•Risk of small for gestational age was higher following fresh embryo transfer.•Risk of small for gestational age was higher following intrauterine insemination.•Risk of large for gestational age was ...higher following frozen embryo transfer.•These risks were also observed in the absence of obstetrical or neonatal morbidity.•Medically assisted reproduction is a risk factor for fetal growth disorders.
What part do maternal context and medically assisted reproduction (MAR) techniques play in the risk of fetal growth disorders?
This retrospective nationwide cohort study uses data available in the French National Health System database and focuses on the period from 2013 to 2017. Fetal growth disorders were divided into four groups according to the origin of pregnancy: fresh embryo transfer (n = 45,201), frozen embryo transfer (FET, n = 18,845), intrauterine insemination (IUI, n = 20,179) and natural conceptions (n = 3,412,868). Fetal growth disorders were defined from the percentiles of the weight distribution according to gestational age and sex: small and large for gestational age (SGA and LGA) if <10th and >90th percentiles, respectively. Analyses were performed using univariate and multivariate logistic models.
Compared with births following natural conception, multivariate analysis showed that the risk of SGA was higher for births following fresh embryo transfer and IUI (adjusted odds ratio aOR 1.26 1.22–1.29 and 1.08 1.03–1.12, respectively) and significantly lower following FET (aOR 0.79 0.75–0.83). The risk of LGA was higher for births following FET (aOR 1.32 1.27–1.38), especially in artificial cycles when compared with ovulatory cycles (aOR 1.25 1.15–1.36). In the subgroup of births without any obstetrical or neonatal morbidity, the same increased risk of SGA and LGA were observed following fresh embryo transfer or IUI and FET (aOR 1.23 1.19–1.27 or 1.06 1.01–1.11 and aOR 1.36 1.30–1.43, respectively).
An effect of MAR techniques on the risks for SGA and LGA is suggested independently from maternal context and obstetrical or neonatal morbidities. Pathophysiological mechanisms remain poorly understood and should be further evaluated, as well as the influence of embryonic stage and freezing techniques.
We studied the quality differences between the different hypo-osmotic swelling test (HOST) classes, as measured by criteria of DNA fragmentation, DNA decondensation, and nuclear architecture. The aim ...was to find particular HOST classes associated with good-quality metrics, which may be potentially used in ICSI (intra-cytoplasmic sperm injection).
En France, depuis 1994, la loi relative à la bioéthique fixe les grands principes pour les dons d’éléments et produits du corps humain et leur utilisation dans le cadre de la médecine. À ce titre, ...elle encadre strictement les activités cliniques et biologiques d’assistance médicale à la procréation (AMP).
Pour tenir compte des évolutions constantes et des enjeux éthiques et sociétaux mobilisés dans ce domaine innovant de la biomédecine, la loi a prévu le principe même de sa révision périodique.
Ainsi les principes généraux de gratuité et d’anonymat du don de gamètes ainsi que la finalité médicale de l’AMP ont été plusieurs fois débattues, puis réaffirmées au cours des différents processus de révision de la loi.
Le cadre légal et réglementaire en vigueur est exposé ici.
Créée par la loi de 2004, l’agence de la biomédecine représente l’autorité compétente assurant au niveau national l’encadrement des activités d’AMP avec pour objectif d’améliorer la qualité, la sécurité et l’équité d’accès à ces techniques.
La dernière loi relative à la bioéthique a été votée en 2011 ; elle prévoyait sa révision après 7 ans. Dans ce cadre, début 2018, le Comité consultatif national d’éthique (CCNE) a lancé les états généraux de la bioéthique pour organiser la réflexion collective.
Un projet de loi s’appuyant sur le rapport de synthèse du CCNE à l’issue des états généraux de la bioéthique ainsi que sur les nombreuses contributions notamment celles de l’agence de la biomédecine, du Conseil d’État et de l’Office parlementaire d’évaluation des choix scientifiques et technologiques (OPECST) devrait être déposé devant le parlement en juillet 2018.
In France, since 1994, the law set up ethical principles applying to the donation of human body elements and products and their use in the context of medicine. A such, assisted reproductive technologies (ART) have been strictly regulated through the law on bioethics.
In order to take into account the constant changes and emergent ethical and social issues in this innovative domain, the French law on bioethics set up the principle of its own periodic review.
The legal provisions on anonymous and free donation and on the medical purpose of ART have been consequently largely debated and then reaffirmed during the different process of review of the law.
The French legal framework in force applying to ART is described here.
Created by law in 2004, the Agence de la biomédecine represents the national Competent Authority for medical and technical aspects of ART practices. Its missions focus on improving quality and safety of ART practices and guarantying an equal access to those treatments.
The most recent law on bioethics was voted in 2011, scheduling its own revision after 7 years. Early 2018, the national committee on ethics (CCNE) launched a large public consultation on bioethics organising the collective thought.
