DOCSLIB.ORG

Obstetric and Perinatal Complications Associated with Assisted Reproductive Treatment in Spain

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Obstetric and Perinatal Complications Associated with Assisted Reproductive Treatment in Spain Journal of Assisted Reproduction and Genetics (2019) 36:2435–2445 https://doi.org/10.1007/s10815-019-01631-6 ASSISTED REPRODUCTION TECHNOLOGIES Obstetric and perinatal complications associated with assisted reproductive treatment in Spain Ana Ballesta-Castillejos1 & Juan Gomez-Salgado2,3 & Julian Rodriguez-Almagro4 & Inmaculada Ortiz-Esquinas5 & Antonio Hernández-Martínez4,5 Received: 20 July 2019 /Accepted: 8 November 2019 / Published online: 18 November 2019 # Springer Science+Business Media, LLC, part of Springer Nature 2019 Abstract Background Although most newborns conceived through assisted reproductive treatments are healthy, there are concerns about the safety of reproductive techniques and their effect on foetal/maternal well-being. Objective This study aims to describe the incidence of obstetric and perinatal complications in women undergoing assisted reproductive treatments in the Spanish Health System. Method This is a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain. The data was collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated, through a multivariate analysis with binary logistic regression and multinomial logistic regression. Results Five thousand nine hundred forty-two women participated, 2.3% (139) through artificial insemination and 8.2% (486) through in vitro fertilisation (IVF) techniques. Women who underwent IVF had a higher likelihood of suffering problems during pregnancy (OR = 1.71; 95% confidence intervals (95% CI), 1.37–2.13), delivery (OR = 1.43; 95% CI, 1.01–2.02), and post- partum (OR = 1.94; 95% CI, 1.40–2.69) than women with spontaneous pregnancy. No increased likelihood of neonatal problems was observed in this group except for twin pregnancy (OR = 9.17; 95% CI, 6.02–13.96) and prematurity (OR = 1.43; 95% CI, 1.01–2.02). No differences were observed between spontaneous pregnancies and those achieved by artificial insemination. Conclusions Pregnancies achieved through IVF present a higher risk of complications before, during and after delivery. However, there is no increased risk of neonatal problems except for a higher likelihood of twin pregnancy and prematurity. Keywords Reproductive techniques assisted . Fertilization in vitro . Quality of health care . Patient safety . Obstetric labour complications . Morbidity Introduction and 12% at European level [2]. The latest estimates indicate that more than 1.6 million of assisted reproduction cycles Infertility affects approximately 10–15% of the world’srepro- worldwide are carried out each year, and more than 5 million ductive age population [1], with a prevalence of between 10 children have already been born using these techniques [3]. As * Julian Rodriguez-Almagro 1 Department of Obstetrics and Gynecology, Hospital Nuestra Señora [email protected] Del Prado, 45600 Talavera de la Reina, Toledo, Spain 2 Department of Sociology, Social Work and Public Health, University Ana Ballesta-Castillejos of Huelva, 21071 Huelva, Spain [email protected] 3 Juan Gomez-Salgado Safety and Health Postgraduate Programme, Universidad Espíritu [email protected] Santo, 091650 Guayaquil, Ecuador 4 Inmaculada Ortiz-Esquinas Department of Nursing, Ciudad Real Nursing School, University of [email protected] Castilla-La Mancha, 13071 Ciudad Real, Spain Antonio Hernández-Martínez 5 Department of Obstetrics and Gynecology, Mancha-Centro Hospital, [email protected] 13600 Alcázar de San Juan, Ciudad Real, Spain 2436 J Assist Reprod Genet (2019) 36:2435–2445 a result of the advances in these techniques and a better acces- in the Spanish Health as compared with women with a spon- sibility to these services, the number of children born through taneous pregnancy. assisted reproductive techniques (ART) has continued to in- crease [4], resulting in an increase in the number of multiple pregnancies and births [5]. Material and method In 1978, the first baby conceived through artificial insem- ination, Louise Joy Brown, was born in England. Gestation Design and selection of the study subjects was considered of high risk because the mother developed pre-eclampsia and the responsible gynaecologist did not want This is a cross-sectional observational study aimed at women to risk a normal delivery and decided to perform a C-section at who have been mothers between 2013 and 2018 in Spain. The week 38 [5]. This example highlights the fact that gestations survey completion was made between January 2019 and through assisted reproductive techniques are associated with June 2019. This study has received the approval of the increased perinatal risk [5, 6]. Ethics and Clinical Research Committee of Alcázar de San Most newborns conceived through ART are healthy, but Juan, in Spain, with protocol number 92-C. these have also been associated with higher rates of adverse The participants were women over the age of 18, who obstetric and perinatal outcomes [7–9]. Concern about the understood Spanish and who agreed to fill in the question- safety of reproductive techniques and their effect on foetal/ naire. Before filling in the questionnaire, the participants had maternal well-being is growing [10]. It is well documented to read the information sheet about the purpose of the study that pregnancies achieved through ART represent a significant and give their consent to participate in it. Survey recipients increase in the risk of multiple pregnancies and adverse peri- were informed