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The present status of assisted reproductive technology in Asia-Oceania

Chang YS, Jun JK, Choi YM, Moon SY

Asia Oceania J Obstet Gynaecol, 1994 Dec;20(4):331-44.
PMID: 7832663

This is a survey on the present status of assisted reproductive technology in the Asia-Oceanic region. The survey formats were sent to the 19-member societies of AOFOG. By the end of August 1991, 11 countries responded: Australia, Egypt, Hong Kong, Israel, Japan, Malaysia, New Zealand, Philippines, Republic of China, Singapore and Thailand. This report is a summary of data from 12 countries including Korea. It comprised of 14 headings: IVF, GIFT, AIH, AID, donor sperm in ART, donor eggs in ART, preembryos from IVF for donation, cryopreservation of eggs, cryopreservation of fertilized eggs and preembryos, research of preembryos, surrogate mothers, additional procedures, quality assurance in reproductive technology and formation of policy for emerging reproductive technology. Each heading is composed of status of regulations, cost and coverage and the results and management of program.

Matched MeSH terms: Reproductive Techniques/statistics & numerical data*
Will sex selection reduce fertility?

Leung SF

J Popul Econ, 1994;7(4):379-92.
PMID: 12288505
Matched MeSH terms: Reproductive Techniques
Evaluation of the infertile male

Lei CCM, Ng PEP, Thambi I

Family Physician, 1996;8:31-34.

In the evaluation of the infertile couple, male factors account for up to 50% of causes. These factors may occur alone or in combination with female causes. Transrectal ultrasound has allowed imaging of the urogenital tract to be less invasive. New assisted reproductive techniques (ART) have revolutionised management. Many previously "hopeless" cases now have a good chance of fathering a child. Such ART include microscopic epididymal sperm aspiration (MESA) and intracytoplasmic sperm injection (ICSI).

Matched MeSH terms: Reproductive Techniques
Should this couple have undergone infertility treatment?

Adibah I, Bakar WY

Indian J Med Ethics, 2005 Oct-Dec;2(4):126.
PMID: 16619438
Matched MeSH terms: Reproductive Techniques, Assisted/ethics*
Fulltext Affordable ART for developing countries: a cost benefit comparison of low dose stimulation versus high dose GnRH antagonist protocol

Noorashikin M, Ong FB, Omar MH, Zainul-Rashid MR, Murad AZ, Shamsir A, et al.

J Assist Reprod Genet, 2008 Jul;25(7):297-303.
PMID: 18654847 DOI: 10.1007/s10815-008-9239-9

Low dose stimulation (LS) is emerging as an alternative regime in assisted reproductive technology (ART). This study aimed to compare the cost-effectiveness of LS to the high dose GnRH antagonist (Atg) regime.

Matched MeSH terms: Reproductive Techniques, Assisted*
Fulltext Advancements in reprogramming strategies for the generation of induced pluripotent stem cells

Lai MI, Wendy-Yeo WY, Ramasamy R, Nordin N, Rosli R, Veerakumarasivam A, et al.

J Assist Reprod Genet, 2011 Apr;28(4):291-301.
PMID: 21384252 DOI: 10.1007/s10815-011-9552-6

Direct reprogramming of somatic cells into induced pluripotent stem (iPS) cells has emerged as an invaluable method for generating patient-specific stem cells of any lineage without the use of embryonic materials. Following the first reported generation of iPS cells from murine fibroblasts using retroviral transduction of a defined set of transcription factors, various new strategies have been developed to improve and refine the reprogramming technology. Recent developments provide optimism that the generation of safe iPS cells without any genomic modification could be derived in the near future for the use in clinical settings. This review summarizes current and evolving strategies in the generation of iPS cells, including types of somatic cells for reprogramming, variations of reprogramming genes, reprogramming methods, and how the advancement iPS cells technology can lead to the future success of reproductive medicine.

