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Assisted reproduction often involves biological contributions by third parties such as egg/sperm donors, mitochondrial DNA donors, and surrogate mothers. However, these arrangements are also characterised by a biological relationship between the child and at least one intending parent. For example, one or both intending parents might use their own eggs/sperm in surrogacy, or an intending mother might conceive using donor sperm or gestate a donor embryo. What happens when this relationship is absent, as in the case of 'double‐donor surrogacy' arrangements (DDS)? Here, a child is conceived using both donor eggs and sperm, carried by a surrogate, and raised by the commissioning parents. In this paper, I critically examine proposals to allow DDS in the United Kingdom, and the intentionalist justification for treating this practice distinctly (morally and legally speaking) from private adoption. I argue that the intentionalist approach cannot plausibly justify such a distinction and that other approaches to moral parenthood are also unlikely to succeed. [ABSTRACT FROM AUTHOR]

Human uterus transplantation (UTx)—the most radical and experimental of all current forms of assisted reproduction—gives rise to a range of complex ethical questions, including those related to individual safety, risk, and informed consent. I have argued elsewhere that the wider social impacts and implications of UTx provision must form part of a comprehensive ethical analysis. My socio‐moral critique of UTx provision has been responded to with a number of defences of possible public funding of UTx. In this paper I examine a select number of those defences. These include: that UTx provision would address harms and needs that already exist and as such have priority; that UTx provision is fully compatible with the needed reform of the procreative context in which it would be offered; that UTx provision would not necessarily involve legitimation or endorsement of what are widely agreed to be problematic pronatalist or geneticist norms; and that UTx provision is required as a matter of justice and consistency with other practices. Importantly, defenders are not proposing a ceteris paribus justification of UTx provision; nor do my responses to their arguments represent a comprehensive opposition to UTx. Rather, my more limited purpose here is to show that whatever other defences may be given of publicly funded UTx provision, those considered here do not ultimately succeed and therefore do not allay the concerns underpinning the original socio‐moral critique. [ABSTRACT FROM AUTHOR]

In this paper I argue that some human reproductive genome editing interventions can be therapeutic in nature, and thus that it is false that all such interventions just create healthy individuals. I do this by showing that the conditions established by a therapy definition are met by certain reproductive genome editing interventions. I then defend this position against two objections: (a) reproductive genome editing interventions do not attain one of the two conditions for something to be a therapy, and (b) some reproductive genome editing interventions are therapeutic but in a nonstandard way. In the Conclusion I call for a more nuanced discussion of the nature of reproductive genome editing interventions. [ABSTRACT FROM AUTHOR]

CRISPR is widely considered to be a disruptive technology. However, when it comes to the most controversial topic, germline genome editing (GGE), there is no consensus on whether this technology has any substantial advantages over existing procedures such as embryo selection after in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). Answering this question, however, is crucial for evaluating whether the pursuit of further research and development on GGE is justified. This paper explores the question from both a clinical and a moral viewpoint, namely whether GGE has any advantages over existing technologies of selective reproduction and whether GGE could complement or even replace them. In a first step, I review an argument of extended applicability. The paper confirms that there are some scenarios in which only germline intervention allows couples to have (biologically related) healthy offspring, because selection will not avoid disease. In a second step, I examine possible moral arguments in favour of genetic modification, namely that GGE could save some embryos and that GGE would provide certain benefits for a future person that PGD does not. Both arguments for GGE have limitations. With regard to the extended applicability of GGE, however, a weak case in favour of GGE should still be made. [ABSTRACT FROM AUTHOR]

In this paper I argue that current law and policy governing germline genetic modification are overly broad and in fact prohibit medical interventions normally considered unobjectionable. The root of the problem lies in the fact law and policy tend to espouse a near categorical ban on medical interventions that alter germline DNA. However, if we pay close attention to the biological mechanisms at play we see that many standard medical interventions result in alterations to DNA that can be transmitted to future generations. The correct focus of policy and regulation thus ought to be determining which kinds of transmissible genetic modifications ought to be permitted, and not whether they should be permitted at all. Given that the scientific classification of biological structures involved in the inheritance of traits is unlikely to be in itself ethically significant, ethicists ought to develop a definition of 'gene' fit for ethical purposes. [ABSTRACT FROM AUTHOR]

The birth of the world's first genetically edited babies in 2018 provoked considerable ethical outrage. Nonetheless, many scientists and bioethicists now advocate the pursuit of clinical uses of human germline gene editing. Progress towards this goal will require research, including clinical trials where genetically edited embryos are implanted into a woman's uterus, gestated, and brought to term. This paper argues that such trials would likely conflict with the fundamental research ethical requirement of non‐exploitation. This is because they would expose people who are in a vulnerable situation to risks and burdens that are substantial and not obviously offset by compensating benefits. I consider how the potential for exploitation in such trials might be mitigated, arguing that a feasible and justifiable approach is not easily found. If this analysis is correct, there is a significant ethical obstacle on the path towards clinical use of human germline gene editing. [ABSTRACT FROM AUTHOR]

Background: There is a global crisis in male reproductive health. Evidence comes from globally declining sperm counts and increasing male reproductive system abnormalities, such as cryptorchidism, germ cell tumors, and onset of puberty. Male factor infertility occurs in ~40% of couples experiencing infertility. Data demonstrate an association between male infertility and overall health. Associated significant health conditions include diabetes mellitus, metabolic disorders, and cardiovascular disease. Adding to the complexity is that men typically do not seek health care unless there is acute medical need or, as in the case of the infertile couple, the male goes for a reproductive examination and semen analysis. However, 25% of the time a reproductive health examination does not occur. Couples are increasingly utilizing IVF at more advanced ages, and advanced paternal age is associated with increased risk for (i) adverse perinatal outcomes for both offspring and mother; (ii) early child mortality, cancer, and mental health issues. In addition to age, paternal lifestyle factors, such as obesity and smoking, impact not only the male fertility but also the offspring wellness. Objectives: The purpose of this paper was (i) to spotlight emerging and concerning data on male reproductive health, the relationship(s) between male reproductive and somatic health, and the heritable conditions father can pass to offspring, and (ii) to present a strategic roadmap with the goals of increasing (a) the awareness of men and society on the aforementioned, (b) the participation of men in healthcare seeking, and (c) advocacy to invigorate policy and funding agencies to support increased research into male reproductive biology. Conclusions: The Male Reproductive Health Initiative (MRHI) is a newly established and rapidly growing global consortium of key opinion leaders in research, medicine, funding and policy agencies, and patient support groups that are moving forward the significant task of accomplishing the goals of the strategic roadmap. [ABSTRACT FROM AUTHOR]

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state‐funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility's disease status remains unclear, one cannot uncontroversially justify or undermine its claim to medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state‐funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine which avoids the problems associated with the concepts of health and disease. [ABSTRACT FROM AUTHOR]

Over the course of recent years, various scientific advances in the realm of reproduction have changed the reproductive landscape, enhancing women's procreative rights and the choices available to them. Uterus transplants (UTx) are the latest of such medical innovations aimed at restoring fertility in women suffering from absolute uterine factor infertility, providing them with the possibility not only of conceiving a genetically related child but also of gestating their own pregnancies. This paper critically examines the primacy of reproductive liberty in the context of uterus transplantation. It questions whether and to what extent we should respect the reproductive autonomy of a woman who chooses UTx, given the significant risks that attach to the procedure and existing concerns that UTx may perpetuate potentially troubling gendered norms surrounding pregnancy and the role of women's bodies in reproduction, which may place undue reproductive pressures on women. [ABSTRACT FROM AUTHOR]