that the overall objective of the study was to natal outcomes. Some studies suggest an increased risk of pre- determine the relationship between complications that occur eclampsia, gestational hypertension, placenta praevia and di- after childbirth, the prevalence of breastfeeding and the factors abetes [6, 11–13]. An increase in the incidence of impaired that may be associated with these phenomena so that their foetal growth, premature births and frequency of intrauterine answers were not conditioned by the fact that they had re- death has been observed regarding perinatal outcomes as com- ceived a fertility treatment. After this, they were provided with pared with the average of all pregnancies [5, 14]. In addition, the necessary information to be able to complete the post-IVF pregnancies have significantly higher rates of in- questionnaire, including a brief explanation in less- duced births and C-sections [5]. technical language of each of the items surveyed. The main factors associated with these adverse outcomes Participants were told that that the questions related to were multiple pregnancies and births [15]. However, as the last pregnancy and the weight reported was expected unique embryo transfers become widespread, these figures to be before pregnancy. Participants could voluntarily decrease, but unique gestations still have a higher incidence provide an e-mail address or phone number through of adverse outcomes as compared with spontaneous pregnan- which they would be contacted in case any additional cies [16]. information related to the study was needed. Different studies conducted at European and North For the sample size estimation, the maximum modelling American levels show the current interest in the use of these criterion that requires ten events for each independent variable techniques and their success rates [17, 18]. However, studies to be included in the multivariate model has been used [20]. focusing on neonatal maternal outcomes of pregnant women We have considered, as a reference event for the sample esti- by assisted reproductive techniques are scarcer, and although mate, twin pregnancy, which amounts to around 3% of the the literature relates ART and maternal and neonatal out- general population [21]. Considering a minimum of ten inde- comes, not all of the studies consider factors such as maternal pendent variables, a minimum of 100 women with twin preg- age and other relevant variables such as obstetric clinical re- nancies would be required, representing a minimum total pop- cords [11], and the underlying cause of these results is still ulation of 3333 women under study within this scenario. being discussed. It is still not clear whether poorest perinatal For data collection, an anonymous online questionnaire outcomes are mainly due to the characteristics of the parents was designed with 42 items (30 yes/no questions and 12 mul- or whether assisted reproductive techniques are a contributing tiple answer questions) on sociodemographic variables, ob- factor in themselves [19]. stetric variables, and complications during pregnancy, deliv- It is undeniable that ART is increasingly present in society, ery and postpartum. The time needed to fill in the question- and this makes it important to know the obstetric and perinatal naire was 12–15 min. The answer options for the pathologies risks involved in order to be able to provide the best assis- were Yes and No. In the instructions, the participants were tance. For these reasons, in this study, we have considered informed of the possibility of stating No in those questions describing the incidence of obstetric and perinatal complica- that raised some doubts. The objective of this procedure was tions in women undergoing assisted reproductive treatments to avoid overstating the pathologies on the one hand, and to J Assist Reprod Genet (2019) 36:2435–2445 2437 Table 1 Sociodemographic and obstetric characteristics
Load more

Recommended publications
  • 20. Riesgos Y Complicaciones En FIV-ICSI
    01 serono 1-6 OK:Maquetación 1 8/3/07 12:14 Página 223 20. Riesgos y complicaciones en FIV-ICSI RIESGOS DERIVADOS DEL TRATAMIENTO HORMONAL Estimulación ovárica y riesgo de cáncer La medicación para estimular la ovulación se utiliza desde hace unos cuarenta años para tratar la infertilidad. En los últimos veinte años, diferentes estudios empiezan a cuestio- nar la seguridad de estos fármacos y su relación con distintos tipos de cáncer. Ayhan y cols. en una revisión en el año 2004, concluyen que se necesitan estudios prospectivos, multicéntricos y durante largos periodos de tiempo para determinar la relación entre el uso de los fármacos para estimular la ovulación y el riesgo de cáncer(1). En el año 2000, Klip et al. realizan una revisión desde 1966 a 1999 donde se analiza la relación entre el uso de fármacos de estimulación ovárica y el riesgo de cáncer de ova- rio, mama, endometrio, tiroides y melanoma. Aunque se sugiere una relación entre el uso de los fármacos y el riesgo de cáncer, no existen estudios epidemiológicos que lo demues- tren(2). Más tarde, Kashyap et al. 2004, en su metaanálisis, demuestran una tendencia hacia un efecto beneficioso de las técnicas de reproducción asistida, ya que suelen fina- lizar en embarazo, que es un factor protector contra el cáncer de ovario(3). Sin embargo, Ness et al., 2002, publicaron un metaanálisis(4), en el que encontraban un ligero aumento de riesgo de neoplasia borderline en pacientes que habían sido expues- tas a tratamientos de infertilidad, cuando se comparaba con la población normal, pero Mosgaard demostró que ello es debido en parte a la propia infertilidad(5).