Matched MeSH terms: Reproductive Techniques
An international view of surgically assisted conception and surrogacy tourism

Ahmad N

Med Leg J, 2011;79(Pt 4):135-45.
PMID: 22156300 DOI: 10.1258/mlj.2011.011029

Modern medicine, specifically assisted reproductive technology (ART), has overtaken the law in many jurisdictions around the world. New technologies and practices open a Pandora's Box of ethical, religious, social and legal questions, and may present a variety of significant legal problems to the courts and legislators. Surrogate motherhood and pregnancy through ART have both attracted controversy. Some groups condemn ART and want it banned while its supporters acknowledge there is a need for legislative guidelines and regulations. A proposed statute, the Assisted Reproductive Technique Services Act, aimed at regulating reproductive technologies, including surrogacy arrangements, will be introduced in the Malaysian parliament, probably in 2012, and the Assisted Reproductive Technology (Regulation) Bill 2010 is already before the Indian parliament. This paper will discuss several of the potential socio-legal issues surrounding ART in the light of the complex situation, with a comparative analysis of the Malaysian, USA, UK and Indian positions.

Matched MeSH terms: Reproductive Techniques, Assisted/legislation & jurisprudence*; Reproductive Techniques, Assisted/ethics
Treatment of the Hypogonadal Infertile Male-A Review

Ho CC, Tan HM

Sex Med Rev, 2013 May;1(1):42-49.
PMID: 27784559 DOI: 10.1002/smrj.4

INTRODUCTION: Testosterone treatment for hypogonadism is detrimental for men in reproductive age as it impairs spermatogenesis, and therefore affects fertility. It is, therefore, not indicated in men with hypogonadism and infertility.
AIM: The aim of this review is to analyze current data regarding options of treatment for men with hypogonadism and infertility.
MAIN OUTCOMES MEASURES: A comprehensive review of the current literature on management of infertility among hypogonadal men.
METHODS: A literature search using PubMed from 1980 to 2012 was done on articles published in the English language. The following medical subject heading terms were used: "infertility," "infertile," "hypogonadism;" "testosterone deficiency" and "men" or "male;" and "treatment" or "management."
RESULTS: The options for hypogonadal testicular failure are limited. Hormonal treatment is by and large ineffective. For secondary hypogonadism (hypogonadotropic/normogonadotropic hypogonadism), the options include gonadotropin-releasing hormone, human chorionic gonadotropin (hCG), human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), and anti-estrogens and aromatase inhibitors. Dopamine antagonist is indicated for prolactinoma. Artificial reproductive technique is indicated for primary testicular failure and also when medical therapy fails.
CONCLUSION: The most suitable option with the current data available is hCG with or without hMG/FSH. Testosterone supplementation should be avoided, but if they are already on it, it is still possible for a return of normal sperm production within 1 year after discontinuing testosterone. Ho CCK and Tan HM. Treatment of the hypogonadal infertile male-A review. Sex Med Rev 2013;1:42-49.

Matched MeSH terms: Reproductive Techniques
A mother with variant Turner syndrome and two daughters with trisomy X: a case report

Ramachandram S, Keng WT, Ariffin R, Ganesan V

J Genet, 2013;92(2):313-6.
PMID: 23970090
Matched MeSH terms: Reproductive Techniques, Assisted
Fulltext Iatrogenic (‘clinician-induced’) damage incurred by human sperm during infertility treatment: postgraduate research and collaborative developments between the universities of Malaya and Oxford

Yelumalai, S., Jones, C., Coward, K.

JUMMEC, 2013;16(2):1-6.
MyJurnal

Assisted Reproductive Technology (ART) is a suite of laboratory techniques designed to rescue infertile phenotypes. While ART has led to the birth of 5 million ART babies worldwide, success rates rarely exceed 40%. One potential factor for this could be iatrogenic (‘clinician-induced’) damage to critical sperm proteins, such as phospholipase C zeta (PLCζ) and protamine, which are fundamental for oocyte activation and sperm DNA integrity, respectively. This report describes how we have begun to investigate the adverse effects of ART techniques upon these key sperm proteins. We also describe the pathway taken by Miss Suseela Yelumalai to acquire a scholarship from the Malaysian Government and her postgraduate experience at the University of Oxford. We introduce the facilities and learning opportunities available at the Institute of Reproductive Sciences (IRS) which houses Dr Kevin Coward’s research laboratory, and finally, highlight the potential for collaborative development between the Universities of Oxford and Malaya.

