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Letter to the editor related to the article "stress in couples undergoing assisted reproductive technology" published by Tuncay et al

Ahmad MF, Sidi H, Das S

Arch Gynecol Obstet, 2021 03;303(3):853-854.
PMID: 32876742 DOI: 10.1007/s00404-020-05756-3
Matched MeSH terms: Reproductive Techniques, Assisted*
Afterword to an update on male infertility: Factors, mechanisms, and interventions

Durairajanayagam D, Agarwal A, Baskaran S, Ko E, Ramasamy R

Andrologia, 2021 Feb;53(1):e13752.
PMID: 33484502 DOI: 10.1111/and.13752
Matched MeSH terms: Reproductive Techniques, Assisted
A scientometric analysis of research publications on male infertility and assisted reproductive technology

Agarwal A, Panner Selvam MK, Baskaran S, Finelli R, Leisegang K, Barbăroșie C, et al.

Andrologia, 2021 Feb;53(1):e13842.
PMID: 33236365 DOI: 10.1111/and.13842

Assisted reproductive technologies (ART) are considered as one of the primary management options to address severe male factor infertility. The purpose of this study was to identify the research trends in the field of male infertility and ART over the past 20 years (2000-2019) by analysing scientometric data (the number of publications per year, authors, author affiliations, journals, countries, type of documents, subject area and number of citations) retrieved using the Scopus database. We used VOS viewer software to generate a network map on international collaborations as well as a heat map of the top scientists in this field. Our results revealed a total of 2,148 publications during this period with Cleveland Clinic Foundation contributing the most (n = 69). The current scientometric analysis showed that the research trend on ART has been stable over the past two decades. Further in-depth analysis revealed that density gradient centrifugation (46%) and intracytoplasmic sperm injection (59.2%) are the most reported techniques for sperm separation and ART, respectively. Additionally, azoospermia was the most studied clinical scenario (60.6%), with majority of articles reporting pregnancy rate (47.25%) as the primary reproductive outcome for ART. This study provides insight into the current focus of research in the area of male infertility and ART as well as the areas that require further research in future.

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*
The ART of bringing extinction to a freeze - History and future of species conservation, exemplified by rhinos

Hildebrandt TB, Hermes R, Goeritz F, Appeltant R, Colleoni S, de Mori B, et al.

Theriogenology, 2021 Jul 15;169:76-88.
PMID: 33940218 DOI: 10.1016/j.theriogenology.2021.04.006

The ongoing mass extinction of animal species at an unprecedented rate is largely caused by human activities. Progressive habitat destruction and fragmentation is resulting in accelerated loss of biodiversity on a global scale. Over decades, captive breeding programs of non-domestic species were characterized by efforts to optimize species-specific husbandry, to increase studbook-based animal exchange, and to improve enclosure designs. To counter the ongoing dramatic loss of biodiversity, new approaches are warranted. Recently, new ideas, particularly the application of assisted reproduction technologies (ART), have been incorporated into classical zoo breeding programs. These technologies include semen and oocyte collection, artificial insemination, and in-vitro embryo generation. More futuristic ideas of advanced ART (aART) implement recent advances in biotechnology and stem-cell related approaches such as cloning, inner cell mass transfer (ICM), and the stem-cell-associated techniques (SCAT) for the generation of gametes and ultimately embryos of highly endangered species, such as the northern white rhinoceros (Ceratotherium simum cottoni) of which only two female individuals are left. Both, ART and aART greatly depend on and benefit from the rapidly evolving cryopreservation techniques and biobanking not only of genetic, but also of viable cellular materials suitable for the generation of induced pluripotent stem cells (iPSC). The availability of cryopreserved materials bridges gaps in time and space, thereby optimizing the available genetic variability and enhancing the chance to restore viable populations.

Matched MeSH terms: Reproductive Techniques, Assisted/veterinary
'Intracytoplasmic sperm injection (ICSI) paradox' and 'andrological ignorance': AI in the era of fourth industrial revolution to navigate the blind spots

Sengupta P, Dutta S, Jegasothy R, Slama P, Cho CL, Roychoudhury S

Reprod Biol Endocrinol, 2024 Feb 13;22(1):22.
PMID: 38350931 DOI: 10.1186/s12958-024-01193-y

The quandary known as the Intracytoplasmic Sperm Injection (ICSI) paradox is found at the juncture of Assisted Reproductive Technology (ART) and 'andrological ignorance' - a term coined to denote the undervalued treatment and comprehension of male infertility. The prevalent use of ICSI as a solution for severe male infertility, despite its potential to propagate genetically defective sperm, consequently posing a threat to progeny health, illuminates this paradox. We posit that the meteoric rise in Industrial Revolution 4.0 (IR 4.0) and Artificial Intelligence (AI) technologies holds the potential for a transformative shift in addressing male infertility, specifically by mitigating the limitations engendered by 'andrological ignorance.' We advocate for the urgent need to transcend andrological ignorance, envisaging AI as a cornerstone in the precise diagnosis and treatment of the root causes of male infertility. This approach also incorporates the identification of potential genetic defects in descendants, the establishment of knowledge platforms dedicated to male reproductive health, and the optimization of therapeutic outcomes. Our hypothesis suggests that the assimilation of AI could streamline ICSI implementation, leading to an overall enhancement in the realm of male fertility treatments. However, it is essential to conduct further investigations to substantiate the efficacy of AI applications in a clinical setting. This article emphasizes the significance of harnessing AI technologies to optimize patient outcomes in the fast-paced domain of reproductive medicine, thereby fostering the well-being of upcoming generations.

