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#91
General Discussion / Magnetic 'radar' could boost m...
Last post by mensfe_admin - 2017-06-08 10:48• Experts at Sheffield University have developed a new method to identify best sperm in a sample without killing them
• Process uses a 10ft high magnetic resonance machine to examine living cells
• Doctors have previously had to examine sperm for health then throw it away
• This could help improve chance of success for IVF by using the healthy sperm
A machine which acts as a 'radar' for sperm could increase the chance of men with fertility problems becoming fathers.
Experts at the University of Sheffield have developed a new technique to identify the best sperm in a sample without killing them.
The process, which uses a 10ft high magnetic resonance spectroscopy machine to examine living sperm cells, will eventually allow doctors to select the most promising cells for use in IVF.
Experts at the University of Sheffield have developed a new technique to identify the best sperm in a sample without killing them
Until now doctors have only been able to examine a sample of sperm for its general health, throw it away, and then take another sample for use in fertility treatment.
That is because usually the very process of examining the sperm kills it.
The new technique approach uses a giant scanner - so big that it requires a step ladder to lower a sample inside - to examine the molectular structure of each sperm cell while keeping it alive.
Read more: http://www.dailymail.co.uk/health/article-4535594/New-sperm-scanner-boost-men-s-chance-IVF-success.html#ixzz4jPFatJ6m
Follow us: @MailOnline on Twitter | DailyMail on Facebook
#92
General Discussion / Daily Mail misses the mark on ...
Last post by mensfe_admin - 2017-05-10 07:5508 May 2017
By Professor Adam Balen
Appeared in BioNews 899
Last week the Daily Mail published an undercover investigation into certain aspects of IVF practice in the UK (reported elsewhere in BioNews this week). Whilst this has highlighted some issues, unfortunately the meaning of published statistics has been misinterpreted and certain aspects of the investigation have been given far more weight than is just. Rather than serving the public good, this has the potential to leave vulnerable patients scared and confused.
The IVF sector is the mostly highly regulated of all areas of medicine in the UK, nonetheless there may well be pockets of bad practice and clearly there is room for improvement in some areas. This is the case in any branch of medicine and the fertility sector is certainly no worse than any other. Information provided to patients must enable them to discern for themselves whether an individual clinic is offering appropriate advice and treatment. My concern is that this report muddies the waters, making it difficult for patients to make an informed choice about their care.
The fertility sector has a higher proportion of private practice because of a lack of NHS funding and the associated postcode lottery. I have been campaigning hard for this to change and, on behalf of the British Fertility Society (BFS), Fertility Network UK and Fertility Fairness am chairing the IVF Pricing Committee for NHS England. The lack of NHS funding has created a unique scenario where all treatments must be itemised and charged for (either to CCGs when there is NHS funding or directly to patients when there is not).
So we are dealing with the symptoms of a much more serious problem, namely that the majority of patients dealing with infertility are unable to access sufficient NHS funded treatments to become pregnant.
The Daily Mail highlighted a few areas where they perceived concern. One of these is egg sharing, whereby women donate some of their eggs during the course of their own IVF treatment cycle in order to be able to help fund that treatment. Donating or sharing eggs for IVF is a completely legitimate practice, and was already happening in the late 1990s. In other countries both egg and sperm donors would be paid for their donation, but here it was decided that it was wrong to incentivise in that way and risk exploiting people who are in poverty. We are only allowed to compensate patients for reasonable expenses, and couples must be very clear about the issues surrounding such treatment.
Egg sharing has been shown to work well for the vast majority of patients and is, of course, dependent upon very careful and thorough counselling about the implications. The Daily Mail's investigation has, however, highlighted some questionable practices that may have affected some patients who participated in egg sharing in return for free or discounted treatment. The UK regulator, the HFEA (Human Fertilisation and Embryology Authority), is rightly taking this seriously. But this, from my viewpoint in active clinical practice, and contrary to the highly critical view expressed by Professor Winston, is not something that is universal in the field.
All couples facing infertility deal with ethical and emotionally challenging decisions around their course of action and their genetic association with their children: anything from adoption to egg-sharing, sperm donation or mitochondrial donation requires complex moral and ethical considerations. There is a myriad of underlying causes including lack of fertility education in schools, lack of NHS funding for IVF that create a financial incentive for patients who struggle to pay for IVF privately and lack of appropriate healthcare advice during reproductive years as to lifestyle factors that can affect gamete quality and fertility.
A further investigation into reporting of OHSS (Ovarian HyperStimulation Syndrome) is somewhat misleading. I do not believe there is a major problem with clinics under-reporting serious cases of OHSS. The numbers reported by NHS hospitals include admissions to hospital after egg collection, the majority of which are for relatively mild symptoms that settle down on their own within a few days – these are very different from full-blown OHSS, which can indeed be very serious. My organisation, the British Fertility Society (BFS), along with the Royal College of Obstetricians and Gynaecologists (RCOG), have taken the lead in developing guidelines on how to prevent and treat OHSS. These guidelines are widely followed across the world.
We at the BFS accept absolutely that there are areas of poor practice in the fertility sector. We do not seek to dismiss valid concerns; exploitation or endangerment of patients is totally unacceptable. We trust that the HFEA will deal with any cases it uncovers and we will encourage our professional community to cooperate in the investigations. Meanwhile, we will continue to argue in support of NHS funding for fertility treatment, the lack of which we believe remains a factor driving potentially contentious practice.
The BFS has written numerous Policy & Practice Papers and guidelines to better inform the profession, alongside our training courses, study weeks and academic symposia. These are attended by those of us in active practice who seek to update our knowledge and ensure that we are providing evidence-based treatments. We are disappointed with the criticism levied at us by Professor Winston in his Daily Mail opinion piece on the investigation – we are a professional body that he himself once chaired. Given this, we would like to send an open invitation to Professor Winston to attend our meetings and hear the latest data and innovations.
The UK leads the way with innovation in IVF and other infertility treatments and the BFS works with our community to share good practice. We also work with the regulators and policy makers to ensure that ethically challenging issues are embraced with tight but permissive regulation. In theory, the UK is one of the best places in the world – scientifically and medically – to be a person dealing with infertility, but without NHS funding for treatment this point is moot.
#93
General Discussion / Regulating the donor-conceptio...
Last post by mensfe_admin - 2017-02-28 14:4227 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.
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.
#94
General Discussion / JOIN THE HOUSE OF COMMONS DEBA...
Last post by mensfe_admin - 2017-01-11 11:40Please 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.
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.
#95
General Discussion / PGS and PGD testing
Last post by mensfe_admin - 2016-11-29 11:44Testing, 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.
#96
Research / PGD (Post Genetic Diagnosis - ...
Last post by mensfe_admin - 2016-11-10 13:44Causes 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.
#97
Let off some Steam / Frozen Assets? Preserving Sper...
Last post by mensfe_admin - 2016-11-10 10:1331 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.
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.
#98
General Discussion / Re: Online banking for UK sper...
Last post by mensfe_admin - 2016-11-08 13:35 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?
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?
#99
Research / Re: Semen quality of young adu...
Last post by mensfe_admin - 2016-10-17 10:10Semen 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.
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.
#100
Research / Male reaction to unsuccessful ...
Last post by mensfe_admin - 2016-10-16 09:59Male 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.
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.