No abstract available.
Korea ; Reproductive Techniques, Assisted

In the follicular phase of the spontaneous menstrual cycle, only one follicle, out of a cohort of 10-20, usually completes maturation and ovulates to release a mature oocyte. The aim of ovarian stimulation in ART protocols is to overcome the selection of a dominant follicle and to allow the growth of a cohort of follicles, thus increasing the number of oocytes and hence embryos available, thereby increasing the chance of replacing, up to 3 viable embryos. However, a major challenge in ART programs is the treatment of patients in their mid 30's and over, as the chance of pregnancy and also live birth begins to dramatically decline. Preimplantation Genetic Screening studies over the last decade have identified that a major contributor to the reduction in embryo viability in older patients is the dramatic increase in the rate of eneuploidy. It has also been demonstrated that in women of advanced maternal age, the amount of mitochondrial DNA in the oocyte cytoplasm is significantly reduced. Additionally, some recent studies suggest that the ovarian stimulation regimen may also play an important role on improving embryo viability as tailoring ovarian stimulation with supplemental LH in the mid to late follicular phase may be beneficial to this older patient group. What could be the mechanisms by which LH supplementation may have an effect? In a recent study of Foong, et al. on low to poor respondrs to r-hFSH only stimulation, intra-follicular estradiol was significantly lower progesterone was significantly higher in poor to low responders to FSH. Previously, it has been demonstrated that in vitro, estradiol plays an important role in human oocyte cytoplasmic maturation manifesting itself im improved fertilization and cleavage rates. On the contrary, androstenedione can irreversibly block the effect of E2. Additionally in the ovine, E2 is assoiciated with upregulation of oocyte DNA repair enzymes. Studies carried out playing an aromatase inhibitor in the late stages of follicular development in the rhesus monkey, just prior to the period pf ovulation, showed reduced capacity on the oocyte to mature and a reduced rate of in vitro fertilization. Overall, it seems that LH may have a beneficial effect through a mechanism, which improves oocyte cytoplasmic maturation, either through E2 or some other intraovarian factor.
REPRODUCTIVE TECHNIQUES, ASSISTED

In considering the uptake of ART around the world and in particular regions, it is crucial to consider outcome and what is considered to be successful treatment. Standardisation of reporting for comparability between clinics and countries is essential. This will be affected by multiple pregnancy and efforts to minimize them and the anxiety relating to possible problems such as imprinting abnormalities. General access is influenced by ethical by ethical and religious value systems, which in turn impinge on the political nature of discussions about provision. Of primary importance is the extent of access to treatment; the need for ART in the first instance is related to the prevalence of STDs and the quality of reproductive health services in the community. Access is critically determined by whether ART is provided by the public health system, otherwise it is the preserve of the better off. However, the public health system does not usually accord ART high priority. Even in the UK where there has been a positive analysis of the evidence base by the public health service, funding remains a major issue. ART is not explicitly included in the UN Millennium Development Goals, however they could be interpreted as including it. Of importance was the WHO Ministerial Summit on Health Research held in Mexico last November. Its recommendations and timetable were aimed at overcoming health system constraints to the delivery of all health care, in particular promoting access in low income settings. Successful implementation of any recommendations will likely have a long term impact on the provision of all health care. Perhaps 50% of all infertility can be treated by ART. It should no longer be seen as the high tech end of provision, only required by a few. It should be widely available and included in public health provision. The technical challenge is to reduce the cost and increase the efficacy. But the greater challenge for the medical scientific communities is to educate the public and the politicians to understand the techniques and their implications. Cost-benefit analyses will be required to demonstrate appropriate and wise spending and to show a rational case for the public health expenditure. The development of trusted regulatory system will also be necessary, ideally with legal flexibility to encompass scientific advances. Only then can public health provision of ART be envisaged; funding allocation must follow for it to become readily available. Although ART births are now contributing significantly to national data in some countries, the social impact on the world community will continue to be minimal until these changes have taken place.
REPRODUCTIVE TECHNIQUES, ASSISTED