Matched MeSH terms: Reproductive Techniques, Assisted
Sunni Islamic perspectives on lab-grown sperm and eggs derived from stem cells - in vitro gametogenesis (IVG)

Serour G, Ghaly M, Saifuddeen SM, Anwar A, Isa NM, Chin AHB

New Bioeth, 2023 Jun;29(2):108-120.
PMID: 36427532 DOI: 10.1080/20502877.2022.2142094

An exciting development in the field of assisted reproductive technologies is In Vitro Gametogenesis (IVG) that enables production of functional gametes from stem cells in the laboratory. Currently, development of this technology is still at an early stage and has demonstrated to work only in rodents. Upon critically examining the ethical dimensions of various possible IVG applications in human fertility treatment from a Sunni Islamic perspective, together with benefit-harm (maslahah-mafsadah) assessment; it is concluded that utilization of IVG, once its efficacy and safety are guaranteed, could be permissible by strictly adhering to Islamic ethical principles related to marriage, biological/genetic relatedness, sexual intercourse, and moral status of the embryo/fetus versus that of the gamete. As a result, IVG will be acceptable for treating primary infertility, age-related infertility, and preventing genetic diseases. However, it will be unacceptable for application in posthumous reproduction, donor gametes, genetic enhancement, and procreation in same-sex couples.

Matched MeSH terms: Reproductive Techniques, Assisted
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
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
Fulltext Comparison of Treatment Outcomes among Sibling Oocytes Using Different Culture Systems-Conventional IVF versus INVOcell Device-And Evaluation of INVOcell User Satisfaction: The INVOcIVF Study

Yang Mohsin WS, Abdullah Chue NS, Abdul Hamid F, Abu MA, Othman S, Mat Jin N, et al.

Int J Environ Res Public Health, 2022 Sep 29;19(19).
PMID: 36231691 DOI: 10.3390/ijerph191912391

INVOcell is considered an alternative to conventional IVF proposed for intravaginal embryo culture; however, implementation is still low because evidence is scanty regarding its outcome and, most importantly, the device's user satisfaction. Thus, we aim to compare the embryo outcome of sibling oocytes following INVOcell culture with conventional IVF (cIVF) by assessing its clinical outcome (fertilization, blastulation rate, and good embryo quality) and the user satisfaction evaluation based on a local validation questionnaire. A prospective study was done at a university-setting hospital for 12 months (July 2021-2022). The oocytes collected were divided into INVOcell and cIVF groups equally. Inclusion criteria included <40 years old and body mass index (BMI) < 30 kg/m2. The pre- and post-satisfaction questionnaires were assessed. In total, 23 women were included following standard controlled ovarian stimulation (COS). The mean age was 32.9, and the mean BMI was 24.9 kg/m2. Most of them suffered from tubal factors. A total of 252 oocytes were collected and incubated accordingly (cIVF; 138, INVOcell; 114). The blastulation rate was superior in the INVOcell group (p = 0.16); otherwise, the fertilization rate and good embryo quality were not significantly different between both methods (p > 0.05). Overall, women were satisfied with the INVOcell device as they were adequately advised, follow-up was scheduled, and the lowest score was obtained for all side effects of the device. Although both methods produce similar fertilization rates and good-quality embryos, the blastulation rates were better in the INVOcell group. Functionally, it is a user-friendly device and tolerable. Therefore, INVOcell can be used as an alternative method for reproductive treatment in carefully selected patients without jeopardizing the IVF outcomes.

Matched MeSH terms: Reproductive Techniques, Assisted
Sperm DNA fragmentation test: usefulness in assessing male fertility and assisted reproductive technology outcomes

Evgeni E, Sabbaghian M, Saleh R, Gül M, Vogiatzi P, Durairajanayagam D, et al.

Panminerva Med, 2023 Jun;65(2):135-147.
PMID: 37103485 DOI: 10.23736/S0031-0808.23.04836-X

Male infertility is attributed to multiple factors including high levels of sperm DNA fragmentation (SDF). Conventional semen analysis continues to be the gold standard for diagnosis of male factor infertility around the world. However, the limitations of basic semen analysis have prompted the search for complementary assessments of sperm function and integrity. Sperm DNA fragmentation assays (direct or indirect) are emerging as important diagnostic tools in male infertility workups, and have been advocated for use in infertile couples for a variety of reasons. While a controlled degree of DNA nicking is required for appropriate DNA compaction, excessive fragmentation of sperm DNA is linked to impaired male fertility potential, decreased fertilization, poor embryo quality, recurrent pregnancy loss, and failure of assisted reproductive technology procedures. However, there is an ongoing debate regarding whether or not to employ SDF as a routine test for male infertility. This review compiles up-to-date information regarding the pathophysiology of SDF, the currently available SDF tests, and the role of SDF tests in natural and assisted conception conditions.