This paper urges reconsideration of analyses of the alternatives to reproductive uterus transplantation (UTx). I focus here specifically on the adoption alternative. Importantly, my purpose is not to oppose UTx provision. Rather, it is to propose ways in which ethical analysis and provision of UTx can potentially accommodate the concerns discussed here. I argue that the adoption alternative to UTx is too readily dismissed, and that this is a dismissal with significant moral costs. I suggest that the radical nature of UTx as a form of assisted reproduction calls for an equivalently radical socio‐moral agenda for reform and transformation of adoption law, policy and practice, as well as of the norms that prevail within our presently strongly bio‐normative reproductive context. In doing so I widen the ethical frame of responsible provision of assisted reproduction to encompass not just obligations towards donors and recipient, but also our broader social responsibilities to ensure that we are doing our best to meet the significant needs of some of the most vulnerable members of our society. [ABSTRACT FROM AUTHOR]

Abstract: The Institute of Medicine has recently endorsed arguments put forward by John Appleby calling for mandatory sex selection against female offspring in the initial trials of mitochondrial replacement techniques. In this paper I argue that, despite this endorsement, the reasons offered by Appleby for mandatory sex selection are inadequate. I further argue that plausible revisions to Appleby's arguments still fail to convincingly defend such an intrusive policy. While I remain neutral about whether intending parents making use of mitochondrial replacement techniques ought to have access to sex selection, I conclude that to date the case for mandatory sex selection has not been satisfactorily made. [ABSTRACT FROM AUTHOR]

Obesity is associated with a reduction in fertility treatment success and increased risks to mother and child. Therefore guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m2 should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF. In this paper we challenge the ethical and scientific basis for such a ban. Livebirth rates for severely obese women are reduced by up to 30%, but this result is still far better than that observed for many older women who are allowed access to IVF. This prohibition is particularly unjust when IVF is the only treatment capable of producing a pregnancy, such as bilateral tubal blockage or severe male factor infertility. Furthermore, the absolute magnitude of risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment. We do not prohibit adults from engaging in dangerous sports, nor do we force parents to vaccinate their children, despite the risks. Similarly, we should not prohibit obese women from becoming parents because of increased risk to themselves or their child. Finally, prohibiting obese women's access to IVF to prevent potential harms such as 'fetal programing' is questionable, especially when compared to that child never being born at all. As such, we believe the RANZCOG ban on severely obese women's access to assisted reproductive treatment is unwarranted and should be revised. [ABSTRACT FROM AUTHOR]

Introduction: Studies that use standardized ultrasonographic criteria to diagnose adenomyosis in subfertile women are needed. These would improve the understanding of the disease burden and enable further studies on its impact on fertility and assisted reproductive treatment (ART) outcome. The aim of this study was to determine the prevalence of different features of adenomyosis in women scheduled for their first ART, diagnosed at two (2D) and three‐dimensional (3D) transvaginal ultrasonography (TVUS) using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions. Material and methods: This was a prospective, observational cross‐sectional study of subfertile women aged 25 to ≤39 years, that were referred to a university hospital for their first ART between December 2018 and May 2021. Of 1224 eligible women, 1160 women fulfilled the inclusion criteria and consented to participate in the study. All women underwent a systematic 2D and 3D TVUS examination. The primary outcome was the presence of direct and indirect features of adenomyosis, as proposed by the MUSA group. Secondary outcomes were to describe the ultrasonographic characteristics of the different features, as well as any difference in the diagnostics at 2D or 3D TVUS and any association with clinical characteristics such as endometriosis. Results: At least one direct or indirect feature of adenomyosis was observed in 272 (23.4%, 95% confidence interval [CI] 21.0–25.9) women. Direct features that are pathognomonic for the disease were observed in 111 (9.6%, 95% CI, 7.9–11.3) women. Direct features were visible only at 3D TVUS in 56 (4.8%, 95% CI 3.6–6.1) women, that is, 56/111 (50.5%) of women with at least one direct adenomyosis feature. Direct features were more common in women with endometriosis (OR 2.8, 95% CI 1.8–4.3). Conclusions: We found than one in 10 women scheduled for ART had direct features of adenomyosis at ultrasound examination. The present study suggests that the use of 3D TVUS is an important complement to 2D in the diagnostics of adenomyosis. Our results may further improve the counseling of women scheduled for ART and enables future studies on the impact of different features of adenomyosis on subfertility, ART results and obstetric outcomes. [ABSTRACT FROM AUTHOR]

This paper explores the shaping of health policy in terms of power relations and group interests, as enacted in Israel's IVF policy. A comparison with the principles of IVF provision in other countries (UK, Canada, USA) shows Israel's policy to be substantially more‘liberal’. In order to explain this exception, the policy is initially located within the context of the state's pro-natalist reproductive policy, women's impaired equality and a complex system of healthcare provision. A Parliament Committee discussion on the subject is then analysed in greater detail, revealing three narratives that are used to account for the state's IVF policy: a nationalised narrative of reproductive medicine as a source of international acclaim, a personalised narrative of compassion for anguished women, and a medicalised narrative of experts as being best capable of regulating IVF. All three narratives have merged within the local IVF discourse, enabling the creation and maintenance of consensus among the participating politicians, physicians, consumers and women activists. Of significance is the muted argument regarding the state's interest in enlarging its Jewish population, which dominated other discussions on this topic. I argue that it is the demographic interest which crucially underlies the state's willingness to sustain its costly IVF policy, and that it is this interest which has enabled the various participants– who all shared an interest in unlimited IVF provision– to present a unanimous agreement. State representatives then used this consensus as a firm civil ground for the development and maintenance of Israel's exceptional IVF policy. The paper concludes with several implications regarding women's health and wellbeing. [ABSTRACT FROM AUTHOR]

Introduction: This systematic review examines whether individualized gonadotropin dosing in in vitro fertilization (IVF) leads to better outcomes with respect to safety, costs, and live birth rates compared with standard dosing.Material and Methods: Electronic databases searched were PubMed, Embase, and Cochrane. The primary outcome was live birth rate. The secondary outcomes included pregnancy rate, costs, and safety. Papers were critically appraised by two reviewers.Results: A total of 7022 articles were retrieved and assessed for eligibility, of which seven randomized controlled trials were selected. All studies used gonadotropin-releasing hormone agonist co-treatment. Clinical and methodological heterogeneity was present, so data could not be pooled for meta-analysis. Only one study, that mainly included women with a good prognosis, revealed an increased chance of ongoing pregnancy in the individualized dosing group compared with standard treatment. With respect to safety, individualized dosing might reduce the occurrence of hyper-response and ovarian hyperstimulation syndrome, without affecting the outcome of pregnancy. In predicted poor responders, higher than standard dosages do not reduce the incidence of poor response. A cost-efficacy analysis was not performed in any of the studies included.Conclusion: It is currently not possible to conclude whether individualized dosing leads to higher pregnancy or live birth rates compared with standard dosing, because evidence from well-designed studies that are adequately powered for one of these outcomes is lacking. So, large well-designed studies that evaluate the impact of individualized dosing on live birth rates are needed to assess whether individualized dosing should become the standard in IVF practice. [ABSTRACT FROM AUTHOR]