Vitrification, as a cryoprotective method for freezing cells or tissues at very high cooling rates, can avoid the formation of intracellular ice crystals that are potentially lethal during freezing and thawing, and maximally reduce the damage to cells. Considerable progress has been achieved in the cryopreservation of human gametes and embryos. Vitrification has been used to successfully cryopreserve immature and mature oocytes, spermatozoa and embryos at various developmental stages in the last decade, and has led to the birth of many healthy babies. Vitrification, with its simple operation and rapid process, is becoming one of the important techniques in human assisted reproduction.
Cryopreservation ; methods ; Humans ; Reproductive Techniques, Assisted

No abstract available.
Female ; Luteal Phase* ; Reproductive Techniques, Assisted*

Medicine, Chinese Traditional ; Reproductive Techniques, Assisted

OBJECTIVE: In this paper, the key points of quality control and safety evaluation of human assisted reproductive medium were summarized to provide reference for the establishment of relevant standards and quality control in the future. METHODS: Through literature research, the key factors of quality control and risk control of human assisted reproductive medium were summarized, and the problems in clinical transformation were discussed. RESULTS: It is very important for the development of human assisted reproduction technology to study the active ingredients and their harmful degradation products and drugs in the culture medium of assisted reproduction. CONCLUSIONS At present, the biggest challenge is to effectively control the quality of the culture medium for human assisted reproduction, establish corresponding inspection methods and quality standards for the key components, ensure the safety and effectiveness during the product shelf life, and thus improve the success rate of human assisted reproduction technology.
Humans ; Quality Control ; Reproduction ; Reproductive Techniques, Assisted

OBJECTIVE: To introduce the test methods of embryo toxicity applied to medical devices for human assisted reproductive technology (ARTMD), and provide the evaluation reference. METHODS: The embryo toxicity test methods of ARTMD were summarized, and the key procedures and challenges in their safety evaluation were also discussed. RESULTS: Establishing sensitive and stable test system is important to guarantee the safety and efficacy of ARTMD. CONCLUSIONS It remains development opportunities in improving sample preparation, extending test technology and expending evaluation method.
Humans ; Reproductive Techniques, Assisted ; Toxicity Tests

Some women may not be able to carry their own children even when capable of conceiving biological offspring. In-vitro fertilization and embryo-transfer (IVF-ET) through surrogacy can now make this possible for these women. Surrogacy however, is still considered unacceptable in the Philippines due to moral and legal issues. This article will explore the need and acceptability of surrogacy in this age of IVF-ET in a country where the prevailing social norms and religious values still disapprove of third-party assisted reproductive technology (ART). Medical indications that would benefit from gestational surrogacy were enumerated and briefly discussed. The differentiation between traditional and gestation surrogacy, as well as commercial and altruistic surrogacy were defined. IVF with gestational surrogacy is a feasible solution to a number of medical difficulties in the carrying of a gestation. Strictly regulating the practice and restricting its use only to cases with legitimate medical indications will prevent its misuse and exploitation. Moral issues, admittedly will still remain an issue particularly for commercial surrogacy. However, limiting these only to altruistic and gestational surrogacy in some cases may be an acceptable compromise.
Child ; Fertilization in Vitro ; Reproductive Techniques, Assisted

With the introduction of assisted reproductive technologies, the incidence of multifetal pregnancies has significantly increased. In vaginal delivery for multifetal pregnancy, the delivery of the second fetus usually follows the first in few minutes. However in rare circumstances, the delivery is delayed for days due to disappearance of uterine contraction after delivery of the first fetus. Successful prolongation of the interdelivery time may improve the neonatal outcomes of the remaining fetus (es), particularly in the cases of extremely premature gestation. We present a case of a delayed delivery of second twin with an interval of 48 days.
Fetus ; Humans ; Incidence ; Pregnancy ; Reproductive Techniques, Assisted ; Uterine Contraction