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Sample records for patients ivf brokers

  1. A case-control pilot study of low-intensity IVF in good-prognosis patients.

    Science.gov (United States)

    Gleicher, Norbert; Weghofer, Andrea; Barad, David H

    2012-04-01

    Low-intensity IVF (LI-IVF) is rapidly gaining in popularity. Yet studies comparing LI-IVF to standard IVF are lacking. This is a case-control pilot study, reporting on 14 first LI-IVF and 14 standard IVF cycles in women with normal age-specific ovarian reserve under age 38, matched for age, laboratory environment, staff and time of cycle. LI-IVF cycles underwent mild ovarian stimulation, utilizing clomiphene citrate, augmented by low-dose gonadotrophin stimulation. Control patients underwent routine ovarian stimulation. LI-IVF and regular IVF patients were similar in age, body mass index, FSH and anti-Müllerian hormone. Standard IVF utilized more gonadotrophins (PIVF demonstrated better odds for pregnancy (OR 7.07; P=0.046) and higher cumulative pregnancy rates (63.3% versus 21.4%; OR 6.6; P=0.02). Adjustments for age, ethnicity and diagnosis maintained significance but oocyte adjustment did not. Cost assessments failed to reveal differences between LI-IVF and standard IVF. In this small study, LI-IVF reduced pregnancy chances without demonstrating cost advantages, raising questions about its utility. In the absence of established clinical and/or economic foundations, LI-IVF should be considered an experimental procedure. Low-intensity IVF (LI-IVF) is increasingly propagated as an alternative to standard IVF. LI-IVF has, however, never been properly assessed in comparison to standard IVF. Such a comparison is presented in the format of a small pilot study, matching LI-IVF cycles with regular IVF cycles and comparing outcomes as well as costs. The study suggests that LI-IVF, at least in this setting, is clinically inferior and economically at best similar to standard IVF. LI-IVF should, therefore, as of this point not be offered as routine IVF treatment but only as an experimental procedure. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  2. Current Internet use and preferences of IVF and ICSI patients.

    NARCIS (Netherlands)

    Haagen, E.C.; Tuil, W.S.; Hendriks, J.H.C.L.; Bruijn, R.P. de; Braat, D.D.M.; Kremer, J.A.M.

    2003-01-01

    BACKGROUND: Nowadays, the Internet has a tremendous impact on modern society, including healthcare practice. The study aim was to characterize current Internet use by IVF and ICSI patients and to identify their preferences regarding Internet applications in fertility care. METHODS: A total of 163

  3. Smoking Decreases Endometrial Thickness in IVF/ICSI Patients.

    Science.gov (United States)

    Heger, Anna; Sator, Michael; Walch, Katharina; Pietrowski, Detlef

    2018-01-01

    Smoking is a serious problem for the health care system. Many of the compounds identified in cigarette smoke have toxic effects on the fertility of both females and males. The purpose of this study was to determine whether smoking affects clinical factors during IVF/ICSI therapy in a single-center reproductive unit. In a retrospective study of 200 IVF/ICSI cycles, endometrial thickness and the outcome of IVF/ICSI therapy were analyzed. Endometrial thickness was significantly lower in smoking patients than in non-smoking patients (10.4 ± 1.5 mm vs. 11.6 ± 1.8 mm). Age was significantly higher in women who failed to conceive. The total dose of gonadotropins administered was significantly lower in pregnant patients and the highest pregnancy rate was achieved with an rFSH protocol. BMI and number of cigarettes smoked did not influence treatment outcomes in this study. We showed that smoking has a negative effect on endometrial thickness on the day of embryo transfer. This may help to further explain the detrimental influence of tobacco smoke on implantation and pregnancy rates during assisted reproduction therapy.

