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 21 
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Started by mensfe_admin - Last post by mensfe_admin
27 February 2017

By Wendy Kramer

Director and co-founder of the Donor Sibling Registry
Appeared in BioNews 890


Since 2000, the Donor Sibling Registry (DSR) has connected more than 14,000 donor-conceived individuals with their donors and half-siblings. We've helped them to create and explore these new familial relationships and to better understand their ancestry and learn about their medical backgrounds. The DSR has also helped to eliminate much of the stigma associated with being a gamete donor or donor-conceived person. Behind the scenes, the DSR's research, education, and counseling service have provided the momentum for the establishment of positive reforms in the egg-donation and sperm-banking industries around the world.

We ask: 'What is in the best interests of the child to be born?' Our many research surveys, which reach thousands of donors, parents and donor offspring, have helped to answer this fundamental question. We are interested in the views of all those involved, particularly regarding medical issues, donor anonymity, and connecting with donor relatives. For almost 10 years, the DSR has partnered with researchers and universities around the world, including Cambridge in the UK, to publish more than two dozen peer-reviewed research papers on parents, donors, offspring, and their family members.

In the US, the donor-conception industry is largely unregulated, and there is wide variation in egg- and sperm-bank policies and procedures. Problems often arise as a result of lack of consistency around medical testing, health history follow-up, sharing and updating medical information, openness and transparency, and record-keeping and communication. The DSR has more than 53,000 members in 105 countries around the world, and US sperm banks ship to many countries, so this lack of oversight and regulation is of concern to donor families around the world.

Many of these issues are not unique to the donor conception industry. The US Federal Government has already acknowledged the importance of quality medical electronic record-keeping (HITECH Act), enacted the Patients' Bill of Rights (ACA), and highlighted the importance of testing for communicable diseases and screening for family health history. However, these federal regulations don't address the complexities within the donor-conception industry, and there remains a great need for more oversight and regulation of sperm banks and egg-donation clinics.

They need only look across the pond for a model of how this can be achieved – the UK's Human Fertilisation and Embryology Authority (HFEA) has been doing an excellent job of regulating the donor-conception industry for many years. Such a regulatory body is desperately needed in the US to improve medical and psychological outcomes of donor-conceived children. Recipients and donors should be fully educated and informed when making the decision to either conceive a child or donate sperm.

As a response to the current lack of oversight, in January 2017 the DSR submitted a Citizen's Proposal to the US Food and Drug Administration (FDA), stating:


'Because the FDA currently mandates minimal medical testing (communicable disease, e.g. STDs) of sperm and egg donors (no other regulation exists), we request that the commissioner of the FDA look into the state of affairs surrounding the sperm donation industry, and then develop the appropriate and much-needed regulation/oversight.'

There are many complexities associated with creating a regulatory body. Effective policy change must involve all stakeholders – not only the Department of Health and Human Services, the Centres for Disease Control (CDC) and the FDA, but also the Donor Sibling Registry, cryobanks, parents, donors, and donor-conceived people themselves.

We invite everyone to add their comments or personal stories to our petition to highlight the importance of oversight and regulation of the reproductive-medicine industry. We hope that mental-health professionals and academics will also give their perspectives on the importance of donor-conceived people having access to their medical records, ancestry, and first-degree genetic relatives.

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Started by mensfe_admin - Last post by mensfe_admin
Please join this debate:

The House of Commons is working to increase public engagement with debates, helping the public to have their voices heard and input into the debate. Our aim to open up the Parliamentary process to the public.

 On Thursday 19 January a Westminster Hall debate is taking place on decommissioning of IVF and other NHS fertility services and we are running a digital debate on the House of Commons Facebook page in the lead up to the debate. On Monday 16 January one of the co-sponsoring MPs, Steve McCabe, will be available live on Facebook from 4.30 – 5.30pm to answer questions as well as ask further questions to the public to help inform the debate - all the comments will then be collated and passed on to the MPs for use in the debate on Thursday.

 Charities, campaign groups and members of the public are invited to share their views on the Facebook debate page.

 Steve McCabe MP has suggested a few questions which would help him inform the debate, but it would also be great to have input from Mensfe about the issues and concerns the public may have about IVF and NHS fertility services. Questions include:

• What regional variation exists in the provision of IVF services and the commissioning costs involved?

• Why is there so much variation in the provision of IVF services on the NHS?