Matched MeSH terms: Reproductive Techniques, Assisted
A pilot study to determine whether progestogen supplementation using dydrogesterone during the first trimester will reduce the incidence of gestational hypertension in primigravidae

Zainul Rashid MR, Lim JF, Nawawi NH, Luqman M, Zolkeplai MF, Rangkuty HS, et al.

Gynecol Endocrinol, 2014 Mar;30(3):217-20.
PMID: 24552449 DOI: 10.3109/09513590.2013.860960

Gestational hypertension (GH) remains one of the main causes of high maternal and perinatal morbidity and mortality worldwide with the highest incidence among primigravidae of about 10%-15%. However, it was noted that the incidence of GH in primigravidae who conceived following assisted reproductive technique (ART) or intrauterine insemination (IUI) supplemented with dydrogesterone during the first trimester was low.

Study site: Obstetrics and Gynecology
Department, Pusat Perubatan Universiti Kebangsaan Malaysia PPUKM

Matched MeSH terms: Reproductive Techniques, Assisted
Fulltext Is Assisted Reproductive Technique Shari’aa-compliant? A case study at a fertility centre in Malaysia

Ahmad Murad Z, Zailin Shah Y, Mansor S, Ahmad Irfan IH, Abdullah L

International Medical Journal Malaysia, 2014;13(2):21-27.
MyJurnal

Introduction: To investigate the questions that Muslim patients, embryologists, paramedics, clinical counsellor and doctors may have pertaining to the compliance of Assisted Reproductive Technique (ART) to Shari’aa.

Methods: As a preliminary study, an open-ended survey was administered to participants. Participants for the survey comprised of 21 patients, 2 embryologists, 2 doctors, 4 paramedics and 1 counsellor.

Results: Data analysis showed that most of the participants posed questions that fall into six classifications which are: Munakahat (Family Law), social Hukm, Fiqh Ibadah, Fiqh Qadha (Islamic Hukm), General Fiqh and Usul Fiqh.

Conclusion: It is clear that even though the participants were rather familiar with some of the existing Fatwas pertaining to ART and IVF in Malaysia, there are still remaining doubts which need to be clarified. This indicates that there are challenges faced in seeking and providing ART treatment to Muslim patients. This needs to be addressed perhaps in the form of Shari’aa-compliant guidelines to provide a clear explanation of each process and procedure in fertility treatment.

Matched MeSH terms: Reproductive Techniques, Assisted
Influence of endometriosis on assisted reproductive technology outcomes: a systematic review and meta-analysis

Hamdan M, Omar SZ, Dunselman G, Cheong Y

Obstet Gynecol, 2015 Jan;125(1):79-88.
PMID: 25560108 DOI: 10.1097/AOG.0000000000000592

OBJECTIVE: To investigate the association of endometriosis on assisted reproductive technology (ART) outcomes and to review if surgical treatment of endometriosis before ART affects the outcomes.
DATA SOURCES: We searched studies published between 1980 and 2014 on endometriosis and ART outcome. We searched MEDLINE, PubMed, ClinicalTrials.gov, and Cochrane databases and performed a manual search.
METHODS OF STUDY SELECTION: A total of 1,346 articles were identified, and 36 studies were eligible to be included for data synthesis. We included published cohort studies and randomized controlled trials.
TABULATION, INTEGRATION, AND RESULTS: Compared with women without endometriosis, women with endometriosis undertaking in vitro fertilization and intracytoplasmic sperm injection have a similar live birth rate per woman (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.84-1.06, 13 studies, 12,682 patients, I=35%), a lower clinical pregnancy rate per woman (OR 0.78, 95% CI 0.65-0.94), 24 studies, 20,757 patients, I=66%), a lower mean number of oocyte retrieved per cycle (mean difference -1.98, 95% CI -2.87 to -1.09, 17 studies, 17,593 cycles, I=97%), and a similar miscarriage rate per woman (OR 1.26, 95% CI (0.92-1.70, nine studies, 1,259 patients, I=0%). Women with more severe disease (American Society for Reproductive Medicine III-IV) have a lower live birth rate, clinical pregnancy rate, and mean number of oocytes retrieved when compared with women with no endometriosis.
CONCLUSION: Women with and without endometriosis have comparable ART outcomes in terms of live births, whereas those with severe endometriosis have inferior outcomes. There is insufficient evidence to recommend surgery routinely before undergoing ART.

