How do costs and effects of in-vitro maturation (IVM) compare to IVF in women with a high antral follicle count (AFC)?
Design
This cost-effectiveness analysis (CEA) was based on data of a previous retrospective cohort study at IVFMD, My Duc Hospital, Ho Chi Minh City, Vietnam. Between July 2015 and December 2017, 608 women underwent IVM and 311 women IVF. The effectiveness measure for the CEA was cumulative live birth rate (LBR) after one completed cycle including subsequent cryo-cycles within 12 months of inclusion. Data were collected on resource use related to treatment, medication and pregnancy from the case report forms. The mean costs and effects, average cost differences and incremental cost-effectiveness ratios (ICER) were calculated using non-parametric bootstrap resampling to assess the effect of uncertainty in the estimates.
Results
Cumulative LBR after one completed cycle were 239/608 (39.3%) in the IVM group versus 155/311 (49.8%) in the IVF group (adjusted odds ratio 0.52, 95% confidence interval [CI] 0.30–0.89). Ovarian hyperstimulation syndrome (OHSS) did not occur in the IVM group versus 11/311 (3.5%) in the IVF group. The mean costs per couple were €4300 (95% CI €1371–18,798) for IVM and €6493 (95% CI €2204–20,136) for IVF. The ICER per additional live birth with IVF was €20,144 (95% CI €9116–50,418). Results were robust over a wide range of assumptions.
Conclusions
IVM is less expensive than IVF in women with a high AFC undergoing treatment with assisted reproductive technology, while leading to a slightly lower effectiveness in terms of cumulative LBR.
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IVF is not associated with affective symptoms during pregnancy and the postpartum.
Women who resorted to IVF could have less perinatal depressive symptoms.
More controlled studies are needed to draw definitive conclusions about this topic.
Abstract
Background
Since mothers who undergo in vitro fertilization (IVF) may experience more anxiety and depressive symptoms than mothers who conceive naturally, a review of the literature was conducted to investigate whether IVF may be considered a risk factor for the development of anxiety or depression during pregnancy and post-partum.
Methods
A thorough search of articles in Pubmed, PsycINFO and Isi Web of Knowledge was performed in order to produce a comprehensive review regarding the potential association of in vitro fertilization and anxiety/depression.
Results
The search resulted in a total of 10 articles. Contradictory results were reported in the articles about the possible association between IVF and the occurrence of anxiety and depressive symptoms both during pregnancy and postpartum period. Three studies found that women who resorted to IVF showed less anxiety and depressive symptoms than those who conceived naturally especially with the progression of pregnancy and in the postpartum.
Limitations
Vulnerability to affective disorders of women affected by infertility may be independent from the outcome of IVF. Other limits are the limited research in this area, the small sample sizes, the heterogeneity of the tools used to assess affective symptoms.
Conclusions
The available data indicate that IVF is not associated with perinatal affective symptoms. Women who resorted to IVF could have less perinatal depressive symptoms as the result of a positive outcome of the technique and the satisfaction of the desire to become mothers. Further studies are necessary in order to draw definitive conclusions about this topic.
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The Fallopian tubes, also known as uterine tubes or salpinges are tubes that stretch from the uterus to the ovaries, and are part of the female reproductive system. The fertilized egg passes through the Fallopian tubes from the ovaries of female mammals to the uterus.
Parts of fallopian tube: –
A uterine tube contains 3 parts. The first segment, closest to the uterus, is called the isthmus. The second segment is the ampulla, which becomes more dilated in diameter and is the most common site for fertilization. The final segment, located farthest from the uterus, is the infundibulum.
Blocked fallopian tube: –
Blocked fallopian tubes don’t often cause symptoms. Many women don’t know they have blocked tubes until they try to get pregnant and have trouble.
In some cases, blocked fallopian tubes can lead to mild, regular pain on one side of the abdomen. This usually happens in a type of blockage called a hydrosalpinx. This is when fluid fills and enlarges a blocked fallopian tube.
Conditions that can lead to a blocked fallopian tube can cause their own symptoms. Only one fallopian tube is blocked, the blockage most likely won’t affect fertility because an egg can still travel through the unaffected fallopian tube. Fertility drugs can help increase your chance of ovulating on the open side.
