The Journal of Reproduction

Editorial Vol.2, No.3

2023-12-15T14:27:12-06:00

Diversity has been a hallmark of this year's publications, with manuscripts hailing from various corners of the globe and addressing subjects seldom explored in other reproduction journals. The thought-provoking articles on alternatives to oocyte donation, in particular, promise to ignite significant discussions within the scientific community. These unique contributions serve as a testament to the innovative spirit that drives the field of reproductive medicine forward.

Does Mitochondrial Transfer An Alternative to Egg Donation?

2023-12-15T14:40:46-06:00

Objective

To evaluate the utility of pronuclear transfer using healthy oocytes from donors in poor prognosis patients.

Design

Retrospective study.

Subjects

A total of 29 patients with no blastocyst development or total fertilization failure were included.

Main Outcome Measures

Our primary outcome was the blastocyst rate. Secondary outcomes measures included euplody rate, clinical pregnacy rate and live birth rate.

Results

On day 5/6 of blastocyst development, an average blastocyst rate of 49.2% was obtained. The average rate of euploid blastocysts obtained after PGT-A was 69.5%. All patients underwent frozen embryo transfer. Single blastocyst transfer was performed in all patients, and the clinical pregnancy rate was 48.3%. Of these patients, 14 had a live birth, and the live birth rate was 48.3%. No genetic or morphologic abnormalities have been detected in the babies born. The 29 patients were grouped based on their age, as <35 (n=2), 35-27 (n=6), 38-40 (n=9), 41-42 (n=6) and >42 (n=6). Based on these age groups, blastocyst formation rates were 47.8%, 50.0%, 45.0%, 50.0% and 66.7%, respectively; euploidy rates were 63.6%, 61.1%, 66.7%, 100.0% and 83.3%, respectively; clinical pregnancy and live birth rates were 100.0%, 50.0%, 44.4%, 50.0% and 33.3%, respectively.

Conclusions

The results of this study show that pronuclear transfer can result in a high blastocyst formation rate, euploidy rate and live birth rate. This was shown among patients across all age groups, particularly in older patients who often show diminished IVF success rates.

Global Regulatory and Clinical Overview of Mitochondrial Replacement Techniques in 2023

2023-12-15T15:08:40-06:00

Mitochondrial replacement techniques offer a solution for women at risk of passing on mitochondrial disorders or experiencing infertility. Globally, the regulation of MRT is inconsistent and mostly banned, with the exception of the United Kingdom and Australia in preventing transmission of mitochondrial disorders. The regulatory landscape is constantly changing, and this review aims to explore the status of MRT in select countries as of 2023, including the UK, Australia, the United States, Singapore, Mexico, Ukraine, Greece and Albania.

Intraovarian platelet-rich plasma injection in poor responders

2023-12-15T15:28:35-06:00

Objective:

To evaluate if it possible to improve ovarian reserve parameters and oocyte retrieval in poor responders who undergo intraovarian injection of platelet-rich plasma (PRP).

Design:

Prospective cohort study. We included 148 poor responders who underwent PRP injection between October 2021 and December 2022 in our institution, comparing pre and post PRP ovarian function. In addition, the IVF outcomes of a subgroup of patients was studied after the intervention in contrast with the previous treatment.

Results:

An improvement in ovarian reserve was observed in relation to previous values: FSH (13,57 vs. 11,32, p=0,11), AMH (0,39 vs. 0,48, p=0,06), antral follicle count (3,98 vs. 5,75, p<0,001); as well as a higher number of oocytes retrieved (2,63 vs. 3,65, p=0,01) and produced embryos (1,64 vs. 2,22, p=0,03); without a great impact on pregnancy rates.

Conclusions:

Although experimental, intraovarian PRP could restore ovarian function and be postulated as an alternative to oocyte donation in patients with low ovarian reserve who do not accept this treatment. There is a lack of randomized controlled trials to support these findings.

Surrogacy Unveiled: Doctors Experience and Stories of Hope and Challenges

2023-12-15T15:43:29-06:00

Objective

To focus on the experiences of doctor’s, intending parents, and surrogates with beautiful surrogate babies, including legal issues and the challenges posed by the pandemic.

Study Design

This study adopts a novel strategy by investigating surrogacy from a medical professional's viewpoint. We want to offer our knowledge and wisdom gained from dealing with surrogacy as a doctor, especially in light of the many challenges brought on, including the COVID-19 pandemic. The purpose of this study is to comprehend the role of the doctor in surrogacy and how it relates to intended parents' and surrogate moms' experiences.

Subjects

This study's subjects include the doctor, who is also its principal investigator, as well as intending couple and surrogate mother. While intending parents and surrogate moms contribute further insights into their involvement in the surrogacy process, the doctor's experiences serve as the central narrative.

Main Outcome Measures

In this study we have looked into indications, neonatal outcomes, legal aspects, in house development, management during covid 19 pandemic of all surrogates through our experience at a single center over 5 years.

Results

This study provides insight into the experiences of couples considering surrogacy, the effective management of surrogates during a pandemic, and the impact of surrogacy on the developmental outcomes of children.

Conclusions

The findings highlight the experiences of intending couples during the challenging period of the COVID-19 pandemic, emphasizing prolonged separations, varying perceptions of baby development, and increased anxiety. The successful handling of surrogates in this context, where 19 out of 54 tested positive for COVID-19 but all recovered, underscores the adaptability and success of established protocols. Additionally, the positive developmental progress in children and the prevalence of donor eggs in surrogacy outcomes contribute to a comprehensive understanding of surrogacy. Overall, this study sheds light on the emotional, physiological, and developmental aspects of surrogacy.