Matched MeSH terms: Reproductive Techniques, Assisted*
In reply

Hamdan M, Cheong Y

Obstet Gynecol, 2015 Jun;125(6):1499.
PMID: 26000533 DOI: 10.1097/AOG.0000000000000892
Matched MeSH terms: Reproductive Techniques, Assisted*
Higher β-HCG concentrations and higher birthweights ensue from single vitrified embryo transfers

Keane KN, Mustafa KB, Hinchliffe P, Conceicao J, Yovich JL

Reprod Biomed Online, 2016 Aug;33(2):149-60.
PMID: 27209497 DOI: 10.1016/j.rbmo.2016.04.014

To examine the effect of cryopreservation on developmental potential of human embryos, this study compared quantitative β-HCG concentrations at pregnancy test after IVF-fresh embryo transfer (IVF-ET) with those arising after frozen embryo transfer (FET). It also tracked outcomes of singleton pregnancies resulting from single-embryo transfers that resulted in singleton live births (n = 869; with 417 derived from IVF-ET and 452 from FET). The initial serum β-HCG concentration indicating successful implantation was measured along with the birthweight of the ensuing infants. With testing at equivalent luteal phase lengths, the median pregnancy test β-HCG was significantly higher following FET compared with fresh IVF-ET (844.5 IU/l versus 369 IU/l; P < 0.001). Despite no significant difference in the average period of gestation (38 weeks 5 days for both groups), the mean birthweight of infants born following FET was significantly heavier by 161 g (3370 g versus 3209 g; P < 0.001). Furthermore, more infants exceeded 4000 g (P < 0.001) for FET although there was no significant difference for the macrosomic category (≥4500 g). We concluded that FET programme embryos lead to infants with equivalent (if not better) developmental potential compared with IVF-ET, demonstrated by higher pregnancy β-HCG concentrations and ensuing birthweights.

Matched MeSH terms: Reproductive Techniques, Assisted*
Religious scholars' attitudes and views on ethical issues pertaining to pre-implantation genetic diagnosis (PGD) in Malaysia

Olesen A, Nor SN, Amin L

J Bioeth Inq, 2016 Sep;13(3):419-29.
PMID: 27365102 DOI: 10.1007/s11673-016-9724-2

Pre-Implantation Genetic Diagnosis (PGD) represents the first fusion of genomics and assisted reproduction and the first reproductive technology that allows prospective parents to screen and select the genetic characteristics of their potential offspring. However, for some, the idea that we can intervene in the mechanisms of human existence at such a fundamental level can be, at a minimum, worrying and, at most, repugnant. Religious doctrines particularly are likely to collide with the rapidly advancing capability for science to make such interventions. This paper focuses on opinions and arguments of selected religious scholars regarding ethical issues pertaining to PGD. In-depth interviews were conducted with religious scholars from three different religious organizations in the Klang Valley, Malaysia. Findings showed that Christian scholars are very sceptical of the long-term use of PGD because of its possible effect on the value of humanity and the parent-children relationship. This differs from Islamic scholars, who view PGD as God-given knowledge in medical science to further help humans understand medical genetics. For Buddhist scholars, PGD is considered to be new medical technology that can be used to save lives, avoid suffering, and bring happiness to those who need it. Our results suggest that it is important to include the opinions and views of religious scholars when it comes to new medical technologies such as PGD, as their opinions will have a significant impact on people from various faiths, particularly in a multi-religious country like Malaysia where society places high value on marital relationships and on the traditional concepts of family.

Matched MeSH terms: Reproductive Techniques, Assisted/ethics*
Fulltext Vitrification of Blastocyst Murine embryos affects PI3K pathway by modulating the expression of XIAP and S6K1 proteins

Mohd Fazirul, M., Sharaniza, A.R., Norhazlin, J.M.Y., Wan Hafizah, W.J., Razif, D., Froemming, G.R.A., et al.