Background Endometriosis is found in 0.5-5% of fertile women and 25-40% of infertile women. It is known that endometriosis is associated with infertility, but there is uncertainty whether women with endometriosis have adverse pregnancy outcomes in in vitro fertilisation ( IVF) treatment. Objectives To explore the association between endometriosis and IVF outcome. Search strategy Searches were conducted on MEDLINE, EMBASE, Cochrane Library and Web of Science (inception, December 2012) in all languages, together with reference lists of retrieved papers. Selection criteria Studies comparing IVF outcome in women with endometriosis with women without endometriosis. Patients were classified by stage of endometriosis. The outcomes were fertilisation, implantation, clinical pregnancy and live birth rates. Study selection was conducted independently by two reviewers. The Newcastle- Ottawa Quality Assessment Scale was used for quality assessment. Data collection and analysis Data extraction was conducted independently by two reviewers. Relative risks from individual studies were meta-analysed. Main results Twenty-seven observational studies were included, comprising 8984 women. Meta-analysis of these studies showed that fertilisation rates were reduced in stage I/ II of endometriosis (relative risk [RR] = 0.93, 95% confidence interval [95% CI] 0.87-0.99, P = 0.03). There was a decrease in the implantation rate (RR = 0.79, 95% CI 0.67-0.93, P = 0.006) and clinical pregnancy rate (RR = 0.79, 95% CI 0.69-0.91, P = 0.0008) in women with stage III/ IV endometriosis undergoing IVF treatment. Conclusion The presence of severe endometriosis (stage III/ IV) is associated with poor implantation and clinical pregnancy rates in women undergoing IVF treatment. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tandberg A, Melve K, Nordtveit T, Bjørge T, Skjaerven R. Maternal birth characteristics and perinatal mortality in twin offspring. An intergenerational population-based study in Norway, 1967-2008. BJOG 2011;118:698-705. To investigate the relationship between maternal preterm birth and fetal growth in one generation and perinatal mortality of twin offspring in the next generation. Population-based cohort study. The Medical Birth Registry of Norway from 1967 to 2008. Linked generational data with 9426 mother-twin pair units. Twin offspring were linked to their mothers by means of the unique national identification numbers. Perinatal mortality in twin offspring. The twin prevalence was not dependent on the mother's gestational age at birth, but increased with increasing birthweight in term mothers. Maternal gestational age was strongly and inversely associated with a risk of perinatal death in one or both of her twin offspring. Compared with term mothers, preterm mothers born at 27-31 and 32-34 weeks had relative risks (RRs) for perinatal loss of 3.83 [95% confidence interval (CI), 1.56-9.36] and 2.41 (95% CI, 1.29-4.50), respectively. This effect was even stronger after the use of assisted reproductive technologies (ART), with a significant interaction between maternal gestational age and ART ( P = 0.03). Further, term mothers with birthweight-by-gestational age Z-scores of −2 or less had more than twice the risk of a perinatal loss in their twin offspring relative to mothers with the most favourable birthweight Z-scores (1-1.99) [RR, 2.42 (95% CI, 1.37-4.29)]. Women born preterm had an increased risk of perinatal mortality in their twin offspring, particularly after ART treatment. The same was true for women who were growth restricted at term. A twin pregnancy is a high-risk pregnancy in general, but even more so if the mother herself was born preterm or was growth restricted at birth. [ABSTRACT FROM AUTHOR]

This paper interprets the British legislative process that initiated the first comprehensive national regulation of embryo research and fertility services and examines subsequent efforts to restrain the assisted reproduction industry. After describing and evaluating British regulatory measures, I consider successive failures to control the assisted reproduction industry in the US. I discuss disparities between UK and US regulatory initiatives and their bearing on regulation in other countries. Then I turn to the political and social structures in which the assisted reproduction industry is embedded. I argue that regulatory bodies are seldom neutral arbiters. They tend to respond most readily to special interests and neglect strategies that could more effectively meet the health needs of the people they represent. Neither national nor international bodies have aggressively pursued policies to harness the industry, reduce infertility rates, or meet the needs of people whose fertility is threatened by substandard healthcare and environmental neglect. In conclusion, I consider recent initiatives by activist groups to mount an alternative response to the industry's current practices and build a transnational reproductive justice movement. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tandberg A, Bjørge T, Nygård O, Børdahl P, Skjaerven R. Trends in incidence and mortality for triplets in Norway 1967–2006: the influence of assisted reproductive technologies. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02530.x. Objective To assess changes in incidence rates and outcomes of triplets over 40 years with a particular focus on the influence of assisted reproductive technology (ART). Design Population-based cohort study. Setting The Medical Birth Registry of Norway. Population 2.18 million pregnancies, including 448 sets of triplets and 27 575 twin pairs, covering the years 1967–2006. Since 1988, pregnancies from ART have been available through a separate registry and linked with the birth record. Methods Incidence rates and outcomes for triplets were analysed and compared with those for singletons and twins. Relative risks were estimated between time periods and between ART and non-ART pregnancies. Main outcome measures Incidence rates, birthweight, gestational age and perinatal mortality. Results The total triplet rate per 10 000 pregnancies increased from 1.0 during 1967–71 to 3.5 during 1987–92, followed by a decline to 2.7 during 2002–06. After excluding ART pregnancies, the incidence was more than doubled at the end of the study period. The mean gestational age and birthweight of triplets were significantly lower during 1988–2006 than 1967–87, but similar for ART and non-ART triplets in the last period. The caesarean rate in triplets increased from 47 to 92%. The relative risk of perinatal death in triplets relative to singletons did not change after the introduction of ART [before: relative risk, 8.9 (95% confidence interval, 6.8–11.7); after: relative risk, 10.4 (95% confidence interval, 8.3–13.0)]. Conclusions The triplet incidence rate in Norway has more than doubled during the last 40 years, even after excluding ART pregnancies. The risk of perinatal death in triplets is ten times higher relative to singletons and has not changed during this 40-year period, independent of the introduction of ART. [ABSTRACT FROM AUTHOR]

Information on gestational age for public health research and surveillance in the US is usually obtained from vital records and is primarily based on the first day of the woman's last menstrual period (LMP). However, using LMP as a marker of conception is subject to a variety of errors and results in misclassification of gestational age. Pregnancies conceived through assisted reproductive technology (ART) are unique in that the estimates of gestational age are not based on the LMP, but on the date when fertilisation actually occurred, and thus most gestational age errors are likely to be due to errors introduced in recording and data entry. The purpose of this paper was to examine the birthweight distribution by gestational age for ART singleton livebirths reported to a national ART surveillance system. Gestational age was categorised as 20–27, 28–31, 32–36 and 37–44 weeks; birthweight distributions were plotted for each category. The distributions of very-low-birthweight (VLBW; <1500 g), moderately low-birthweight (1500–2499 g) and normal-birthweight infants for each gestational week were examined. At both 20–27 and 28–31 weeks, there was an extended right tail to the distribution and a small second mode. At 32–36 weeks, there were long tails in either direction and at 37–44 weeks, an extended tail to the left. There was a high proportion of VLBW infants at low gestational ages and a decreasing proportion of VLBW infants with increasing gestational age. However, there was also a fairly constant proportion of normal-birthweight infants at every gestational age below 34 weeks, which suggested misclassification of gestational age. Approximately 12% of ART births classified as 28–31 weeks' gestation had a birthweight in the second mode of the birthweight distribution compared with approximately 29% in national vital statistics data. Even when the birthweight and dates of conception and birth are known, questions remain regarding the residual amount of misclassification and the true nature of the birthweight distributions. [ABSTRACT FROM AUTHOR]

The many dimensions of the field of reproduction (clinical, scientific, social, ethical, legal) must be addressed by those with editorial responsibility for the major journals in the field. As the editorial team of the leading reproductive journal Human Reproduction, we have evolved processes that attempt to ensure a transparent but robust approach to complexities whose impact varies across international boundaries. [ABSTRACT FROM AUTHOR]