Cause of blocked fallopian tube: –
The most common cause of blocked fallopian tubes is PID.Pelvic inflammatory disease is the result of a sexually transmitted disease, although not all pelvic infections are related to STDs. Also, even if PID is no longer present, a history of PID or pelvic infection increases the risk of blocked tubes.
Diagnosis: –
Blocked tubes are usually diagnosed with a specialized x-ray called a hystero salpingogram, or HSG. An HSG is one of the basic fertility tests ordered for every couple struggling to conceive. The test involves placing a dye through the cervix using a tiny tube. Once the dye is in place, x-rays of the pelvic area are taken.
If all is normal, the dye will go through the uterus and fallopian tubes and spill out around the ovaries and into the pelvic cavity. If the dye doesn’t get through the tubes, then you may have a blocked fallopian tube.
It’s important to know that 15% of women have a “false positive,” where the dye doesn’t get past the uterus and into the tube. The blockage appears to be right where the fallopian tube and uterus meet. If this happens, the doctor may repeat the test another time, or order a different test to confirm.
Laparoscopic Surgery: –
In some cases, laparoscopic surgery can open blocked tubes or remove scar tissue. Unfortunately, this treatment doesn’t always work. The chance of success depends on how old you are the younger, the better how bad and where the blockage is, and the cause of blockage. If just a few adhesions are between the tubes and ovaries, then the chances of getting pregnant after surgery are good.
Prevention: –
The majority of blocked fallopian tubes are caused by pelvic infections. Most—but not all—of these infections are caused by a sexually transmitted infection.Regular screening for STIs, as well as getting worrisome symptoms checked out right away, is an important step in preventing tubal infertility. If the STI or pelvic infection is caught early enough, treating it may help prevent the development of scar tissue.
However, most infections are not acute, and often do not result in any signs or symptoms. But “quiet” doesn’t mean harmless. The longer the infection is present, the higher the risk of scar tissue forming and creating inflamed or blocked tubes.
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Intrauterine insemination (IUI) is a simple procedure that puts sperm directly inside your uterus, which helps healthy sperm get closer to your egg.
How does IUI work?
IUI stands for in intrauterine insemination. It’s also sometimes called donor insemination, alternative insemination, or artificial insemination. IUI works by putting sperm cells directly into your uterus around the time you’re ovulating, helping the sperm get closer to your egg. This cuts down on the time and distance sperm has to travel, making it easier to fertilize your egg.
Before having the insemination procedure, you may take fertility medicines that stimulate ovulation. Semen is collected from your partner or a donor. It goes through a process called “sperm washing” that collects a concentrated amount of healthy sperm from the semen.
Then your doctor puts the sperm right into your uterus. Pregnancy happens if sperm fertilizes your egg, and the fertilized egg implants in the lining of your uterus.
IUI is a simple and low-tech procedure, and it can be less expensive than other types of fertility treatments. It increases your chances of pregnancy, but everyone’s body is different, so there’s no guarantee that IUI will work.
What can I expect during IUI?
Before IUI, you may take fertility medicines that help make your eggs mature and ready to be fertilized. Your doctor will do the insemination procedure during ovulation (when your ovaries release an egg). Sometimes you’ll be given hormones that trigger ovulation. They’ll figure out exactly when you’re ovulating and ready for the procedure to maximize your chances of getting pregnant.
Your partner or donor collects a semen sample at home or in the doctor’s office. The sperm are prepared for insemination through a process called “sperm washing” that pulls out a concentrated amount of healthy sperm. Sperm washing also helps get rid of chemicals in the semen that can cause reactions in your uterus and make it harder to get pregnant. If you’re using donor sperm from a sperm bank, the sperm bank generally sends the doctor’s office sperm that’s already “washed” and ready for IUI.
During the IUI procedure, the doctor slides a thin, flexible tube through your cervix into your uterus. They use a small syringe to insert the sperm through the tube directly into your uterus. Pregnancy happens if sperm fertilizes an egg, and the fertilized egg implants in the lining of your uterus.
The insemination procedure is done at your doctor’s office or at a fertility clinic, and it only takes about 5-10 minutes. It’s pretty quick, and you don’t need anesthesia. IUI is usually not painful, but some people have mild cramping.