• Are other NHS fertility services also being reduced and decommissioned?

 The debate is being supported by the Fertility Network but we are keen to have as many opinions, comments and questions from as many people as possible and it would be fantastic if you were able to share details of this debate with your contacts and encourage the public to take part.

 We have been running digital debates for just over a year and you can find examples of previous digital debates we have run on our website:  Digital debates.

 

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Started by mensfe_admin - Last post by mensfe_admin
 
Testing, Testing 1, 2, 3: PGS and PGD

26 September 2016

By Dr Nicoletta Charolidi
Appeared in BioNews 870


There was a captivating debate around the emerging genetic choices, legal framework and ethical issues from the use of PGS (pre-implantation genetic screening) and PGD (pre-implantation genetic diagnosis) at this event produced by the Progress Educational Trust (PET).

The event's chair Dr Sue Avery, who is a trustee of PET and director of the Birmingham Women's Fertility Centre, started off the discussion by asking whether experts and the general public can fully understand the current Human Fertilisation and Embryology Authority (HFEA) guidance on PGS and PGD.

The first speaker to take the stand was Dr Tony Gordon, who is managing director of Genesis Genetics in the USA and laboratory director of Genesis Genetics in the UK, the most experienced PGS and PGD laboratory. Dr Gordon explained that they perform tests for fertility clinics and are therefore distant from the patient and the HFEA.

Because his role has been divided between Europe and the USA, Dr Gordon has seen various PGS/PGD licensing systems, ranging from complete absence of regulation to the organised system of the UK. The HFEA has licensed more than 250 genetic tests that correspond to known genetic disorders, which are listed on their website by name and a bioinformatics number. The downside of this system is that it can take up to six months to gain a licence to test for a new genetic condition.

Dr Gordon said that karyomapping – a new, UK-invented technology – is often used nowadays for PGD. Next-generation sequencing is used for PGS. He explained that karyomapping looks at haplotypes rather than mutations, and that next-generation sequencing in this context is not whole-genome sequencing but is simply for counting chromosomes to identify aneuploidy.

The second speaker was Dr Christine Patch, a trustee at PET and clinical lead in genetic counselling at Genomics England. Dr Patch explained the purpose, intention and limitations of PGD and PGS. She explained that PGD is a technology that detects a particular genetic abnormality and therefore offers a reproductive choice to a couple with increased risk of passing on a genetic condition. PGS, by contrast, is performed to detect particular genetic variations which can decrease chances of implantation if present.

Dr Patch also discussed the costs involved in embryo testing – not just the financial costs but also the emotional costs, such as the cost of failed expectations or the cost of uncertainty. The patients may not know how to interpret the results nor understand how they are communicated back to them. These are important aspects of embryo testing.

We all have genetic variations, Dr Patch concluded, and patients are seeking the best chance to have a healthy baby.

The next speaker was James Lawford Davies, who is a partner at the law firm Hempsons. He gave a historical perspective on how the regulatory and legal framework for PGS and PGD was developed in the UK. He used examples of legal cases involving HFEA and three families, the Hashmis, the Whitakers and the Fletchers. Each of these families had requested tissue typing to produce a sibling and tissue donor for their first child, who was affected with an inheritable disease.

The legal outcomes for these families informed the Human Fertilisation and Embryology Act in 2008, which included provision for a number of scenarios requiring PGS, PGD and tissue typing.

With the technology advancing fast, Lawford Davies explained that in 2015 the HFEA requested legal advice for the use of PGD and PGS at the same time, as well as the use of PGD for more than one condition. The advice given to them stated that PGD and PGS should be considered separately and requirements for each should be satisfied. Consequently PGS is not a gateway to PGD and vice versa; patients must be eligible for both technologies if both are to be used.

As for the use of PGD for more than one condition, the HFEA was advised that it is possible to test for additional conditions, providing there is a satisfactory, 'significant' risk. Although these provisions are listed in HFEA's guidance, Lawford Davies raised concerns that they lack clarity, and so interpretations may vary.

The final speaker was Professor Michael Parker, who is professor of bioethics at the University of Oxford and director of the university's Ethox Centre. Professor Parker's take on the subject was based on his interest in genetic information and the additional information that can be produced by PGS and PGD. His main concern was how or under what conditions this knowledge should become available.