Background: The birth of the first 'test-tube' baby in 1978 has led to the creation of family types that would not otherwise have existed. Methods: This paper examines research on the psychological outcomes for parents and children in assisted reproduction families with particular attention to the issues and concerns that have been raised by creating families in this way. Results: Parents of children conceived by assisted reproduction appear to have good relationships with their children, even in families where one parent lacks a genetic link with the child. With respect to the children themselves, there is no evidence of cognitive impairment in singleton children born at full term as a result of assisted reproduction procedures, although the findings regarding the cognitive development of intracytoplasmic sperm injection (ICSI) children are currently unclear. In relation to socioemotional development, assisted reproduction children appear to be functioning well. Conclusions: Few studies have included children at adolescence or beyond, and little is known about the consequences of conception by assisted reproduction from the perspective of the individuals concerned. In addition, there are some types of assisted reproduction family, such as families created through a surrogacy arrangement or through embryo donation, about whom little is known at all. Although existing knowledge about the impact of assisted reproduction for parenting and child development does not give undue cause for concern, there remain a number of unanswered questions in relation to children born in this way. [ABSTRACT FROM AUTHOR]

Objectives: To compare the reported rate of any congenital anomaly and perinatal outcome of pregnancy following blastocyst‐ vs cleavage‐stage embryo transfer using a pairwise meta‐analysis and to evaluate the same outcomes following fresh‐blastocyst, frozen‐blastocyst, fresh‐cleavage or frozen‐cleavage embryo transfer using a network meta‐analysis. Methods: A literature search was performed in PubMed, Scopus and CENTRAL and registers for ongoing studies, from inception to February 2022, for randomized controlled trials (RCTs) with any sample size and observational studies including at least 100 live births per group, comparing the rates of any congenital anomaly and perinatal outcome of pregnancy following fresh/frozen embryo transfer at cleavage (day 2–3) vs blastocyst (day 5–7) stage. Risk ratios (RRs) along with their 95% CIs were pooled via a random‐effects model meta‐analysis. Within a frequentist network meta‐analysis framework, outcomes of all four treatment modalities (i.e. fresh‐blastocyst, fresh‐cleavage, frozen‐blastocyst, frozen‐cleavage) were compared further. Any congenital anomaly constituted the primary outcome, whereas preterm delivery (delivery < 37 weeks), low birth weight (LBW; < 2500 g), gender of the neonate (male), perinatal death and healthy neonate (defined as liveborn neonate, delivered at term, weighing ≥ 2500 g, surviving for at least 28 days postbirth and without any congenital anomaly) were considered as secondary outcomes. Subgroup analyses by plurality (liveborn singleton vs multiple pregnancy) were conducted in the pairwise and network meta‐analyses. The risk of bias was assessed using the RoB2 tool for RCTs and the ROBINS‐I tool for non‐randomized studies. Certainty of evidence was assessed using GRADE. Results: Through the literature search, 550 studies were retrieved and 33 were included in the systematic review. We found no significant difference in the risk for any congenital anomaly between blastocyst‐ and cleavage‐stage transfer (RR, 0.80 (95% CI, 0.63–1.03); 10 studies; n = 192 442; I2 = 85.5%). An increased probability of a male neonate was observed following blastocyst‐ vs cleavage‐stage transfer (RR, 1.07 (95% CI, 1.06–1.09); 18 studies; n = 227 530; I2 = 32.7%). No significant differences in other secondary outcomes or significant subgroup differences between liveborn singletons and multiple pregnancies were observed. The network meta‐analysis showed a significantly lower risk for LBW following frozen‐blastocyst vs fresh‐blastocyst (RR, 0.76 (95% CI, 0.60–0.95)) or fresh‐cleavage (RR, 0.74 (95% CI, 0.59–0.93)) transfer. Frozen‐blastocyst transfer was associated with an increased risk for perinatal death compared with the fresh‐cleavage method (RR, 2.06 (95% CI, 1.10–3.88)). The higher probability of a male neonate following blastocyst transfer remained evident in the network comparisons. All outcomes were assessed to be of very‐low certainty of evidence. Conclusions: Current very‐low certainty of evidence shows that there may be little‐to‐no difference in the risk for congenital anomaly or adverse perinatal outcome of pregnancy following blastocyst‐ vs cleavage‐stage embryo transfer, although there was a slightly increased probability of a male neonate following blastocyst transfer. When considering cryopreservation, frozen‐blastocyst transfer was associated with a reduction in the risk for LBW compared with both fresh‐transfer modalities, and fresh‐cleavage transfer may be associated with a reduction in the risk for perinatal death compared with frozen‐blastocyst transfer. High‐quality RCTs with separate data on fresh and frozen cycles and consistent reporting of culture conditions and freezing methods are mandatory. Individual participant data meta‐analyses are required to address the substantial inconsistency resulting from current aggregate data approaches. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The moral acceptability of anonymous gamete donation remains contested. Although the view that the value of parent–child relationships should not depend on genetic ties is "nearly axiomatic" among philosophers and bioethicists, one well‐known dissenter remains: David Velleman. I argue that most rebuttals to Velleman have simply talked past him because they have failed to understand his fundamental point—that donor conception is a violation of human dignity and as such is wrong even if it does not harm individuals. I challenge Velleman on his own terms by endorsing his metaphysical picture before showing that donor conception is not necessarily a violation of human dignity. I show this by arguing that gamete donation is held to a double standard of self‐knowledge. I develop an account of the self that recognizes that certain kinds of challenges to one's flourishing can contribute to an individual's strength and self‐knowledge. I defend my view against objections that genetic knowledge is categorically different from other ways of knowing oneself and I show that donor conception can respect human dignity as long as it meets certain conditions. [ABSTRACT FROM AUTHOR]

In a recent article in this journal, Alex Mullock, Elizabeth Chloe Romanis and Dunja Begović provide an analysis of gestational surrogacy and uterus transplantation (UTx) from the perspective of those who may decide to act as gestational surrogates and womb donors, referred to as 'womb‐givers'. In this article, I advance two sets of claims aimed at critically engaging with some aspects of their analysis. Firstly, I argue that the expression 'womb‐givers' obscures the biologically, socially and politically salient issue that those who engage in these practices are primarily persons and women. My contention is that this is of substance in discussions of the burdens and benefits of gestational surrogacy and UTx, which need to consider the specific position that women occupy in society, and the hierarchies that mediate their lives, experiences and preferences. Second, I argue that, if one were to take seriously the experiences and preferences of the women who may engage in these practices, and their bodily autonomy, then gestational surrogacy and UTx should be regarded as biologically and sociopolitically incommensurable. Mullock et al. overlook important aspects of gestational surrogacy, such as the embodied nature of pregnancy and childbirth, the sociopolitical significance of these experiences, and the often‐oppressive social norms that shape them. Whilst biology is not destiny, I suggest that it is socially and politically 'sticky' when it comes to this significance and norms, especially within the sphere of reproduction. Towards the end of the article, I query the authors' conceptualisation of bodily autonomy and of the instruments that enable its respect and promotion. [ABSTRACT FROM AUTHOR]