Gestational surrogacy: 12-year experience of the first program developed in Argentina

2023-12-15T15:53:12-06:00

Objective:

To evaluate and share the experience of our Surrogacy program at Halitus Instituto Medico, which is the first one of its kind in Argentina. The study aimed to identify and describe demographic, physiological, social, and treatment-related factors associated with successful surrogacy outcomes.

Design:

Retrospective cohort study. Identification of all clinic consults for surrogacy was performed. Anonymized data on 1152 surrogacy consults occurring between 2011 and 2023 was extracted directly from the clinic database.

Results:

Between April 2011 and September 2023, there were 1152 consultations for uterine surrogacy, and out of these, 161 (14%) patients proceeded with the treatment. Eighty-four percent were couples while 21,7 % were single-parent projects. Main reasons for consultation were: male patients 346 (30.4%), obstetric factors 293 (30.4%) and uterine factors 254 (22.05%).

161 patients underwent 1 or more gestational surrogacy cycles. We achieved 127 (79%) pregnancies and 62 (48,8%) live births. The rate of multiple pregnancies was 3,1%.

Conclusion:

Gestational surrogacy is a global trend that sparks controversies and ethical debates. Despite this, it stands as a beneficial procedure, with a high success rate and a comparatively low risk of complications. The multidisciplinary collaboration of medical, psychological, and legal professionals is essential to carry out these treatments safely and effectively.

The symbiosis of diet, lifestyle, and fertility

2023-12-15T16:20:49-06:00

Diet, an inextricable component of our existence, wield a formidable influence on reproductive health. The Mexican cuisine, a delectable amalgamation of diverse ingredients, presents both boons and banes in the fertility domain. Rich in fresh fruits, vegetables, and grains, it carries the essence of nutrients vital for enhancing fertility. However, an inclination towards processed foods and sugary beverages, often exacerbated by socioeconomic disparities, casts a shadow of nutritional imbalance, posing risks to optimal reproductive health.

Stress, Health and Well-being of Clinical Embryologists

2023-12-15T16:43:48-06:00

Clinical embryology is a demanding profession where the clinical embryologist is not only involved in the laboratory work with gametes and embryos but often a lot of logistic support. The pressures of timing, heavy workload, the monotony of procedures and the uncertainty of outcomes often creates a lot of pressures and stress on the embryologist. A stressed person is more likely to make errors, some can be insignificant while some can be disastrous like a mix-up or an accident. To add-on, long hours on the microscope can lead to soreness of muscles and joints leading to neck, back and shoulder pain. Physical pain with mental stress leads to discomfort and an unhealthy work environment. There are many publications on the burn out of health care professionals but not much is discussed about the health of an embryologist, a relatively new disciple. This paper discussed the various cause of stress in the life of an embryologist and also provides suggestions to overcome the same.

Embryological Perspectives on Gamete and Embryo Donation

2023-12-15T16:02:32-06:00

This article addresses the issue of gamete and embryo donation from the perspective of the assisted reproduction laboratory, where the so-called "clinical" embryologists work making all the current variants of in vitro fertilization including the andrology laboratory, oocyte collection, conventional insemination or through ICSI, embryo culture, gamete and embryo quality evaluation, embryo transfer, cryopreservation of gametes and embryos, preimplantation genetic studies, results analyses and quality control, assessment and improvement. To think that the responsibility of an ART laboratory only attains the strictly technical or logistical areas is an error or a simplification that excludes embryologists from other important matters. Clinical embryologists have the obligation to ensure that procedures follow strict ethical rules, highlight deviations or errors from these canons, and refuse to act in cases of violation of said standards. Donating embryos to assist in others´ efforts on building a family is an important option for patients who are considering the disposal of cryopreserved embryos, in excess those needed to meet their own fertility goals.

Gamete donation, a more widespread procedure, can help us to better understand certain aspects of embryo donation. Donation must be a free transaction, not influenced by guilt or any other type of pressure or coercion of any kind.

We are facing a totally new issue because we are the only species on the planet that can manipulate our own gametes and embryos in a context where assisted reproduction represents a dramatic challenge to the social values that govern our way of being born, without precedent in human history.

Motherhood in Female Same-Sex Couples: Reception of Oocytes from Partner (ROPA method): Review Article

2023-12-15T16:14:09-06:00

The evolving concept of "family" reflects contemporary social changes, influenced by historical and cultural shifts. This review explores unconventional family models, focusing on same-sex families, particularly female same-sex couples. As advancements in assisted reproductive techniques (ART) empower these couples, the Reception of Oocytes from Partner (ROPA) method gains popularity. ROPA involves active participation of both partners in conception, with one as the oocyte provider and the other as the gestational mother. This review delves into clinical, ethical, and psychosocial aspects of ROPA, comparing it with other ART options like donor intrauterine insemination (DIUI) or in vitro fertilization (IVF). A comprehensive bibliographic search conducted in 2023 forms the basis of this exploration. Historical perspectives on ART's acceptance for same-sex couples, legislative changes, and global variations in donor anonymity are discussed. The ROPA method's procedural details, including donor selection and the roles of the genetic and gestational mothers, are outlined. The review also emphasizes the impact of donor anonymity laws on decision-making. Roles and responsibilities in the ROPA method are explored, with a focus on the reciprocal and reverse ROPA approaches. Medical indications, potential benefits, and the impact on obstetric risks are scrutinized. The review concludes with insights into motherhood in female same-sex couples, highlighting the prevalence of children raised in such families across diverse regions in the United States. This comprehensive examination aims to provide practitioners and patients with valuable insights into the clinical, ethical, and psychosocial dimensions of the ROPA method, fostering a better understanding of its advantages in comparison to other ART options.