Professor Parker talked about patient-centredness and the current worry that health professionals may take decisions without proper acknowledgement of people's values. With the explosion of genetic research, he said, we tend to consider that people should not have access to choices unless their uncertainty can be managed or unless they fully understand the information given to them.

But then Professor Parker spoke about autonomy and social justice. He said that assurances should be put in place so that patients can make their own choices even in this context of uncertainty and open-endedness. He also talked about resources, including the availability of time, trained professionals and costs for making genomic information accessible. He wondered whether there will be a 'slippery slope' towards the selection of patients for these technologies. In principle, he said, if these services are cost effective, they ought to be available, and women should have access to this kind of information.

Next, it was over to the audience for their questions and comments. The themes raised by the audience included sex selection, the prospect of genome editing, the extent to which we understand genetic information today and how it should be handled, the broadness of the legal framework in the UK, and the increasingly complex issue of consent. The need to train more genetic counsellors was widely recognised by both the audience and the panel.

The panellists covered all concerns and reflected their final thoughts on the subject. They said that they are comfortable and pleased with how far PGS and PGD have come. Of course, there are ethical considerations, but work and progress seem harmonised within a legal framework that has been built well for the future.

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Started by mensfe_admin - Last post by mensfe_admin


Causes and estimated incidences of sex-chromosome misdiagnosis in preimplantation genetic diagnosis of aneuploidy

Krithika Ravichandran, Luis Guzman, Tomas Escudero, Xuezhong Zheng, Pere Colls, Amy Jordan, Jacques Cohen, Dagan Wells, Santiago MunnécorrespondencePress enter key for correspondence informationemailPress enter key to Email the author

Declaration: The authors report no financial or commercial conflicts of interest.

Article has an altmetric score of 313


Abstract

Preimplantation genetic diagnosis of aneuploidy (PGD-A) with comprehensive chromosome analysis has been known to improve pregnancy outcomes. Accuracy in detecting sex chromosomes becomes important when selecting against embryos at risk for sex-linked disorders. A total of 21,356 PGD-A cycles consisting of day-3 (cleavage) or day-5 (blastocyst) biopsies were received at the same laboratory for PGD-A via fluorescence in situ hybridization (FISH) or array comparative genome hybridization (aCGH) from multiple fertility centres. The misdiagnosis rates were 0.12% (Wilson 95% CI 0.05 to 0.25%) in day-3 FISH cycles, 0.48% (Wilson 95% CI 0.19 to 1.22%) in day-3 aCGH cycles and 0.0% (Wilson 95% CI 0 to 0.26) in day-5 aCGH cycles. Although rare, the likely causative biological event for true misdiagnosis is embryonic XX/XY mosaicism. Reanalysis of 1219 abnormal cleavage-stage research embryos revealed a 73% incidence of minor and major mosaicism. Only four (0.3%) embryos were found to be diploid and contained XX and XY cells that could potentially account for the misdiagnosis of sex. Our investigation identified errors leading to misdiagnosis and their attribution to specific events during PGD-A testing. The reported misdiagnosis rates suggest that PGD-A for sex determination is highly accurate, particularly when using aCGH applied to blastocyst biopsies.

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Started by mensfe_admin - Last post by mensfe_admin
31 October 2016

By Sarah Norcross
Appeared in BioNews 875


If you ask someone whether fertility preservation should be offered to people who have an illness, or who are undergoing a treatment that places them at risk of infertility, then in my experience the answer is usually 'yes'.

There seems to be more sympathy for people in this predicament than there is for women who choose to freeze their eggs for non-medical reasons. However, public support does not mean that the topic is without scientific, legal and ethical challenges. This is why the Progress Educational Trust thought the area was worthy of discussion at 'Frozen Assets? Preserving Sperm, Eggs and Embryos', an event which took place in Edinburgh on 25 October.

As fertility can often be compromised by cancer treatment, it seemed fitting to start the discussion with a presentation from Alison Hume, a breast cancer nurse. She explained how the pathway for young breast-cancer patients at her unit included discussion of fertility preservation, and how – if appropriate – these women were then referred to the fertility unit for further discussion of their options. These might include fast-tracked IVF or egg freezing. For some women, just discussing future plans to have a family is of therapeutic benefit because this conversation implies they will survive.

