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An ESHRE document in this issue, the 15th from the ESHRE Task Force on Ethics and Law, discusses the ethical aspects of cross-border reproductive care especially the evasion of law and the unequal access to treatment (p. 2182). The discussion focuses on the obligation of physicians to refer patients, their duty to provide information and counseling and some of the financial arrangements involved such as the acceptability of fee-splitting. The recommendations of the Task Force include measures to avoid this cross-border reproductive care as well as the guarantee that good care needs to be provided everywhere.
Human embryonic stem cell (hESC) lines are sometimes derived from poor-quality discarded embryos donated for research. A group from China reported on seven such hESC lines; five of them had a normal karyotype, while two of them had an abnormal karyotype (p. 2185). A battery of tests were performed on these cell lines and indicated that the biological characteristics were similar in the normal and abnormal cell lines. All lines could undergo differentiation and had similar imprinted gene expression and DNA methylation. These findings indicate that even chromosomally abnormal hESC lines may be considered as useful experimental material.
Outcome studies in terms of health of the children born after all forms of Assisted Reproductive Technology are one of the key issues in reproductive medicine. A report on the neonatal outcome of 937 children born after transfer of cryopreserved embryos (cryo IVF and cryo ICSI) adds information to the limited number of studies of cryo-children so far published (p. 2227). The results were compared with previous results from the same group regarding children born after IVF and ICSI. Birth characteristics of cryo ICSI and cryo IVF children were similar. No difference was observed between children from multiple pregnancies in fresh and cryo cycles. The mean birthweight of all cryo singletons was higher than the mean birthweight of singletons after fresh embryo transfer. There were more major congenital malformations in cryo ICSI than in cryo IVF children and there was a trend to more abnormal karyotypes in cryo ICSI children. This information is useful in counseling of patients and indicates that further such studies as well as studies of older ART children are needed.
Timed intercourse is the usual control treatment in trials of intrauterine insemination. A systematic review and meta-analysis was designed to estimate in IUI trials whether the trials in which the comparison is timed intercourse have a different treatment effect from trials in which there is no influence on timing of intercourse in the comparison group (p. 2239). The difference in pregnancy rates between IUI and timed intercourse controls was 6.1% in favour of IUI compared with 3.9% in trials with expectant management. This difference is not significant in the broader group of 19 trials and also not in the couples of the most relevant trials. Additional benefit of IUI when timed intercourse is the control group, although not significant, is consistent with the possibility that pregnancy is more likely in expectant management than in timed intercourse.
Freezing of ovarian tissue has been introduced to preserve fertility in patients with malignant disease. The most optimal freezing and thawing procedure is still not clearly established. A novel vitrification procedure, needle immersed vitrification, was compared with slow freezing and vitrification on mouse and human ovarian cortex fragments (p. 2256). The procedure, which is practical and convenient, had similar or better outcome than the two other procedures in terms of preservation of structure, better quality follicles, better ultrastructure and satisfactory viability.
A small case series reports on autotransplantation of frozen–thawed ovarian tissue in six patients who had ovarian freezing to preserve fertility whilst undergoing cancer treatment (p. 2266). Autotransplantation of ovarian tissue resulted in resumption of ovarian cyclicity in all patients, initiation of pregnancy in four patients and the delivery of two health children in two patients.
Cumulus cells are one of the sources of sperm chemoattractants and secrete progesterone, which is also recognized as a chemoattractant. A series of elegant experiments suggest that progesterone is the main, if not sole, sperm chemoattractant secreted by human cumulus cells (p. 2339).
As an additional study on the influence of controlled ovarian stimulation protocol on IVF cycle outcome, a randomized controlled trial compared highly purified HMG against recombinant FSH in GnRH antagonist cycles (p. 2346). Previous reports had studied the two gonadotrophins in GnRH agonist cycles. The primary end-point of the study, ongoing pregnancy rate, was similar for the two stimulation protocols, but some differences were found in ovarian response in terms of oocyte yield and hormonal profile.
The prevalence and characteristics of metabolic syndrome in PCOS was investigated using three different definitions (p. 2352). The study was done in 168 PCOS patients and 883 age-matched controls. There was a 4-fold increase in prevalence of metabolic syndrome in PCOS patients as compared with general population. The role of insulin and obesity in the syndrome implies a greater risk of cardio-metabolic disease in women with PCOS. The estimates differ according to the PCOS definition and aetiological pathways and the ethnicity of the patients.
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Related articles in Hum. Reprod.:
- ESHRE Task Force on Ethics and Law 15: Cross-border reproductive care
- G. Pennings, G. de Wert, F. Shenfield, J. Cohen, B. Tarlatzis, and P. Devroey
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Hum. Reprod. 2008 23: 2185-2193.[Abstract] [FREE Full Text] - Neonatal outcome of 937 children born after transfer of cryopreserved embryos obtained by ICSI and IVF and comparison with outcome data of fresh ICSI and IVF cycles
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Hum. Reprod. 2008 23: 2256-2265.[Abstract] [FREE Full Text] - Two successful pregnancies following autotransplantation of frozen/thawed ovarian tissue
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Hum. Reprod. 2008 23: 2266-2272.[Abstract] [FREE Full Text] - The sperm chemoattractant secreted from human cumulus cells is progesterone
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Hum. Reprod. 2008 23: 2339-2345.[Abstract] [FREE Full Text] - Highly purified hMG versus recombinant FSH in ovarian hyperstimulation with GnRH antagonists—a randomized study
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Hum. Reprod. 2008 23: 2352-2358.[Abstract] [FREE Full Text]
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