Matched MeSH terms: Reproductive Techniques, Assisted
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*
Tri-parent Baby Technology and Preservation of Lineage: An Analysis from the Perspective of Maqasid al-Shari'ah Based Islamic Bioethics

Ibrahim AH, Rahman NNA, Saifuddeen SM, Baharuddin M

Sci Eng Ethics, 2019 02;25(1):129-142.
PMID: 29071572 DOI: 10.1007/s11948-017-9980-5

Tri-parent baby technology is an assisted reproductive treatment which aims to minimize or eliminate maternal inheritance of mutated mitochondrial DNA (mtDNA). The technology became popular following the move by the United Kingdom in granting license to a group of researchers from the Newcastle Fertility Centre, Newcastle University to conduct research on the symptoms of defective mtDNA. This technology differs from other assisted reproductive technology because it involves the use of gamete components retrieved from three different individuals. Indirectly, it affects the preservation of lineage which is important from an Islamic point of view. This paper aims to analyze and discuss the implications of the tri-parent technology on preservation of lineage from the perspective of Maqasid al-Shari'ah based the Islamic bioethics. The analysis shows that there are a few violations of the preservation of lineage, hence the tri-parent baby technology should not be permitted.

Matched MeSH terms: Reproductive Techniques, Assisted/ethics*
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*
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*
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*
Maqasid al-Shariah Based Islamic Bioethics: A Comprehensive Approach

Ibrahim AH, Rahman NNA, Saifuddeen SM, Baharuddin M

J Bioeth Inq, 2019 Sep;16(3):333-345.
PMID: 30715660 DOI: 10.1007/s11673-019-09902-8

Maqasid al-Shariah based Islamic bioethics is an Islamic bioethics concept which uses the objectives of the Shariah (maqasid al-Shariah) as its approach in analysing and assessing bioethical issues. Analysis based on maqasid al-Shariah based Islamic bioethics will examine any bioethical issues from three main aspects namely intention, method, and output or final goal of the studied issues. Then, the evaluation will be analysed from human interest hierarchy, inclusivity, and degree of certainty. The Islamic bioethics concept is a manifestation of dynamic Islamic jurisprudence which can overcome new complex and complicated bioethical issues such as tri-parent baby technology issues. Therefore, this article will introduce and explain the concept of maqasid al-Shariah based Islamic bioethics and outline a general guidance of maqasid al-Shariah based Islamic bioethics to determine a maqṣad (objective) based on standards of human good or well-being (maslahah) and harm (mafsadah).

Matched MeSH terms: Reproductive Techniques, Assisted/ethics
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
Predicting successful live birth from single serum hCG measurement in assisted reproductive technology (ART) cycle

Rahilah AS, Murizah MZ

Med J Malaysia, 2023 Jan;78(1):14-19.
PMID: 36715185

INTRODUCTION: Assisted reproductive technology may result in various outcomes, causing a significant stress both physically and emotionally to the patients. This study aims to determine the level of serum human chorionic gonadotrophin (hCG) following embryo transfer in predicting successful live births in in vitro fertilisation (IVF) cycles.
MATERIALS AND METHODS: This is a retrospective analysis of 407 IVF pregnancies in Hospital Sultanah Bahiyah Kedah from 2014 to 2019. Serum hCG was withdrawn on either (i) day 16 post-oocyte retrieval for fresh IVF cycle or (ii) day 16 from the addition of progesterone in frozen embryo cycles. Outcomes of IVF pregnancies were analysed in relation to the level of serum hCG.
RESULTS: The overall median hCG level in singleton live birth was 304.7 IU/L, 547.10 IU/L for multiple live births, and early pregnancy loss level was 77 IU/L. When the ROC graphs were plotted, serum hCG level of 152.85 IU/L predicted singleton livebirth with a sensitivity of 81.3%. Serum hCG of 322.40 IU/L predicted multiple live births with sensitivity of 78.6% and a specificity of 64.3%. In the subgroup analysis comparing prediction hCG level in singleton live birth; the cut-off point in frozen cycle was found to be higher as compared to fresh cycle, 277.05 IU/L vs 117.5 IU/L. Blastocyst pregnancies recorded overall higher predictor hCG level as compared to cleavage state in all the outcomes measured; singleton live birth (372.30 IU/L), early pregnancy loss (107.60 IU/L), and multiple pregnancies (711.40 IU/L).
CONCLUSION: A single reading of serum hCG taken at day 16 post-oocyte retrieval or day 16 from the addition of progesterone in a frozen cycle will help to determine the outcomes of IVF pregnancies and direct the physicians during counselling sessions and plan for further follow-up of the patients.

Matched MeSH terms: Reproductive Techniques, Assisted

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