However, Hume cautioned that many women do not have a conversation about their fertility as part of their cancer treatment. Research conducted by Breast Cancer Care earlier this year has found that just over half (53 percent) of younger women diagnosed with breast cancer in the UK have no discussion with healthcare professionals about fertility preservation. Hume has contributed to a fertility toolkit developed by Breast Cancer Care to address this situation.

The second speaker, Professor Richard Anderson, explained that fertility preservation for women is not new but remains challenging. There are issues of access and funding for the relevant treatments, and women need to weigh up the pros and cons of fertility preservation in light of the risk posed to their fertility by illness or treatment – and the risk posed to their health by delaying treatment. Women don't produce mature eggs every day, so there is generally a need for treatment to stimulate the ovaries, as in IVF. This takes time, which is not something that every patient has.

Fortunately, egg-freezing technology has improved dramatically in the last decade. Increasingly, young women are able to freeze their eggs rather than needing their eggs to be fertilised by their partner's sperm or a donor's sperm and then freezing the resulting embryos. But current evidence suggests that the chance of achieving a pregnancy using frozen eggs is still relatively low. So there is a need for a thoroughgoing discussion with female patients to decide how 'we' should proceed.

Freezing ovarian tissue is also possible. Earlier this year, a cancer patient in Edinburgh became the first woman in the UK to have a child following a transplant of her frozen ovarian tissue, and Professor Anderson led the team responsible for this breakthrough (see BioNews 860). This is potentially a good option for very young girls, who cannot produce mature eggs, although it requires an operation to remove the tissue. The advantage is that, if the tissue is transplanted successfully, there is no need for further treatment – the patient's periods will return, and she can conceive naturally. For the time being, however, this is still regarded as an 'experimental' treatment at any age.

Sperm freezing, by contrast, is far from being an experimental treatment. Professor Allan Pacey, our next speaker, explained that people have been freezing sperm since at least 1776, when an Italian priest recorded the effect of snow on human sperm. This was a dramatic start to Professor Pacey's presentation, and was made more dramatic by the fact that this renowned andrologist was sporting a bow tie decorated with images of sperm. Although he began in a jocular manner, he went on to deliver a serious message – banking sperm for men prior to cancer treatment, and prior to other treatments where there is a risk of infertility – should now be a routine part of medical care.

'It's technically quite straightforward and relatively cheap, but we know that it isn't always offered to the right men, and sometimes many men who would benefit from it also decline the offer when it's made. If you add to all this the fact that in some parts of the UK the NHS doesn't always fund sperm banking in the way that NICE says they should, then the future fertility needs of many men diagnosed with cancer (or other medical conditions) are not adequately taken care of.'

Consent was the watchword when it came to the final presentation by Dr Mary Neal, senior lecturer in Law at the University of Strathclyde. Dr Neal talked us through cases where consent was either ambiguous or absent – the landmark case being that of Diane Blood, whose husband's sperm was retrieved without his written consent. After protracted legal proceedings, the sperm was ultimately exported to Belgium, where Blood used it to conceive her two sons (see BioNews 144).

Next, Dr Neal discussed the key case where consent was withdrawn – that of Natallie Evans, whose former partner withdrew his consent for their embryos to be used in treatment. Ms Evans tried unsuccessfully to persuade the courts to allow her to use these embryos (see BioNews 402). We were then brought bang up to date with the case of Samantha Jefferies – an example of a situation when the wishes of the deceased partner are clear and undisputed but, because of an anomaly on a consent form, the case has to go to court to permit the embryos to be used (see BioNews 871).

The chair of the discussion – Alison McTavish, one of the founders of the Aberdeen Fertility Centre – then fielded questions from the audience, and also contributed her own observations from her extensive experience as a fertility nurse. Issues raised by the audience included keeping fertility options open for girls with Turner's syndrome, and there was a poignant reminder from a paediatrician in the audience that, for prepubescent boys – an often 'a forgotten population' in these discussions – there are currently no fertility preservation options.

What about women who freeze their eggs or embryos, but don't wish to use them before the age of 50? Professor Anderson said that older women would not be able to access NHS-funded treatment, and many in the UK's private sector would be reluctant to treat them, but older women may still seek to export their eggs and use them in treatment overseas.

More than one audience member raised the issue of fertility preservation prior to gender reassignment. Professor Pacey responded that since gender dysphoria is recognised by many clinics as a medical condition, and since gender reassignment is available on the NHS, then it would seem appropriate and ethical to offer egg or sperm storage to the relevant patients.