    [Show full text]
  • The ART of Assisted Reproductive Technology
    Infertility • THEME The ART of assisted reproductive technology BACKGROUND One in six Australian couples of The Australian Institute of Health and Welfare's reproductive age experience difficulties in National Perinatal Statistical Unit's annual report Jeffrey Persson, conceiving a child. Once a couple has been Assisted reproductive technology in Australia and New MD, FRANZCOG, CREI, is Clinical appropriately assessed, assisted reproductive Zealand 2002, shows that babies born in 2002 using Director (City), technology (ART) techniques can be used to assisted reproductive technology (ART) had longer IVFAustralia. overcome problems with ovulation, tubal patency, gestational ages, higher birth weights and fewer peri- [email protected] male fertility or unexplained infertility. natal deaths than their counterparts of 2 years OBJECTIVE This article discusses the range of previously.1 ART techniques available to subfertile couples. This is the first year national data have been avail- able on the age of women (and their partners) using DISCUSSION Intracytoplasmic sperm injection is now the most common form of ART used in ART. The average age of women undergoing treat- Australia, being used in almost half of all fresh ment in 2002 was 35.2 years, and the average cycles, with in vitro fertilisation being used in age of partners was 37.6 years.1 Age remains the approximately one-third of all fresh cycles. most significant issue affecting a couple's chance of conceiving and carrying a pregnancy to full term. Women need to understand the impact age has on their chance of becoming pregnant. Once a couple has been assessed and investigations suggest subfer- tility, the treatment options depend on the underlying cause (Table 1).
    [Show full text]
  • Scientific Programme 30 April
    Scientific Programme 30 April - 3 May 2014 Adding pieces to the puzzle of endometriosis Contents 16.00 to 18.30 Sponsors 4 Welcome 5 Partner organisations 8 WES and committees 9 Venue plan 10 At a glance programme 12 Pre-congress courses Wednesday 14 Opening ceremony 19 Programme Thursday 20 Programme Friday 24 Programme Saturday 28 Closing ceremony 31 Exhibitor / poster floor plan 32 Sponsor profiles 33 List of presenters 36 Local information 42 The organisers of WCE2014 would like to thank our generous sponsors Diamond Gold Ruby Silver Bronze Supported by 4 Welcome Dear Colleagues and Friends, Welcome to São Paulo and to the 12th World Congress on Endometriosis. The theme of WCE2014, “Adding pieces to the puzzle of endometriosis”, has been chosen because we Maurício Simões Abrão, are currently experiencing a rapid advancement of new technologies for the diagnosis and management WCE2014 President of endometriosis and, with that, improvements in our understanding of the disease. At the heart of every congress is the scientific programme, which keeps the momentum of our advancements in endometriosis alive through a robust exchange of ideas among the experts and learners in the field. We have received more than 500 outstanding abstracts from the international community, and have put together an extensive and in-depth programme featuring more than 150 speakers and close to 300 poster presentations spanning almost every topic you can imagine that has relevance to endometriosis. This is truly the world event on endometriosis and I welcome each and every one of you to São Paulo to be part of this clinical and scientific extravaganza! For me it is an exciting time to welcome you to São Paulo, one of the top international capitals for gastronomy, architecture and design, cultural heritage and music.