Aim: The aim was to provide updated evidence on the association of male body mass index (BMI) with outcomes of assisted reproduction technology (ART). Methods: PubMed, Embase, and Scopus databases were systematically searched. The review included observational studies in patients undergoing ART, that is, either in‐vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and compared rate of clinical pregnancy and live birth based on different categories of male BMI. Quality of the pooled findings was assessed using the GRADE criteria. Results: A total of 19 studies were included in the review. Among subjects undergoing IVF, there were no significant differences in the rates of clinical pregnancy among overweight (odds ratio [OR] 1.38, 95% confidence interval [CI]: 0.65, 2.96) and obese (OR 1.86, 95% CI: 0.75, 4.58) BMI, compared to normal male BMI. Similarly, there were no significant differences in the rates of live birth among overweight (OR 1.04, 95% CI: 0.97, 1.13) and obese BMI (OR 0.90, 95% CI: 0.69, 1.18) when compared to males with normal BMI. Further, among those undergoing ICSI, there were no significant differences in the odds of clinical pregnancy among overweight (OR 0.98, 95% CI: 0.73, 1.33) and obese (OR 0.89, 95% CI: 0.62, 1.29). The odds of live births among overweight (OR 0.97, 95% CI: 0.89, 1.05) and obese (OR 0.95, 95% CI: 0.84, 1.07) male BMI were statistically similar to males with normal BMI undergoing ICSI. Conclusions: The low to very low‐quality findings suggest no significant association of overweight and obese BMI with clinical pregnancy and live birth rates among couples undergoing either IVF or ICSI. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean section affects subsequent spontaneous pregnancies because of implantation issues. However, its impact on post-embryo transfer pregnancies is still debated. This review aimed to evaluate the impact of a previous cesarean section on fertility and pregnancy outcomes of women undergoing fresh or frozen embryo transfer.Material and Methods: MEDLINE, Scopus, ClinicalTrials.gov, Scielo, EMBASE, Cochrane Library at the CENTRAL, and LILACS were searched from inception to February 2021. Studies were included if they evaluated reproductive or pregnancy outcomes after fresh or frozen embryo transfer in infertile women with a previous cesarean section relative to women with a previous vaginal delivery. Random-effect meta-analyses to calculate risk ratio (RR) or mean differences with 95% confidence intervals (CI) followed by subgroup analysis for fresh and frozen embryo transfer were performed. Risk of bias and quality assessment were conducted using Newcastle-Ottawa scale and GRADE criteria. The review was registered in the International Prospective Register of Systematic Reviews (CRD42021226297).Results: Ten studies, with data provided for 13 696 participants, were eligible. For embryo transfers after cesarean section, compared with vaginal delivery, there was a significant reduction of the live birth rate (RR 0.88, 95% CI 0.79-0.99) and biochemical pregnancy rate (RR 0.89, 95% CI 0.82-0.96). No statistically significant differences were found for clinical pregnancy rate (RR 0.92, 95% CI 0.84-1.02), ectopic pregnancies (RR 1.00, 95% CI 0.68-1.46), pregnancy loss (RR 1.05, 95% CI 0.94-1.18), multiple pregnancies (RR 0.80, 95% CI 0.63-1.02), stillbirths (RR 0.86, 95% CI 0.27-2.69), birth defects (RR 1.71, 95% CI 0.49-5.96) or birthweight (mean difference 46.82, 95% CI -40.16 to 133.80). Subgroup analysis revealed an increased risk for preterm birth in post-cesarean section fresh embryo transfer pregnancies (RR 1.59, 95% CI 1.16-2.19).Conclusions: Low-grade evidence shows that post-embryo transfer pregnancies in infertile women who had a previous cesarean delivery result in reduced biochemical pregnancy and live birth rates relative to women with a previous vaginal delivery. An increased risk for preterm birth is notable in post-fresh embryo transfer pregnancies. [ABSTRACT FROM AUTHOR]

In a recent article Thomas Douglas and Katrien Devolder propose a theory of genetic parenthood according to which a human child can have only two genetic human parents. I argue this theory is arbitrarily narrow and fails to account for cases such as hybrids, cloning, chimerism, twinning, parthenogenesis, mitochondrial replacement techniques, and more. I propose an alternate theory of genetic parenthood, one that is prima facie consistent with our commonsense intuitions about genetic parenthood and relevant to a right to procreative autonomy. [ABSTRACT FROM AUTHOR]

Background: In vitro methods of conception are associated with adverse perinatal outcomes. It is unclear if the risk of stillbirth is increased also. Objective: This systematic review and meta‐analysis aimed to estimate the risk of stillbirth in singleton gestations following in vitro methods of conception compared to non‐in vitro conceptions. Search strategy: A comprehensive search in PubMed, Embase, CINAHL, and Cochrane Library was undertaken from database inception to February 2021, with backward citation tracking. Selection criteria: Eligible studies included randomized controlled trials, cohort studies, or case‐control studies that assessed stillbirth following in vitro fertilisation and/or intracytoplasmic sperm injection in comparison to non‐in vitro methods of conception, including spontaneous conceptions, intrauterine insemination, and ovarian stimulation. Data collection and analysis: The Newcastle‐Ottawa Scale was used to assess risk of bias. A summary odds ratio (OR) for stillbirth following in vitro methods of conception compared to non‐in vitro methods was calculated using a random‐effects model for meta‐analysis. Main results: Thirty‐three cohort studies met inclusion criteria. There was an increased risk of stillbirth with in vitro methods: OR 1.41 (95% CI 1.20–1.65); however, the crude baseline risk of stillbirth was low (4.44/1000 total births). Subgroup analysis did not demonstrate an increased risk when in vitro methods were compared to conception without in vitro methods in the context of subfertility. Conclusions: Compared to non‐in vitro conceptions, in vitro conceptions have an increased risk of stillbirth. However, there is insufficient evidence to demonstrate whether this risk is associated with in vitro techniques or underlying subfertility. This meta‐analysis found an increased risk of stillbirth in singletons from in vitro methods of conception. This meta‐analysis found an increased risk of stillbirth in singletons from in vitro methods of conception. [ABSTRACT FROM AUTHOR]

Female fertility is inversely correlated with maternal age due to a depletion of the oocyte pool and a reduction in oocyte developmental competence. Few studies have addressed the effect of maternal age on the human mature oocyte (MII) transcriptome, which is established during oocyte growth and maturation, however, the pathways involved remain unclear. Here, we characterize and compare the transcriptomes of a large cohort of fully grown germinal vesicle stage (GV) and in vitro matured (IVM‐MII) oocytes from women of varying reproductive age. First, we identified two clusters of cells reflecting the oocyte maturation stage (GV and IVM‐MII) with 4445 and 324 putative marker genes, respectively. Furthermore, we identified genes for which transcript representation either progressively increased or decreased with age. Our results indicate that the transcriptome is more affected by age in IVM‐MII oocytes (1219 genes) than in GV oocytes (596 genes). In particular, we found that transcripts of genes involved in chromosome segregation and RNA splicing significantly increased representation with age, while genes related to mitochondrial activity showed a lower representation. Gene regulatory network analysis facilitated the identification of potential upstream master regulators of the genes involved in those biological functions. Our analysis suggests that advanced maternal age does not globally affect the oocyte transcriptome at GV or IVM‐MII stages. Nonetheless, hundreds of genes displayed altered transcript representation, particularly in IVM‐MII oocytes, which might contribute to the age‐related quality decline in human oocytes. [ABSTRACT FROM AUTHOR]

Introduction: Biological rhythms, the innate cycle of changes in the body's physiological functions, are circadian if they have a 24‐hour period. It is known that sleep is a key feature of human circadian rhythm but the relation between sleep and female fertility is largely unknown. This paucity of research is surprising given that circadian rhythms are paramount to human physiology and sleep is related to major female reproductive events. This study was designed to investigate whether there is a difference between the sleep and activity parameters of women with poor reproductive outcome compared with healthy, fertile parous women (comparator group) using subjective (questionnaires) and objective (actigraphy and light exposure) measures. Material and methods: A prospective cohort study in a tertiary in vitro fertilization referral center in the UK; composed of three study groups: women diagnosed with recurrent implantation failure, women with recurrent miscarriage (RM) and a comparison group (fertile women without endometrial pathology). Comparison women were selected gynecology patients without endometrial disease (ie perineal complaints or altruistic egg donors). Primary outcome was differences in objective length of sleep in each of the participant groups using actigraphy. Secondary outcomes were subjective sleep quality and quantity, using participant questionnaires, light exposure, and the feasibility of machine learning in activity‐pattern interpretation. Results: Women with recurrent implantation failure slept daily on average for 7 hours 35 minutes (± 57 min), 53 minutes less than the comparison group (P =.03), although quality of their objective sleep, and quantity of their subjective sleep, were not significantly different. Women with recurrent miscarriage slept less that the comparison women (36 minutes less/night) but more than women with recurrent implantation failure (17 minutes more/night). No difference in light exposure was found between recurrent miscarriage and the recurrent implantation failure and comparison groups. Conclusions: This study demonstrates an objective observation of sleep time reduction in women with subfertility, although it is not yet clear if this association is casual. Given our increased understanding of the internal body clock and circadian rhythm on fertility, our observation warrants further investigation. [ABSTRACT FROM AUTHOR]