Perhaps the most challenging question came from a legal academic, who asked each member of the panel what they would change if they could change just one aspect of the law relating to this area. To find out what was on the panel's wish list you'll need to listen to our podcast of the discussion, which we will be publishing on BioNews in the next few weeks.

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 Does gamete donation need an overhaul?

07 November 2016

By Anthony Bagshawe

Director of Altrui Egg Donors
Appeared in BioNews 876


It is disappointing to read about the closure of the National Sperm Bank (NSB) as its success could have helped many more people have a family using UK-donated sperm (see BioNews 875).

As has been well documented, in the past it has not been easy to recruit either sperm or egg donors in this country. The failure of the NSB may lead people to believe that it is still difficult, and that consequently those needing donated gametes should be referred or encouraged to go abroad for treatment. This would be a great shame for several reasons, not least of which is that there are donors in the UK but also because the UK donation service is probably one of the best regulated in the world.

The NSB is not the only body recruiting sperm donors in the UK. Several licensed treatment centres recruit both sperm and egg donors, with varying degrees of success. As most recruiters will have found, the majority of applicants do not actually end up as donors, yet they all need to be processed, informed and assessed for suitability. This makes donor recruitment an extremely time-consuming process and, sadly, neither easy or cheap.

Gamete donation also requires a significant commitment of time and resolve. Donors need to be committed to the process itself and the logistical arrangements required to complete the course. They must come to understand the emotional and social implications for themselves, their families and any children that might be born from their donation. They also have to be apprised of the legal requirements, particularly concerning the disclosure of identifying information of donors to future children on reaching the age of 18. Given these potential obstacles and difficulties, which they have to manage and overcome to donate successfully, it is not surprising that so many drop out along the way.

As the UK's only independent egg-donor agency that specialises in recruiting altruistic egg donors, we at Altrui have collected a number of statistics that demonstrate the large drop-out rate. Over 6000 women have approached us about donating their eggs since we set up in 2010. We filtered out roughly 15 percent at an early stage, based on medical or genetic issues. A further six percent had too high a BMI and have been put on hold until they lose sufficient weight to go ahead. Finally, another 70 percent fell out for a range of other reasons. The remaining nine percent or so have gone on to donate successfully.

Raising awareness of the great need for altruistic donors in this country might eventually produce another UK sperm or egg bank, but it will require a good deal of joined-up thinking, careful planning and a credible business model to make it viable. Recruiting donors successfully requires dedication, focus, knowledge, understanding and perseverance from a full-time team.

The social, physical and psychological differences of egg and sperm donors must be taken into account when recruiting. We have found that making the overall journey easier for egg donors makes them more inclined to help, and we imagine that this would also be the case for sperm donors. Perhaps, therefore, it is time to review just whether the path for sperm donors is as easy as it could be. For instance, should men be expected to produce so many samples? Are the number of visits required set for their convenience or to make the system financially attractive to the clinics? Should we be exploring whether moderating the number of samples demanded from each donor might lessen the time commitment and result in a lower dropout rate? Perhaps questions need to be asked about what other factors are limiting the number of donors. Given the current tests and technologies available, are there ways which might make the donor experience easier and therefore more appealing?

The closure of the NSB could be a trigger to review whether gamete donation is sufficiently focused on donors to attract enough of them and to seriously review each stage of the donation process. Surely our collective aim is to enable recipients to get an egg or sperm from the UK, rather than seek help from abroad simply because we can't get the UK donation process right for donors?

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Semen quality of ICSI-born males - not as bad as we thought

10 October 2016

By Professor Allan Pacey
Appeared in BioNews 872


When ICSI – intracytoplasmic sperm injection – was first introduced into clinical practice in the early 1990s, many doctors and scientists were concerned about the consequences for the health and development of individuals conceived this way. After all, the selection of sperm by an embryologist, and its subsequent injection into an unfertilised oocyte, was hardly under the influence of any kind of Darwinian evolution. Moreover, the poor sperm quality that required the use of ICSI in the first place almost certainly had some underlying genetic factor which was not yet understood.

Therefore, as time passed and ICSI was used more and more frequently around the world, reports began to emerge about the health and well-being of the ICSI children, who were being intensively studied and monitored as they grew up. The results of some of these studies have been reported in the pages of BioNews – the incidence of congenital abnormalities, neurological and mental development, the development of the male reproductive organs, IQ and motor skills, weight, height, body mass index and finger length.