    [Show full text]
  • In Vitro Fertilisation and Embryo Research
    Briefing Note INFORMATION FOR MEMBERS FROM THE 6 Parliamentary Office of Science and Technology November 1989 Figure 1.. Conceptus after 15 days In Vitro Fertilisation and Embryo Research Actual size Following the Warnock Report of 1984 and the 1987 White Paper, the Government has introduced the Human Fertilisation and Embryology Bill con­ taining provisions on research involving human embryos. Parliament is asked to decide between two options set out in Section 11 of the Bill which determine whether the Human Fertilisation and Embryology Authority(HFEA) is empowered to grant licences for research involving human embryos less than 14 days old. This question involves substantial ethical and religious considerations. An understanding of scientific aspects of human fertilisation and embryology may assist Parliamentarians to come to grips with these considerations. Some of the relevant science and technology is de­ scribed in this note. it is argued that this should not be such as to prevent the benefits to others which research may provide. THE STATUS OF THE EARLY EMBRYO Science alone cannot resolve this question, but a clearer understanding of the early developmental process of An important issue relates to the status afforded the the fertilised egg may provide illumination to allow in­ fertilised egg and the early (pre-14 day) embryo or dividuals to reach their own decision. conceptus1. Some argue that these should have the status of a human being from the moment of fertilisa­ Early Human Development tion, since the fusion of egg and sperm produces a unique genetic combination which, if it develops nor­ After the egg has been fertilised, it divides into two mally, will develop into a child.
    [Show full text]
  • The Protection of the Human Embryo in Vitro
    Strasbourg, 19 June 2003 CDBI-CO-GT3 (2003) 13 STEERING COMMITTEE ON BIOETHICS (CDBI) THE PROTECTION OF THE HUMAN EMBRYO IN VITRO Report by the Working Party on the Protection of the Human Embryo and Fetus (CDBI-CO-GT3) Table of contents I. General introduction on the context and objectives of the report ............................................... 3 II. General concepts............................................................................................................................... 4 A. Biology of development ....................................................................................................................... 4 B. Philosophical views on the “nature” and status of the embryo............................................................ 4 C. The protection of the embryo............................................................................................................... 8 D. Commercialisation of the embryo and its parts ................................................................................... 9 E. The destiny of the embryo ................................................................................................................... 9 F. “Freedom of procreation” and instrumentalisation of women............................................................10 III. In vitro fertilisation (IVF).................................................................................................................. 12 A. Presentation of the procedure ...........................................................................................................12
    [Show full text]
  • (IVF/ICSI) Treatment
    Policy of Reducing Multiple Births following In Vitro Fertilisation / Intracytoplasmic Injection (IVF/ICSI) Treatment Introduction When you really want to have a child, the idea of becoming pregnant with more than one baby as a result of your fertility treatment may sound ideal, especially if you have been waiting a long time. However, there are some significant risks associated with multiple pregnancies. Indeed, a multiple pregnancy is considered the single greatest health risk to both mother and child following IVF. Up until recently, about 1 in 4 IVF/ICSI pregnancies lead to the birth of twins or higher order multiple births (e.g. triplets). This means that after IVF/ICSI treatment, you are around 20 times more likely to have a multiple pregnancy than you would be if you conceived naturally. The reason for this high rate of multiple pregnancy is because, in most cases, more than one embryo is transferred during treatment. Research has also shown that women receiving fertility treatment are more likely to have identical twins (that is 2 babies derived from a single embryo), although this only accounts for a small proportion of the total number of twin pregnancies. In order to reduce the rates of multiple pregnancy, the Human Fertilisation and Embryology Authority (HFEA) has established regulations and targets, with which all fertility centres providing IVF/ICSI treatments must comply. What are the risks of a Multiple Pregnancy? A table comparing the risks of multiple and singleton pregnancies is available separately from this leaflet. Risks to the Mother All the risks of pregnancy and birth are significantly increased for women who are SDFC161 | Issue 5 | Author – David Chui | Authorised by – Jane Skelton 1 Publish Date: May 2020 | Review Due: May 2022 pregnant with more than one baby.