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Maternityis the perfect concoction of love, care , nervousness; a completely different yet precious experience for any woman. A woman gets her rebirth with her child. For some women living this moment turn impossible due to infertility. Infertility refers to a condition when the female cannot conceive even after frequent and regular intercourse for an year or more due to any phys2iological or pathological conditions. It is a condition that disturbs the physical, mental and social state of a woman. The cause of infertility may lie in males too, but here we will mention about the infertility in females.
Most of the infertility causes are treatable and can be treated with medications or surgeries and in severe cases where the conservative and surgical approaches don’t work there comes the technology and assistive reproductive techniques. To land to the treatment approach detection of infertility and is cause is most important.
Here Are The Symptoms That Would Alarm You About Infertility:
Absent Menstrual Cycle
Too early (<21 days) or too late (>35 days) menstrual cycle or the excessive painful menstrual cycle
Multiple miscarriage
What Can Cause Infertility In females?
Hormonal Imbalances: Pregnancy in humans is a hormone mediated process. Starting from ova maturation to ovulation and preparing the uterus for conceiving and even the abortion is mediated by hormones. Any imbalance in the gonadal hormones involving the oestrogen, progesterone, follicle stimulating hormone, oxytocin may lead to infertility.
Ovulation Disorders: Ovulation isthe process of release of mature ova from female ovary. The ovulation disorders are most common cause of infertility:
Polycystic Ovary Syndrome
Hypothalamic Dysfunction
Premature Ovarian Failure
Hyperprolactinemia
Tubal Involvement: Damage to fallopian tubes or it’s blockagecan cause infertility , as it is the passage where ova and sperm fuse to form zygote
Fallopian tube may be too narrow to allow entry of sperm or egg.
Any infection in fallopian tube
Any surgical trauma or previous ectopic pregnancy leading to rupture of membrane.
Pelvic Inflammatory Diseases
Pelvic Tuberculosis
Uterus Involvement : Uterus is the major reproductive organ that provides the growing environment to the foetus. Any structural or pathological condition of uterus may lead to infertility.
Fibroids and uterine tumour
Endometriosis
Congenital conditions
Cervical Involvement: Block in cervix or vagina or any infection that lead to sperm death. The quality of mucous in cervix would affect the entry of sperm. Cervical cancer is a leading cause of infertility in female. Cervical stenosis is another such cause of infertility in female.
What adds the risk ?
Any abusive substance be it alcohol or any other drugs.
Smoking or environmental hazards.
Overweight can lead to hormonal imbalance.
Sexually transmitted diseases like HIV, chlamydial infection and gonorrhoea due to previous unprotected sex.
Overage women , after mid 30’s face more issues due to decrease in follicle maturation rate and improper maturation.
Infertility is a condition that affect the family along with the parents emotionally and mentally, thus with improved technology and secured guidance, live the moments of parenthood.
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Most women with PCOS grow a number of small cysts, or fluid-filled sacs, on their ovaries. The cysts are not harmful, but they can lead to an imbalance in hormone levels.
Women with PCOS may also experience menstrual cycle abnormalities, increased androgen (sex hormone) levels, excess hair growth, acne, and obesity.
In addition to the many health conditions associated with PCOS, which will be discussed in this article, PCOS is the most common cause of infertility in women – because it can prevent ovulation.
Women who can conceive with PCOS have a higher incidence of miscarriage, gestational diabetes, pregnancy-induced high blood pressure, preeclampsia, and premature delivery.
Causes
Currently, there is no known cause of PCOS. However, there are associations with excess insulin, low-grade inflammation, and genetics.
Symptoms
Apart from cysts on the ovaries, symptoms of PCOS include:
irregular menses
excess androgen levels
sleep apnea
high stress levels
high blood pressure
skin tags
infertility
acne, oily skin, and dandruff
high cholesterol and triglycerides
acanthosis nigricans, or dark patches of skin
fatigue
female pattern balding
insulin resistance
type 2 diabetes
pelvic pain
depression and anxiety
weight management difficulties including weight gain or difficulty losing weight
excessive facial and body hair growth, known as hirsutism
decreased libido
Tests and diagnosis
No single test can determine the presence of PCOS, but a doctor can diagnose the condition through medical history, a physical exam that includes a pelvic exam, and blood tests to measure hormone, cholesterol, and glucose levels.