On the whole, these reports have been largely reassuring, with the overall health and development measures of ICSI-conceived children largely the same as those conceived naturally, when appropriate adjustments have been made for factors such as multiple births and the age of parents. However, there has, until now, been one of the pieces of the jigsaw missing: the fertility of those born using this technique when they reach adulthood, specifically the fertility of males. This has been of great interest because the reason for using the ICSI procedure to conceive these males in the first place was because of their father's poor sperm quality, which was almost certainly of genetic origin. Therefore, if those genes were inherited by any sons born through the ICSI procedure (and that seemed extremely likely given that ICSI just bypasses the problem rather than repairs it), then the logical conclusion is they would have a similar level of infertility as their father and therefore potentially require the use of ICSI themselves when they wanted to become a dad.

Therefore, the paper published this week in Human Reproduction by Belva et al has been long awaited and gives some intriguing insights about the semen quality – and therefore the future fertility prospects – of 54 males aged between 18 and 22 years old who were born between 1992 and 1996 following ICSI using fresh sperm and the transfer of fresh embryos (see BioNews 872). The authors of the paper then compared the semen quality of these males with a control group of 57 age matched, naturally conceived men) as well as with the sperm quality of their fathers at the time of ICSI.

Clearly, this is a study which has not been possible to perform until these males reached adulthood. The data shows that their sperm quality is noticeably lower than that seen in men who were conceived naturally. However, this result is completely expected, as the naturally conceived men are unlikely to have inherited a fertility-related genetic problem from their fathers and therefore should be able to produce more and better sperm, all other things being equal.

To me, what was more interesting about the paper was the fact that when the authors compared the semen quality of the ICSI-conceived males with that of their fathers, only a poor relationship was observed. The ICSI-conceived males were no more likely to have a sperm concentration below 15 million per ml even if their father had a sperm concentration of below 15 million per ml. This is not as expected, and it suggests that our assumptions about the inheritance of male infertility may be more complex than we have realised until now. Although the study only looked at a relatively small number of men – and it certainly needs to be repeated with a larger cohort – I see this result as being quite reassuring. Our worries over the past 25 years have been that ICSI-born males were destined for a poor reproductive future that may be equivalent to (or even worse than) that of their fathers, but this paper suggests this is not necessarily going to be the case.

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Male psychological adaptation to unsuccessful medically assisted reproduction treatments: a systematic review

Mariana Veloso Martins1,2,*,
 Miguel Basto-Pereira3,
 Juliana Pedro1,2,
 Brennan Peterson3,4,
 Vasco Almeida4,5,
 Lone Schmidt6 and
 Maria Emília Costa1,2
 

+
 Author Affiliations
1Faculty of Psychology and Education Sciences, University of Porto, 4200-135 Porto, Portugal 
2Center for Psychology at University of Porto, 4200-135 Porto, Portugal 
3School of Psychology, University of Minho, 4710-057 Braga, Portugal 
4Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA 
5Faculty of Sciences, University of Porto, 4169-007 Porto, Portugal 
6Section of Social Medicine, University of Copenhagen, 1014 Copenhagen K, Denmark 
↵*Correspondence address. Faculty of Psychology and Education Sciences, Porto University, R. Alfredo Allen, 4200-135 Porto, Portugal. E-mail: mmartins@fpce.up.pt
Received July 30, 2015.
Revision received February 15, 2016.
Accepted February 25, 2016.


Abstract


BACKGROUND Similarly to women, men suffer from engaging in fertility treatments, both physically and psychologically. Although there is a vast body of evidence on the emotional adjustment of women to infertility, there are no systematic reviews focusing on men's psychological adaptation to infertility and related treatments.


OBJECTIVE AND RATIONALE The main research questions addressed in this review were ‘Does male psychological adaptation to unsuccessful medically assisted reproduction (MAR) treatment vary over time?’ and ‘Which psychosocial variables act as protective or risk factors for psychological maladaptation?’


SEARCH METHODS A literature search was conducted from inception to September 2015 on five databases using combinations of MeSH terms and keywords. Eligible studies had to present quantitative prospective designs and samples including men who did not achieve pregnancy or parenthood at follow-up. A narrative synthesis approach was used to conduct the review.