    [Show full text]
  • The Influence of Infertility and in Vitro Fertilization Treatment on Postpartum
    Linköping University Medical Dissertations No. 1554 The influence of infertility and in vitro fertilization treatment on postpartum and long-term mental health in women Josefin Vikström Eckevall Division of Obstetrics and Gynaecology Department of Clinical and Experimental Medicine Faculty of Medicine and Health Sciences Linköping University, Sweden © Josefin Vikström Eckevall The published articles have been reprinted with permission of the copyright holders. Printed by LiU-Tryck, Linköping 2016. ISBN - 978-91-7685-637-6 ISSN - 0345-0082 Table of contents Abstract 1 Sammanfattning 3 List of papers 9 Abbreviations 11 Introduction to the thesis 13 General introduction 13 Involuntary childlessness, infertility and psychological well-being 15 Infertility treatment outcome and psychological well-being 18 Voluntary childlessness 21 Infertility, IVF treatment and postpartum psychiatric disorders 21 Postpartum psychiatric disorders after infertility treatment 26 Long-term psychological consequences of infertility treatment 28 Psychological well-being and social support in middle and old age 30 Rationale and aims of the thesis 35 Aims of the individual studies 36 Material and methods 39 Study I-II 39 Population 39 Data sources 39 Study design 41 Data analyses 43 Study III 43 Population 45 Data sources 45 Study design 46 Data analyses 47 Study IV 47 Population 47 Data sources 48 Study design 49 Data analyses 50 Results 53 Study I 53 Study II 56 Study III 59 Study IV 61 General discussion and conclusions 67 Summary of principal findings 67 Methodological considerations 68 Principal findings in relation to other research 74 Limitations 88 Conclusions 91 Ethical considerations 93 Clinical implications 94 Future perspectives 95 Acknowledgements 97 References 99 Papers I-IV 111 To Björn and Karl Abstract Introduction: It is estimated that about 10-15% of couples suffer from infertility, i.e.
    [Show full text]
  • In Vitro Fertilisation (Ivf)
    IN VITRO 2. OVULATION STIMULATION PHASE IN VITRO Daily injections with a Follicle Stimulating Hormone (FSH) (Gonal FERTILISATION F or Puregon) for 8-12 days. This stimulates the growth of several FERTILISATION follicles instead of just 1 or 2. The response of the ovaries is (IVF) monitored by ultrasound and occasionally by the use of blood tests. Most women learn to give their own injections to reduce (IVF) the number of visits to the clinic. 3. EGG RETRIEVAL PHASE DID YOU KNOW Once the ultrasounds indicate a reasonable size and number of In general, about 20 to 25% of healthy fertile couples follicles, an injection of hCG is given, causing final maturation become pregnant each month they try. In contrast, the and loosening of the egg from the wall of the follicle. The egg retrieval occurs two mornings after this final injection (34 to 36 pregnancy rate among couples with infertility is usually hours later). about 2 to 5% per month. Various treatments have been The egg retrieval is performed by an ultrasound guided needle used in an attempt to improve these pregnancy rates. puncture through the top of the vagina. The fluid is drained In-vitro fertilisation (IVF) is a process used to treat infertility from each follicle and examined under the microscope for the presence of an egg. that has failed to respond to other medical or surgical interventions. Since the world’s first IVF baby, Louise Brown, 4. FERTILISATION PHASE born in 1978, more than 3,000,000 babies have been The sperm sample is washed and concentrated, then added to the eggs a few hours after retrieval.
    [Show full text]
  • What Is Fertility Treatment?
    V01 2021 PG01 What is fertility treatment? This factsheet describes fertility treatment options. Ask your doctor about the best options for you. Fertility treatments are used: • for people who can’t become pregnant, carry a pregnancy or give birth • to reduce the chance of a baby being born with a genetic disease or abnormality • to preserve fertility. Simple fertility treatments Ovulation induction (OI) Artificial insemination (AI) OI can be used if a woman is not ovulating AI is sometimes called intrauterine (releasing an egg) regularly. It involves: insemination (IUI). It involves: • taking a hormone medication (tablets • putting sperm into a woman’s uterus or injections) to stimulate ovulation at or just before ovulation. • checking progress with ultrasound • having an injection to trigger ovulation • having sex just before ovulation. Complex fertility treatments More complicated fertility treatments are known as assisted reproductive technology (ART) treatments. In-vitro fertilisation (IVF) Intracytoplasmic sperm injection (ICSI) IVF involves: ICSI is the same as IVF, but more expensive because a • hormone injections to stimulate the ovaries to produce single sperm is directly injected into each egg. several eggs ICSI is used to overcome sperm problems (male factor • egg collection during a short surgical procedure infertility). • adding sperm to the eggs to form embryos • embryo transfer (an embryo is placed in the uterus) Preimplantation genetic testing (PGT) • pregnancy test two weeks after embryo transfer PGT can be used by people who are at a high risk of • if the test is positive, an ultrasound two weeks later passing on a genetic condition to their children. to check the pregnancy.