Establishing the nature of genetic parenthood is an important task. This is, firstly, because many people desire that relationship and it is in their interest to know what that is, and secondly, because there is a view that it may incur certain moral obligations between the genetic parent and their child. Many theorists have made attempts to define exactly what genetic parenthood is. I show that these definitions are deficient if they wish to fully capture all reproductive scenarios in ways that are intuitive and/or meaningful. Through a series of cases involving technologies such as cloning and genome editing, we see that in lieu of the traditional two parents, there are possible beings who have no genetic parents, one genetic parent, or many genetic parents. Establishing these cases complicates our understanding of genetic parenthood. From this, we must reconsider current definitions, as well as the usefulness of defining genetic parenthood in these complex cases. Here I do not aim to establish a new definition, but rather to suggest that this complexity makes it necessary to re‐assess the importance of the connection between genetic parenthood and parental obligations and authorities. [ABSTRACT FROM AUTHOR]

Background: The sperm vitrification developed by this group is based on the ultrarapid freezing of a vitrification solution composed of a non‐permeable cryoprotectant (saccharides and protein), in which previously selected spermatozoa are resuspended, free of seminal plasma, and then plunged directly into liquid nitrogen. Compared to traditional sperm freezing, vitrification does not cause chemical or physical damage to the intracellular structures and reduces the damage to the plasma membrane because no ice crystals form, thus preserving motility and DNA integrity. Objectives: This manuscript is a review of the vitrification methodology developed by the authors' research group, including studies showing the application in human reproduction therapy. Materials and methods: The authors perform a review of the work initiated more than a decade ago by this research group, on the implementation of sperm vitrification, a more effective technique for cryopreservation of human spermatozoa, discussing the results obtained by other authors and the projection of this technique. Results and discussion: The vitrification technique has been developed in selected spermatozoa free of seminal plasma supplemented with saccharides such as sucrose, trehalose, and dextran, together with albumin, providing a high motility rate and protective structures of the cytoskeleton. In patients, it can be used to preserve their fertility for oncological reasons, genetics, inflammatory diseases, or reproductive medicine techniques. The possibility that vitrified spermatozoa can be preserved at temperatures of −80°C can simplify sample storage, optimizing the space and time as well as operator safety. Conclusion: Vitrification techniques have demonstrated the preservation of selected spermatozoa without seminal plasma and with non‐permeable cryoprotectants and protein. Currently, it is one of the most effective ways to maintain sperm function and has been used in in vitro fertilization or intrauterine insemination in humans, achieving healthy live births. [ABSTRACT FROM AUTHOR]

Infertility is an unpredictable but widespread condition. While high-income countries grapple with when, or how to cover the costs of assisted reproductive technology (ART), such as in-vitro fertilisation (IVF), these services are generally only available to wealthy persons at private facilities in low- and middle-income countries (LMICs). Although the principle of non-interference with normal individual reproductive rights is robust, whether it is also the responsibility of collective society to provide the means (when ART applies) to achieve pregnancy, is controversial. Recently, a low-cost model was developed at a South African public institution. The target population for this model was "helpless and marginalised, childless couples", but a new threat has arisen, namely, infertile couples who could conceivably afford private care. In the allocation of this scarce resource, we argue for a prioritarian response that first addresses the worst-off, in order to even out unequal access imposed by sharp differences in income. [ABSTRACT FROM AUTHOR]

The objective was to explore presence/detection of microorganisms in the male reproductive tract (PMMRT) in asymptomatic patients undergoing infertility treatment and their effects on semen quality in our region. This study enrolled 205 men (mean age, 35.9 years) in a single‐centre, tertiary university hospital from December 2015 to December 2016. We used the modified Meares–Stamey test, real‐time polymerase chain reaction (rt‐PCR) and the National Institutes of Health Chronic Prostatitis Sympton Index (NHI‐CPSI) questionnaire to address this issue. No patient met the prostatitis criteria by the modified Meares–Stamey 4‐sample test, 33 (16.1%) were positive for rt‐PCR in the first‐voided urine for any of the Mycoplasma (Ureaplasma urealyticum/parvum, Mycoplasma hominis/genitalium) and C. trachomatis was detected in two cases (1%), and three for rt‐PCR in semen for HPV high‐risk genotypes non‐16/18 (1.5%). Significant statistical differences were reported among patients with and without PMMRT in terms of lower rate of progressive spermatozoa (PR) (p <.034), total motile sperm count (p <.028), normal morphologic forms, especially in the sperm head (p <.001) and highest viscosity (p <.012). It was concluded that PMMRT, specially Mycoplasmas, in asymptomatic infertility men, affects semen quality. The NIH‐CPSI questionnaire was not a valid initial screening to subsequently evaluate the presence of prostatitis/PMMRT. [ABSTRACT FROM AUTHOR]

In a recent publication Tom Douglas and Katrien Devolder have proposed a new account of genetic parenthood, building on the work of Heidi Mertes. Douglas and Devolder's account aims to solve, among other things, the question of who are the genetic parents of an individual created through somatic cell nuclear transfer (i.e. cloning): (a) the nuclear DNA provider or (b) the progenitors of the nuclear DNA provider. Such a question cannot be answered by simply appealing to the folk account of genetic parenthood, according to which the genetic parents of an individual are those individuals who produced the egg and sperm, respectively, which fused to create the embryo. It cannot be so as in cloning there is no fertilization as such. In this article I critically examine Douglas and Devolder's new account of genetic parenthood and demonstrate that it is vulnerable to counterexamples that exploit the lack of a condition specifying that genetic parents should cause a child's coming into existence. [ABSTRACT FROM AUTHOR]

Introduction: The demand for fertility treatment with donated oocytes is increasing in many European countries. In order to offer oocyte donors an attractive treatment, it is necessary to understand the views of the donors. Therefore, the aim of this study was to explore how women who donate oocytes describe their motives and attitudes towards oocyte donation, as well as their experiences with oocyte donation.Material and Methods: A qualitative study based on individual face-to-face interviews with 12 oocyte donors with a donor identity as either anonymous or open. Oocyte donors who had donated oocytes at least once were recruited from the fertility clinic at Herlev University Hospital, Denmark. Data were collected using a piloted, semi-structured interview guide and were analyzed using qualitative content analysis. The analysis was handled in NVIVO 11 PRO.Results: The analysis resulted in three themes: (1) helping others, (2) the treatment, and (3) being an oocyte donor. The financial compensation had varying degrees of importance for the oocyte donors but was always secondary to the desire to help others. All participants were interested in knowing whether their donation had resulted in pregnancy or birth of a child. Many donors had not gained a full understanding of the realistic outcomes of their donation.Conclusions: Our results suggest that oocyte donors are mainly motivated by altruism, and financial compensation was found to be a secondary motive. Further, political awareness could be directed toward particularly open donors and the need to provide information about the outcome of their donation. Finally, it seems that future oocyte donors, in a treatment with a high need for information, can benefit from clinicians giving more exact information in relation to the probability of the birth of a donor child. [ABSTRACT FROM AUTHOR]

