproductive technologies. Image by João Ramalho-Santos. This article belongs to the Collection Dedication to Jim Cummins. [ABSTRACT FROM AUTHOR]

In vitro fertilization (IVF) has transformed the sector of assisted reproductive technology (ART) by presenting hope to couples facing infertility challenges. However, conventional IVF strategies include their own set of problems such as success rates, invasive procedures, and ethical issues. The integration of micro/nanorobotics into IVF provides a prospect to address these challenging issues. This article provides an outline of the use of micro/nanorobotics in IVF specializing in advancing sperm manipulation, egg retrieval, embryo culture, and capacity future improvements in this swiftly evolving discipline. The article additionally explores the challenges and obstacles associated with the integration of micro/nanorobotics into IVF, in addition to the ethical concerns and regulatory elements related to the usage of advanced technologies in ART. A comprehensive discussion of the risk and safety considerations related to using micro/nanorobotics in IVF techniques is likewise presented. Through this exploration, we delve into the core principles, benefits, challenges, and potential impact of micro/nanorobotics in revolutionizing IVF procedures and enhancing affected person outcomes. [ABSTRACT FROM AUTHOR]

In 2022, the Society for Reproductive Biology came together in Christchurch New Zealand (NZ), for its first face-to-face meeting since the global COVID-19 pandemic. The meeting showcased recent advancements in reproductive research across a diverse range of themes relevant to human health and fertility, exotic species conservation, and agricultural breeding practices. Here, we highlight the key advances presented across the main themes of the meeting, including advances in addressing opportunities and challenges in reproductive health related to First Nations people in Australia and NZ; increasing conservation success of exotic species, including ethical management of invasive species; improvements in our understanding of developmental biology, specifically seminal fluid signalling, ovarian development and effects of environmental impacts such as endocrine-disrupting chemicals; and leveraging scientific breakthroughs in reproductive engineering to drive solutions for fertility, including in assisted reproductive technologies in humans and agricultural industries, and for regenerative medicine. [ABSTRACT FROM AUTHOR]