Pertanika Journal of Science & Technology, 2017;25(108):187-198.
MyJurnal

Cryopreservation by vitrification has been widely used in Assisted Reproductive Technology (ART) to preserve embryos for an extended period of time. However, the effect of vitrification on development of the embryos is lacking. Therefore, understanding on vitrification effects on embryonic proteins, especially those involved in preimplantation development is crucial to provide high quality embryos for further usage. In this study, XIAP and S6K1 protein expressions following vitrification was investigated, since they have been implicated in diverse cellular processes including cell growth, migration, proliferation, differentiation, survival and development of preimplantation embryos via the PI3K pathway. Embryos were obtained from superovulated female ICR mice which were mated with fertile males. The embryos were harvested at the 2-cell stage and cultured until blastocyst stage. Blastocysts were then vitrified in ESF40 cryoprotectant. Western blot was carried out to determine the expression of XIAP and S6K1 proteins. The results showed the expression of XIAP and S6K1 significantly decreased in vitrified blastocyst compared to the control. This indicates that blastocyst vitrification may impact developmental competence through the activation of apoptotic pathways.

Matched MeSH terms: Reproductive Techniques, Assisted
A survey of scientists' awareness of and attitudes to the use of human blood products and alternatives in human assisted reproductive technology

Peirce K, Roberts P, Ali J, Coombes J, Matson P

Hum Fertil (Camb), 2018 Sep;21(3):174-182.
PMID: 28589740 DOI: 10.1080/14647273.2017.1334131

Scientists working in assisted reproduction [members of Scientists in Reproductive Technology (SIRT) Australia, and subscribers of the online forums EmbryoMail and Quartec] were invited to complete an online questionnaire on the use of human blood products in assisted reproductive technologies (ART). A total of 260 started the questionnaire, with 208 (80%) completing it. A total of 62% of respondents had worked in human ART ≥8 years and 68% had post-graduate qualifications. The majority (82%) reported using products of animal or human origin, with 75% knowing why protein was added to culture media and 41% not worried by this. Almost half (49%) of respondents were unaware of regulations surrounding the use of human blood products in health care and 70% were unaware of adverse events involving human blood products in human ART. Most respondents (70%) indicated that they were not concerned about infections such as hepatitis, but agents such as prions were a cause for concern (57%). A total of 57% of respondents were unaware of alternatives, but 77% would use a suitable alternative. Using blood products in human ART is surrounded by a lack of awareness, often independent of respondents' qualifications or experience. A better understanding of these products and possible alternatives is required if informed decisions about their suitability are to be made.

Matched MeSH terms: Reproductive Techniques, Assisted/adverse effects*; Reproductive Techniques, Assisted/standards
Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa

Ibrahim AH, Rahman NNA, Saifuddeen SM

Sci Eng Ethics, 2018 10;24(5):1493-1502.
PMID: 28895055 DOI: 10.1007/s11948-017-9963-6

Rapid development in the area of assisted reproductive technology (ART), has benefited mankind by addressing reproductive problems. However, the emergence of new technologies and techniques raises various issues and discussions among physicians and the masses, especially on issues related to bioethics. Apart from solutions provided using conventional bioethics framework, solutions can also be derived via a complementary framework of bioethics based on the Higher Objectives of the Divine Law (Maqasid al-Shariah) in tackling these problems. This approach in the Islamic World has been applied and localised in the Malaysian context. Thus, this paper highlights a conceptual theoretical framework for solving current bioethical issues, with a special focus on ART in the Malaysian context, and compares this theory with conventional theories of bioethics.

Matched MeSH terms: Reproductive Techniques, Assisted/ethics*
Reactive oxygen species-induced alterations in H19-Igf2 methylation patterns, seminal plasma metabolites, and semen quality

Darbandi M, Darbandi S, Agarwal A, Baskaran S, Dutta S, Sengupta P, et al.

J Assist Reprod Genet, 2019 Feb;36(2):241-253.
PMID: 30382470 DOI: 10.1007/s10815-018-1350-y

PURPOSE: This study was conducted in order to investigate the effects of reactive oxygen species (ROS) levels on the seminal plasma (SP) metabolite milieu and sperm dysfunction.
METHODS: Semen specimens of 151 normozoospermic men were analyzed for ROS by chemiluminescence and classified according to seminal ROS levels [in relative light units (RLU)/s/106 sperm]: group 1 (n = 39): low (ROS

Matched MeSH terms: Reproductive Techniques, Assisted

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