    [Show full text]
  • GONAL-F, INN-Follitropin Alfa
    ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT GONAL-f 75 IU powder and solvent for solution for injection 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each vial contains 5.5 micrograms of follitropin alfa* equivalent to 75 IU. Each mL of the reconstituted solution contains 75 IU. * recombinant human follicle stimulating hormone (r-hFSH) produced in Chinese Hamster Ovary (CHO) cells by recombinant DNA technology For the full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Powder and solvent for solution for injection. Appearance of the powder: white lyophilised pellet. Appearance of the solvent: clear colourless solution. The pH of the reconstituted solution is 6.5-7.5. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications In adult women • Anovulation (including polycystic ovarian syndrome) in women who have been unresponsive to treatment with clomiphene citrate. • Stimulation of multifollicular development in women undergoing superovulation for assisted reproductive technologies (ART) such as in vitro fertilisation (IVF), gamete intra-fallopian transfer and zygote intra-fallopian transfer. • GONAL-f in association with a luteinising hormone (LH) preparation is recommended for the stimulation of follicular development in women with severe LH and FSH deficiency. In clinical trials these patients were defined by an endogenous serum LH level < 1.2 IU/L. In adult men • GONAL-f is indicated for the stimulation of spermatogenesis in men who have congenital or acquired hypogonadotrophic hypogonadism with concomitant human Chorionic Gonadotropin (hCG) therapy. 4.2 Posology and method of administration Treatment with GONAL-f should be initiated under the supervision of a physician experienced in the treatment of fertility disorders.
    [Show full text]
  • Recurrent Pregnancy Loss
    Recurrent Pregnancy Loss November 2017 Version 2 0 ESHRE Early Pregnancy Guideline Development Group [1] Version 2 was published 1 April 2019 and includes a correction in the numbers mentioned in section 4.2 on page 39 (changes were marked in green). No further changes were made as compared to version 1 (published November 2017) DISCLAIMER The European Society of Human Reproduction and Embryology (hereinafter referred to as 'ESHRE') developed the current clinical practice guideline, to provide clinical recommendations to improve the quality of healthcare delivery within the European field of human reproduction and embryology. This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. The aim of clinical practice guidelines is to aid healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients. However, adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not override the healthcare professional's clinical judgment in diagnosis and treatment of particular patients. Ultimately, healthcare professionals must make their own clinical decisions on a case-by-case basis, using their clinical judgment, knowledge, and expertise, and taking into account the condition, circumstances, and wishes of the individual patient, in consultation with that patient and/or the guardian or carer. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose.
    [Show full text]
  • Mean? Prenatal Diagnosis Or Screening What Is Amniocentesis?
    What does ‘assisted conception’ mean? Assisted conception or assisted reproductive technology is any method used to help couples who cannot conceive naturally or who need IVF for other reasons. These include in vitro fertilisation (IVF) where an egg is fertilised with sperm outside of the body (in vitro meaning ‘in glass’, which is why the term ‘test-tube baby’ is often used). The “glass” is usually a flat plastic dish – no test tubes are involved! Assisted conception can also include using a third party (egg or sperm donation), using methods to insert sperm directly into the woman’s uterus (intrauterine insemination - IUI), transferring eggs and sperm into the woman’s fallopian tubes (gamete intrafallopian transfer - GIFT), or even surrogacy, where another woman carries the embryo to full term and gives birth to the baby. Prenatal diagnosis or screening These are the tests done to find out if an embryo or fetus has a particular condition, e.g. thalassaemia, sickle cell anaemia, cystic fibrosis, Huntingdon’s disease or muscular dystrophy. Prenatal screening can also used to determine whether the baby will be a boy or a girl. Examples of prenatal screening includes amniocentesis and chorionic villus sampling. What is amniocentesis? Amniocentesis is a procedure where a small amount of amniotic fluid containing fetal cells is collected by inserting a needle through the mother’s abdominal wall. It is usually performed at around 16-18 weeks of pregnancy. The cells can be analysed for genetic abnormalities. such as Down’s Syndrome. What is chorionic villus sampling (CVS)? Chorionic villus sampling involves taking a small part of the placenta, which is then tested for genetic abnormalities.
    [Show full text]