A project for the future law based on the summary report of the CCNE and the numerous inputs of the official reports including the Agence de la biomédecine, Council of state and the parliamentary group on technologic and scientific options’ reports should be submitted to the parliament in July 2018.
Abstract Several reports have described an association between the presence of soluble human leukocyte antigen G (sHLA-G) in human embryo culture supernatants (ES) and implantation success. However, ...not all studies agree with these findings. To further document this debate, a multicentre blinded study was performed to investigate, on a large number of IVF ES and ICSI ES, whether sHLA-G is a useful criterion for embryo selection before transfer. A total of 1405 ES from 355 patients were collected from three assisted reproductive technique (ART) centres and evaluated for their sHLA-G content in a single laboratory, using a chemiluminescence enzyme-linked immunosorbent assay. In only one centre was a significant association between sHLA-G-positive ES and successful implantation established ( P = 0.0379), whereas no such association was observed in the other centres. It was found that the percentages and concentrations of sHLA-G-positive ES varied between centres, depending on culture media and ART conditions. The percentage of sHLA-G-positive ES was significantly higher in IVF ES than ICSI ES ( P < 0.001 and P < 0.01 for two centres). These data demonstrate that substantial variations of sHLA-G content in ES occur between different ART centres, highlighting the influence of several technical parameters that differ from one centre to another.
: Even though cryopreservation of human spermatozoa is known to alter sperm motility and viability, it may also induce nuclear damages. The present study set out to determine whether or not ...cryopreservation alters motile sperm morphology under high magnification and/or is associated with chromatin decondensation. For 25 infertile men, we used high‐magnification microscopy to determine the proportions of various types of motile spermatozoa before and after freezing‐thawing: morphometrically normal spermatozoa with no vacuole (grade I), ≤2 small vacuoles (grade II), at least 1 large vacuole or >2 small vacuoles (grade III), and morphometrically abnormal spermatozoa (grade IV). The spermatozoa's chromatin condensation and viability were also assessed before and after freezing‐thawing. Cryopreservation induced sperm nuclear vacuolization. It decreased the proportion of grade I + II spermatozoa (P < .001). It induced a decrease in the sperm viability rate (P < .001) and increased the proportion of sperm with noncondensed chromatin (P < .001). The latter parameter was strongly correlated with sperm viability (r / 0.71; P < .001). However, even motile sperm presented a failure of chromatin condensation after freezing‐thawing, because the proportion of sperm with noncondensed chromatin was correlated with high‐magnification morphology (r = −0.49 and 0.49 for the proportions of grade I + II and grades III + IV, respectively; P < .001). Cryopreservation alters the organelle morphology of motile human spermatozoa and induces sperm chromatin decondensation. High‐magnification microscopy may be useful for evaluating frozen‐thawed spermatozoa before use in assisted reproductive technology procedures (such as intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection) and for performing research on cryopreservation methods. If frozen‐thawed sperm is to be used for intracytoplasmic sperm injection, morphological selection under high magnification may be of particular value.
Objective To examine sperm meiotic segregation in a man with mosaic ring chromosome 21. Design Case report. Setting Hospital departments of reproductive biology, cytogenetics, gynecology, and ...obstetrics. Patient(s) One patient referred for cryptozoospermia, heterozygous for a ring chromosome. Intervention(s) Fluorescence in situ hybridization with chromosome 21–specific probes after sperm selection. Result(s) A total of 169 spermatozoa were selected; 92.3% carried a normal 21 chromosome, 6.5% the ring chromosome, and 1.2% both. Conclusion(s) Ring chromosome frequency in mature sperm cells was low and may be due to preferential meiosis of normal spermatogonia,which could explain the cryptozoospermia and unexpected ratio in this case.
Objective To assess sperm quality as a function of the sampling site (testis or epididymis) in obstructive azoospermia (OA). Materials and Methods DNA fragmentation rates in spermatozoa sampled from ...the testis and epididymis (from patients with different etiologies of OA) were assessed in a dUTP nick-end labeling assay Results Twenty-one OA patients were included: 5 had congenital bilateral absence of the vas deferens, 8 had genital tract infections, and 8 had idiopathic OA. A total of 8506 spermatozoa sampled from the testis, 18,358 sampled from the caput epididymis, and 18,881 sampled from the corpus/cauda epididymis were assessed. For each patient, spermatozoa from the testis had a lower overall DNA fragmentation rate (6.71% ± 0.75 in average) than epididymal spermatozoa from the caput (14.86% ± 1.89 in average; P = .0007) or the corpus/cauda (32.61% ± 3.11 in average; P < .0001). The DNA fragmentation rates did not differ significantly as a function of the etiology of OA. In this small series, all deliveries were obtained with sperm samples with a low DNA fragmentation rate and delivery rates tended to be higher when testicular sperm (rather than epididymal sperm) was used (35.7% vs 12.1%, respectively; P = .06). Conclusion Our data argue in favor of using testicular sperm (rather than epididymal sperm) for patients with obstructive azoospermia.
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