OUTCOMES Twelve studies from three continents were eligible from 2534 records identified in the search. The results revealed that psychological symptoms of maladjustment significantly increased in men 1 year after the first fertility evaluation. No significant differences were found two or more years after the initial consultation. Evidence was found for anxiety, depression, active-avoidance coping, catastrophizing, difficulties in partner communication and the use of avoidance or religious coping from the wife as risk factors for psychological maladjustment. Protective factors were related to the use of coping strategies that involve seeking information and attribution of a positive meaning to infertility, having the support of others and of one's spouse, and engaging in open communication about the infertility problem.


WIDER IMPLICATIONS Our findings recommend an active involvement of men during the treatment process by health care professionals, and the inclusion of coping skills training and couple communication enhancement interventions in counselling. Further prospective large studies with high-quality design and power are warranted.

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 Author Affiliations
1Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium 
2Environment and Health/Youth Health Care, Department of Public Health and Primary Care, Kapucijnenvoer 35, 3000 Leuven, Belgium 
3Department of Urology, Universitair Ziekenhuis (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium 
4Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium 
↵*Correspondence address. E-mail: florence_belva@hotmail.com
Received July 15, 2016.
Revision received August 25, 2016.
Accepted August 31, 2016.


Abstract


STUDY QUESTION What is the semen quality of young adult men who were conceived 18–22 years ago by ICSI for male infertility?


SUMMARY ANSWER In this cohort of 54 young adult ICSI men, median sperm concentration, total sperm count and total motile sperm count were significantly lower than in spontaneously conceived peers.


WHAT IS KNOWN ALREADY The oldest ICSI offspring cohort worldwide has recently reached adulthood. Hence, their reproductive health can now be investigated. Since these children were conceived by ICSI because of severe male-factor infertility, there is reasonable concern that male offspring have inherited the deficient spermatogenesis from their fathers. Previously normal pubertal development and adequate Sertoli and Leydig cell function have been described in pubertal ICSI boys; however, no information on their sperm quality is currently available.


STUDY DESIGN, SIZE, DURATION This study was conducted at UZ Brussel between March 2013 and April 2016 and is part of a large follow-up project focussing on reproductive and metabolic health of young adults, between 18 and 22 years and conceived after ICSI with ejaculated sperm. Results of both a physical examination and semen analysis were compared between young ICSI men being part of a longitudinally followed cohort and spontaneously conceived controls who were recruited cross-sectionally.


PARTICIPANTS/MATERIALS, SETTING, METHOD Results of a single semen sample in 54 young adult ICSI men and 57 spontaneously conceived men are reported. All young adults were individually assessed, and the results of their physical examination were completed by questionnaires. Data were analysed by multiple linear and logistic regression, adjusted for covariates. In addition, semen parameters of the ICSI fathers dating back from their ICSI treatment application were analysed for correlations.


MAIN RESULTS AND THE ROLE OF CHANCE Young ICSI adults had a lower median sperm concentration (17.7 million/ml), lower median total sperm count (31.9 million) and lower median total motile sperm count (12.7 million) in comparison to spontaneously conceived peers (37.0 million/ml; 86.8 million; 38.6 million, respectively). The median percentage progressive and total motility, median percentage normal morphology and median semen volume were not significantly different between these groups. After adjustment for confounders (age, BMI, genital malformations, time from ejaculation to analysis, abstinence period), the statistically significant differences between ICSI men and spontaneously conceived peers remained: an almost doubled sperm concentration in spontaneously conceived peers in comparison to ICSI men (ratio 1.9, 95% CI 1.1–3.2) and a two-fold lower total sperm count (ratio 2.3, 95% CI 1.3–4.1) and total motile count (ratio 2.1, 95% CI 1.2–3.6) in ICSI men compared to controls were found. Furthermore, compared to men born after spontaneous conception, ICSI men were nearly three times more likely to have sperm concentrations below the WHO reference value of 15 million/ml (adjusted odds ratio (AOR) 2.7; 95% CI 1.1–6.7) and four times more likely to have total sperm counts below 39 million (AOR 4.3; 95% CI 1.7–11.3). In this small group of 54 father–son pairs, a weak negative correlation between total sperm count in fathers and their sons was found.


LIMITATIONS, REASONS FOR CAUTION The main limitation is the small study population. Also, the results of this study where ICSI was performed with ejaculated sperm and for male-factor infertility cannot be generalized to all ICSI offspring because the indications for ICSI have nowadays been extended and ICSI is also being performed with non-ejaculated sperm and reported differences may thus either decrease or increase.