Aim: To describe our first clinical pregnancy following a uterus transplant from a brain‐dead donor and to discuss current issues with deceased donor uterus transplantation as they relate to obstetrical success. Methods: In August 2016, a 26‐year‐old woman with Mayer–Rokitansky–Küster–Hauser syndrome was the fourth person worldwide to receive a uterine transplant from a deceased donor and was the second in our trial. in vitro fertilization treatments using the long gonadotropin‐releasing hormone agonist protocol preceded the transplantation procedure. Frozen embryo transfers were performed in months 12, 13, 16, 19 and 23 after transplant. Results: Recovery of the uterus of a 24‐year‐old brain‐dead nulliparous donor and the transplant procedure itself was uncomplicated. No abnormalities were revealed on Pap smears, which were performed every 6 months during the post‐transplant period, and cervical biopsies showed no epithelial dysplasia. The fifth frozen embryo transfer resulted in a clinical pregnancy. Three weeks after embryo transfer, an intrauterine gestational sac containing an embryo with a heartbeat was detected. One week later, signs of a missed abortion were revealed by ultrasound. Two weeks later, spontaneous bleeding occurred, and an ultrasound examination performed a week later confirmed an empty uterine cavity. Conclusion: In light of present research, both deceased donor uterine procurement and transplantation surgeries are technically feasible; however, more experience is needed to determine the pregnancy success rate associated with this method. Thus, additional trials of deceased donor uterine transplantation should be performed in the future to continue research related to this promising concept for the treatment of absolute uterine factor infertility. [ABSTRACT FROM AUTHOR]

Objective: To assess academic performance in singletons aged 15–16 years conceived after frozen embryo transfer (FET) compared with singletons born after fresh embryo transfer (ET) in Danish cohorts born from 1995 to 2001. Design: Danish national registry‐based cohort study. Setting: Danish national registries. Population: All 6495 singletons conceived after assisted reproductive technology (ART) treatment in Denmark from 1995 to 2001 [FET (n) = 423; fresh ET (n) = 6072]. Methods: Mean test scores on a national standardised and international comparable grading‐scale. Comparisons of test score were first made in univariate analysis (Model 1) and secondly in a multivariate linear model (Model 2) adjusting for relevant reproductive and socio‐demographic covariates such as the occupational and educational level of the parents. Sensitivity analyses on FET‐IVF (in vitro fertilisation) versus fresh ET‐IVF and FET‐ICSI (intracytoplasmic sperm injection) versus fresh ET‐ICSI were made. Linear mixed models were used to account for the correlation in test scores of siblings for continuous outcome. Main outcome measures: Mean overall test score and test score in Danish, mathematics, English, and physics/chemistry. Results: Crude and adjusted mean test scores were similar for adolescents conceived after FET compared with fresh ET. The crude mean difference was +0.11 (95% CI −0.11; 0.34), and the adjusted mean difference was +0.12 (95% CI −0.09; 0.34). Conclusions: Adolescents conceived after FET had similar academic performance at 15–16 of years of age compared with children conceived after fresh ET. Using frozen embryos in fertility treatment does not affect school performance in Danish adolescents aged 15–16 years. Using frozen embryos in ART treatment does not affect school performance in Danish adolescents aged 15–16 years. [ABSTRACT FROM AUTHOR]

Background: Assisted reproductive techniques are associated with an increased risk of adverse pregnancy outcomes, including low birthweight and intrauterine growth restriction. Yet, the long-term follow-up on the growth of these children is limited.Objective: To systematically review the literature on post-neonatal height and weight among children conceived following in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment, compared with that of children born after spontaneous conception.Search Strategy: A systematic computerised literature search using the online databases PubMed, Embase, and Scopus.Selection Criteria: Cohort or case-control studies with an exposed group of singletons conceived following IVF or ICSI along with a control group of spontaneously conceived singletons.Data Collection and Analysis: Studies were reviewed by at least two authors. Meta-analyses were conducted using Cochrane Review Manager. The quality of the studies was assessed with the Newcastle-Ottawa Scale.Main Results: Twenty studies were included, with 13 of these eligible for meta-analyses. The meta-analyses compared 3972 children born after IVF/ICSI with 11 012 spontaneously conceived children and revealed no statistically significant difference in child weight [mean difference (MD) in weight of -160 g; 95% confidence interval (95% CI) -360, 3]. When stratifying by age of child at follow-up, we found a significant lower weight in children aged 0-4 years conceived following IVF/ICSI treatment (MD -180 g; 95% CI -320, -4), but this was no longer significant in children from 5 years of age (MD -160 g; 95% CI -580, 260). The pooled analysis revealed no statistically significant difference in childhood height.Conclusions: In vitro fertilisation/ICSI was not associated with long-term weight and height.Tweetable Abstract: Children born following IVF/ICSI do not have impaired long-term weight or height compared with spontaneously conceived children. [ABSTRACT FROM AUTHOR]

In vitro gametogenesis (IVG) is believed to be the next big breakthrough in reproductive medicine. The prima facie acceptance of this possible future technology is notable when compared to the general prohibition on human reproductive cloning. After all, if safety is the main reason for not allowing reproductive cloning, one might expect a similar conclusion for the reproductive application of IVG, since both technologies hold considerable and comparable risks. However, safety concerns may be overcome, and are presumably not the sole reason why cloning is being condemned. We therefore assess the non‐safety arguments against reproductive cloning, yet most of these can also be held against IVG. The few arguments that cannot be used against IVG are defective. We conclude from this that it will be hard to defend a ban on reproductive cloning while accepting the reproductive use of IVG. [ABSTRACT FROM AUTHOR]

We seek to develop a plausible conception of genetic parenthood, taking a recent discussion by Heidi Mertes as our point of departure. Mertes considers two conceptions of genetic parenthood—one invoking genetic resemblance and the other genetic inheritance—and presents counter‐examples to both conceptions. We revise Mertes' second conception so as to avoid these and related counter‐examples. [ABSTRACT FROM AUTHOR]

Abstract: It has been more than 15 years since the measurement of serum anti‐Müllerian hormone (AMH) first allowed the quantitative assessment of ovarian reserve. Meanwhile, the clinical implication of serum AMH has been expanding. The measurement of serum AMH has been applied in various clinical fields, including assisted reproduction, menopause, reproductive disorders and assessment of ovarian damage/toxicity. Well‐known findings about the usefulness of serum AMH revealed by numerous studies executed in the early era include decline with aging, a good correlation with oocyte yield in assisted reproduction, upregulation in polycystic ovarian syndrome and a decrease on ovarian surgery and toxic treatment. More intensive research, including a meta‐analysis, cutting‐edge clinical trial and advances in AMH assays, has yielded newer findings and firmer clinical interpretations in serum AMH in the past few years. Variations in the AMH decline trajectory in the general population do not support the accurate prediction of menopause. The ability to predict pregnancy in infertility treatment and natural conception is poor, while a nomogram integrating serum AMH as a stimulation protocol is useful for avoiding poor and/or hyper‐responses. On the other hand, improvements in measuring very low concentrations of serum AMH may be capable of distinguishing women with poor ovarian function. Age‐independent standardization of AMH values may be helpful for comparing ovarian reserves among women at different ages. [ABSTRACT FROM AUTHOR]