An ultrasound may be used to look at the uterus and ovaries.
Treatment
There is no cure for PCOS, but treatment aims to manage the symptoms that affect an individual.
This will depend on whether the individual wants to become pregnant and aims to reduce the risk of secondary medical conditions, such as heart disease and diabetes.
There are several recommended treatment options, including:
Birth control pills: These can help regulate hormones and menstruation.
Diabetes medications: These help manage diabetes, if necessary.
Fertility medications: If pregnancy is desired, these include the use of clomiphene (Clomid), a combination of clomiphene and metformin, or injectable gonadotropins, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications. In certain situations, letrozole (Femara) may be recommended.
Excessive hair growth may be reduced with the drug spironolactone (Aldactone) or eflornithine (Vaniqa). Finasteride (Propecia) may also be recommended, but it should not be handled by women who may become pregnant.
Anyone using spironolactone should use birth control, due to the risk of birth defects if taken while pregnant. Breast-feeding on this medication is not recommended.
Other possible options to manage hair growth is laser hair removal, electrolysis, hormonal treatments, or vitamin and mineral use.
Surgical options include:
Ovarian drilling: Tiny holes made in the ovaries can reduce the levels of androgens being produced. Oophorectomy: Surgery removes one or both ovaries. Hysterectomy: This involves removal of all or part of the uterus. Cyst aspiration: Fluid is removed from the cyst.
Pregnancy and menopause
Women who are affected by PCOS may experience the effects throughout their lifetime.
There may be an increased risk of miscarriage, gestational diabetes, preeclampsia, and preterm births.
After delivery, there is an increased risk of the newborn being placed in the neonatal intensive care unit or death before, during, or soon after birth. These complications are more common in multiple births, for example, twins or triplets.
Symptoms such as excessive hair growth and male pattern baldness can last beyond menopause and may become worse.
With aging also comes the risk of the secondary health complications related to PCOS, including heart disease.
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The spontaneous loss of a woman’s pregnancy before the 20th week that can be both physically and emotionally painful.
Miscarriage is the most common type of pregnancy loss and often occurs because the foetus isn’t developing normally. Miscarriage can also be genetically.
Symptoms of miscarriage include:-
Miscarriage are both physically and mentally painful. In some cases female can’t have next pregnancy. Some of the symptoms include:
cramps
Abdominal pain
Bleeding which turn from low to high level
Weakness which some time cause faint
Back pain
Fever
Abdominal infection
Urinal problems
Can I get pregnant after miscarriage :
Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control , and ask your health care .
Can a Miscarriage Be Prevented?
Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available. Sometimes,treatment of a mother’s illness can improve the chances for a successful pregnancy. Basically to prevent miscarriage a female should take some basic medicine that helps in building up the baby Or foetus. sure to take at least 400 mg of folic acid every day, beginning at least one to two months before conception, if possible.
Exercise regularly.
Eat healthy, well-balanced meals.
Manage stress.
Keep your weight within normal limits.
Don’t smoke and stay away from smoke.
Don’t drink alcohol
Avoid illicit drugs.
Take proper rest
Make sure you are up to date on immunizations.
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In order to extract and fertilize the eggs during IVF, doctors generally follow the same process everytime. Once fertilization has occurred, there are a few different options available for embryo transfer:
Fresh embryo transfer: Once eggs have been fertilized, they are cultured for 1-2 days. The best embryos are chosen to transfer directly to the woman’s uterus.
Frozen embryo transfer: Any healthy embryos that were not used in the first transfer can be frozen and stored for future use. These can be thawed and transferred to the uterus.
Blastocyst embryo transfer: If many healthy embryos develop after the fertilization, it is common to wait to see if the embryos develop into blastocysts. According to a study in the Indian Journal of Clinical Practice, blastocyst embryo transfer has a higher success rate than the standard embryo transfer on day 3. However, another recent study suggests that it may pose risks later in pregnancy and should not always be recommended.
Assisted hatching (AH): A study in the Reproductive Biomedicine Online found that the process of assisted hatching – weakening the outer layer of the embryo before it is transferred to the uterus – does not improve pregnancy and implantation rates in women who are having fresh embryos transferred. The researchers noted, however, that women having frozen embryos implanted do benefit from having their embryos treated in this way.
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