WIDER IMPLICATIONS OF THE FINDINGS These first results in a small group of ICSI men indicate a lower semen quantity and quality in young adults born after ICSI for male infertility in their fathers.


STUDY FUNDING/COMPETING INTEREST(S) This study was supported by Methusalem grants and by grants from Wetenschappelijk Fonds Willy Gepts, all issued by the Vrije Universiteit Brussel (VUB). All co-authors except M.B. and H.T. declared no conflict of interest. M.B. has received consultancy fees from MSD, Serono Symposia and Merck. The Universitair Ziekenhuis Brussel (UZ Brussel) and the Centre for Medical Genetics have received several educational grants from IBSA, Ferring, Organon, Shering-Plough and Merck for establishing the database for follow-up research and organizing the data collection. The institution of H.T. has received research grants from the Research Fund of Flanders (FWO), an unconditional grant from Ferring for research on testicular stem cells and research grants from Ferring, Merck, MSD, Roche, Besins, Goodlife and Cook for several research projects in female infertility. H.T. has received consultancy fees from Finox, Abbott and ObsEva for research projects in female infertility.

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05 September 2016

By Dr Kamal Ahuja


The notion persists that sperm donation in Britain limps ahead in a state of perpetual crisis: difficulties at the much vaunted national sperm bank, imports of donor sperm flooding in from Denmark, and UK donors terrified of disclosing their identity. Yet nothing could be further from the truth.

Sperm donors, clearly unfazed by the removal of anonymity a decade ago, are now recognised for their altruistic motivation and adequately compensated for their time and expense. There is no need for a UK fertility patient to source donor sperm from an overseas bank, for despite the perpetuating myths, the UK is now entirely self-sufficient in quality donor sperm from donors readily compliant with the Human Fertilisation and Embryology Authority (HFEA) requirements of traceability.

The myth of crisis only continues to be told based on low and outdated numbers of registered donors recorded by the HFEA (just 586 new registrations in 2013), and long memories in the media of a British Fertility Society report which described the UK's shortage of donor sperm as 'critical'.

The key to reversing this sperm donor 'crisis', as reflected in our experience at the London Sperm Bank, has been the internet and an online business model which we have followed since 2011. Since then, and with the introduction of our online donor catalogue, we have treated more than 3000 infertile women and received enquiries from more than 30,000 men interested in becoming donors.

These 'few good men' are from all walks of life – not only IT and finance (the most frequent donors), but also from the building and fashion trades, as well as the armed forces. More than 80 percent of them initiated their enquiry via a mobile phone or tablet.

As a result, we now have more than 30,000 sperm samples in storage and can meet the matching requirements of all women needing donor sperm throughout the UK.

We are now extending the digital approach even further by introducing in July this year a London Sperm Bank mobile app for patients, which allows them to browse our catalogued donor details, including characteristics, donor self-summaries and extended profiles. Patients can also submit their donor preferences through a wish-list, allowing them to receive an immediate alert when a donor meeting their criteria becomes available. After browsing, patients can choose their ideal donor and order sperm, just as they would in any other online transaction. Their chosen sperm is then delivered to a registered clinic of their choice. Already, a large number of women have registered to receive these alerts following consultations at their chosen clinics.

Ordering sperm from an online catalogue or an app does not trivialise treatment, and every step meets the requirements of the HFEA. Donors remain anonymous, and only the details of ethnicity, character and achievement are recorded. Moreover, each vial of stored sperm processed in a HFEA-licensed laboratory fulfils the minimum WHO semen standards, and most specimens contain more than 20 million progressively motile sperm per ml. Indeed, fewer than four percent of our 30,000 potential donor enquiries have met our selection criteria and go on to become donors. At the London Sperm Bank at any give time we now have more than 100 sperm donors available who meet all screening criteria.

Patients are reassured by such compliance, and especially by the traceability of each UK-based donor (again, in accordance with HFEA regulation). But they also appreciate the immediacy and freedom to choose at their leisure, using a model they are familiar with. So far, the London Sperm Bank has been the first to use this model, but it surely will not be the last. Donor recruitment according to the old model of advertising is unlikely to succeed, but by embracing new technologies we have shown that it can thrive and prosper.

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