Objective: To detect if removing the cervical mucus before performing intrauterine insemination (IUI) could improve pregnancy outcomes in patients with unexplained infertility.Design: Prospective randomized study.Setting: An Egyptian University Hospital.Population: Seven hundred and fourteen couples with unexplained infertility who underwent intrauterine insemination (IUI) with or without cervical mucus removal.Methods: Using computer-generated numbers, patients were randomly allocated to cervical-mucus-removal (removed from both internal and external os) or non-mucus-removal groups. Only participants were blinded as to group assignment.Main Outcome Measures: The clinical pregnancy rate.Results: Of 714 IUI patients between November 2014 and March 2017, 361 were in the mucus removal group, and 353 in the non-mucus-removal group. Difficult catheterization was encountered in 17 cases out of 666 (2.6%) 12 in the cervical-mucus-removal group and five in the non-mucus-removal group). A total of 666 IUI cycles were completed while 48 were either cancelled or lost in their follow-up. The clinical pregnancy rate was significantly higher in the mucus-removal group [31.0% (n = 112)] than in the non-mucus-removal group [21.8% (n = 77); P = 0.005]. Ovarian hyperstimulation developed in 33 (4.6%) cases: 18 cervical mucus-removal and 15 non-mucus-removal. All except one were mild and managed with outpatient care.Conclusions: Cervical mucus removal before IUI could improve pregnancy outcomes in women with unexplained infertility.Tweetable Abstract: Cervical mucus removal before IUI can improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prevalence of congenital uterine anomalies, including arcuate uterus, and their effect on reproductive outcome in subfertile women undergoing assisted reproduction.Methods: Consecutive women referred for subfertility between May 2009 and November 2015 who underwent assisted reproduction were included in the study. As part of the initial assessment, each woman underwent three-dimensional transvaginal sonography. Uterine morphology was classified using the modified American Fertility Society (AFS) classification of congenital uterine anomalies proposed by Salim et al. If the external contour of the uterus was uniformly convex or had an indentation of < 10 mm, but there was a cavity indentation, it was defined as arcuate or septate. Arcuate uterus was further defined as the presence of a concave fundal indentation with a central point of indentation at an obtuse angle. Subseptate uterus was defined as the presence of a septum, not extending to the cervix, with the central point of the septum at an acute angle; if the septum extended to the internal cervical os, the uterus was defined as septate. Reproductive outcomes, including live birth, clinical pregnancy and preterm birth, were compared between women with a normal uterus and those with a congenital uterine anomaly. Subgroup analysis by type of uterine morphology and logistic regression analysis adjusted for age, body mass index, levels of anti-Müllerian hormone, antral follicle count and number and day of embryo transfer were performed.Results: A total of 2375 women were included in the study, of whom 1943 (81.8%) had a normal uterus and 432 (18.2%) had a congenital uterine anomaly. The most common anomalies were arcuate (n = 387 (16.3%)) and subseptate (n = 16 (0.7%)) uterus. The rate of live birth was similar between women with a uterine anomaly and those with a normal uterus (35% vs 37%; P = 0.47). The rates of clinical pregnancy, mode of delivery and sex of the newborn were also similar between the two groups. Preterm birth before 37 weeks' gestation was more common in women with uterine anomalies than in controls (22% vs 14%, respectively; P = 0.03). Subgroup analysis by type of anomaly showed no difference in the incidence of live birth and clinical pregnancy for women with an arcuate uterus, but indicated worse pregnancy outcome in women with other major anomalies (P = 0.042 and 0.048, respectively).Conclusions: Congenital uterine anomalies as a whole, when defined using the modified AFS classification, do not affect clinical pregnancy or live-birth rates in women following assisted reproduction, but do increase the incidence of preterm birth. The presence of uterine abnormalities more severe than arcuate uterus significantly worsens all pregnancy outcomes. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background: Women following unilateral oophorectomy (UO) are occasionally encountered during assisted reproduction treatment.Objective: To explore the impact of UO on ovarian reserve in assisted reproduction.Search Strategy: An electronic database search was performed using PubMed, EBSCO, ISI, Trip, ClinicalTrial.gov and the Cochrane library followed by a manual search to identify published research between January 1978 and December 2015.Selection Criteria: Controlled studies that compared infertile women following UO undergoing IVF-ET treatment with women with two intact ovaries.Data Collection and Analysis: Two reviewers independently extracted the data concerning the impact of UO on ovarian reserve tests, ovarian response to controlled ovarian hyperstimulation and clinical pregnancy rate. Meta-analysis was performed using these measures.Main Results: Twenty-one studies were eligible for quantitative analysis. They included 1045 and 18 172 IVF cycles in women with one and two intact ovaries, respectively. Basal FSH weighted mean difference (WMD) was significant (2.01 IU/l; 95% CI: 0.24-3.79, P = 0.026). Similarly, the WMD of serum E2 level on the day of hCG administration was significant (WMD: -431 pg/ml; 95% CI: -616 to -246, P < 0.001). However, the weighted overall odds ratio (OR) of clinical pregnancy between women with a single ovary and women with two ovaries was comparable (overall OR: 0.76; 95% CI: 0.57-1.00, P = 0.054). All eligible studies were retrospectively conducted and the heterogeneity among ovarian response measures was high.Conclusions: Available pooled data supports an adverse effect of UO on ovarian reserve involving the quantity but not the quality of the ovarian pool.Tweetable Abstract: Review finds women with one ovary removed have less IVF capacity but the same pregnancy rate as women with two ovaries. [ABSTRACT FROM AUTHOR]

The new reproductive technologies have significantly impacted definitions of motherhood. Historically, mothers were defined through the act of giving birth, but egg donation, embryo donation, and surrogacy disrupt this. Now multiple women can potentially claim maternity through gestational, genetic, legal, and social ties. Although there is some legal precedent for designating parentage, there is no simple solution to identify the 'true' mother. I address maternal claims-making in third party reproduction via a content analysis of US patient literature for infertile women. Major tensions arise over which link to privilege, especially regarding genetic versus gestational ties in egg donation versus surrogacy; however, adding embryo donation to the analysis illuminates another crucial dimension previously overlooked - that heterosexual women's maternal claims are supported by their partner's paternity claims. Ultimately, I argue that although reproductive organisational discourse carefully constructs credible options for maternal claims-making, contemporary reproductive medicine does not define maternity through assisted reproduction as a truly autonomous connection. Rather, maternity is highly contingent and thus potentially discreditable. [ABSTRACT FROM AUTHOR]

Introduction: There is no accepted consensus on thromboprophylaxis in relation to in vitro fertilization (IVF). We aimed to study the frequency of thromboembolism and to assess thromboprophylaxis in relation to IVF.Material and Methods: We performed a systematic review. All study designs were accepted except single case reports. Language of included articles was restricted to English.Results: Of 338 articles, 21 relevant articles (nine cohort studies, six case-control studies, three case series, and three reviews of case series) were identified. The antepartum risk of venous thromboembolism (VTE) after IVF is doubled (odds ratio 2.18, 95% CI 1.63-2.92), compared with the background pregnant population. This is due to a 5- to 10-fold increased risk during the first trimester in IVF pregnancies, in turn related to a very high risk of VTE after ovarian hyperstimulation syndrome (OHSS), i.e. up to a 100-fold increase, or an absolute risk of 1.7%. The interval from embryo transfer to VTE was 3-112 days and the interval from embryo transfer to arterial thromboembolism was 3-28 days. No robust study on thromboprophylaxis was found.Conclusions: The antepartum risk of VTE after IVF is doubled, compared with the background pregnant population, and is in turn related to a very high risk of VTE after OHSS in the first trimester. We recommend that IVF patients with OHSS be prescribed low-molecular-weight heparin during the first trimester, whereas other IVF patients should be given thromboprophylaxis based on the same risk factors as other pregnant women. [ABSTRACT FROM AUTHOR]

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Contents The hidden treasure represented by epididymal spermatozoa has great potential in the current reproductive technologies in dogs. In case of azoospermia or when a donor male accidentally dies or undergoes orchiectomy, the retrieval of epididymal spermatozoa opens new possibilities to generate progeny. Spermatozoa can be collected by different techniques from ex vivo or in vivo testicles and can be cryopreserved for a future use. Freeze tolerance of canine epididymal spermatozoa seems lower than that of ejaculated spermatozoa; however, puppies were born after artificial insemination with frozen epididymal semen, other than with fresh and chilled. Even though several aspects need to be further investigated, advances have been recently made in the use of epididymal spermatozoa in assisted reproduction in dogs. [ABSTRACT FROM AUTHOR]