  4. The patient as experience broker in clinical learning.

    Science.gov (United States)

    Stockhausen, Lynette J

    2009-05-01

    A review of the literature reveals deficit information on patient's involvement in student's learning. The study presented in this paper investigates how the educationally unprepared patient engages with students and experienced clinicians to become involved in learning and teaching encounters. As a qualitative study 14 adult patients were interviewed to determine how they perceived experienced clinicians and students engage in learning and teaching moments and how the patient contributes to students learning to care. Revealed is a new and exciting dimension in learning and teaching in the clinical environment. Patients as experience brokers are positioned in a unique learning triad as they mediate and observe teaching and learning to care between students and experienced clinicians whilst also becoming participants in teaching to care. Further investigation is warranted to determine the multi-dimensional aspects of patients' involvement in student learning in various clinical environments. Future studies have the potential to represent a new educational perspective (andragogy).

  5. Prediction of individual probabilities of livebirth and multiple birth events following in vitro fertilization (IVF): a new outcomes counselling tool for IVF providers and patients using HFEA metrics.

    Science.gov (United States)

    Jones, Christopher A; Christensen, Anna L; Salihu, Hamisu; Carpenter, William; Petrozzino, Jeffrey; Abrams, Elizabeth; Sills, Eric Scott; Keith, Louis G

    2011-01-01

    In vitro fertilization (IVF) has become a standard treatment for subfertility after it was demonstrated to be of value to humans in 1978. However, the introduction of IVF into mainstream clinical practice has been accompanied by concerns regarding the number of multiple gestations that it can produce, as multiple births present significant medical consequences to mothers and offspring. When considering IVF as a treatment modality, a balance must be set between the chance of having a live birth and the risk of having a multiple birth. As IVF is often a costly decision for patients-financially, medically, and emotionally-there is benefit from estimating a patient's specific chance that IVF could result in a birth as fertility treatment options are contemplated. Historically, a patient's "chance of success" with IVF has been approximated from institution-based statistics, rather than on the basis of any particular clinical parameter (except age). Furthermore, the likelihood of IVF resulting in a twin or triplet outcome must be acknowledged for each patient, given the known increased complications of multiple gestation and consequent increased risk of poor birth outcomes. In this research, we describe a multivariate risk assessment model that incorporates metrics adapted from a national 7.5-year sampling of the Human Fertilisation & Embryology Authority (HFEA) dataset (1991-1998) to predict reproductive outcome (including estimation of multiple birth) after IVF. To our knowledge, http://www.formyodds.com is the first Software-as-a-Service (SaaS) application to predict IVF outcome. The approach also includes a confirmation functionality, where clinicians can agree or disagree with the computer-generated outcome predictions. It is anticipated that the emergence of predictive tools will augment the reproductive endocrinology consultation, improve the medical informed consent process by tailoring the outcome assessment to each patient, and reduce the potential for adverse

  6. IVF and retinoblastoma revisited

    NARCIS (Netherlands)

    Dommering, Charlotte J.; van der Hout, Annemarie H.; Meijers-Heijboer, Hanne; Marees, Tamara; Moll, Annette C.

    2012-01-01

    Objective: To evaluate the suggested association between IVF, retinoblastoma, and tumor methylation characteristics. Design: Laboratory analysis. Setting: National Retinoblastoma Center in the Netherlands. Patient(s): Retinoblastoma tumors from seven children conceived by IVF or intracytoplasmic

  7. IVF and retinoblastoma revisited

    NARCIS (Netherlands)

    Dommering, Charlotte J.; van der Hout, Annemarie H.; Meijers-Heijboer, Hanne; Marees, Tamara; Moll, Annette C.

    Objective: To evaluate the suggested association between IVF, retinoblastoma, and tumor methylation characteristics. Design: Laboratory analysis. Setting: National Retinoblastoma Center in the Netherlands. Patient(s): Retinoblastoma tumors from seven children conceived by IVF or intracytoplasmic

  8. Patient-centred care: using online personal medical records in IVF practice.

    NARCIS (Netherlands)

    Tuil, W.S.; Hoopen, A.J. ten; Braat, D.D.M.; Vries Robbé, P.F. de; Kremer, J.A.M.

    2006-01-01

    BACKGROUND: Generic patient-accessible medical records have shown promise in enhancing patient-centred care for patients with chronic diseases. We sought to design, implement and evaluate a patient-accessible medical record specifically for patients undergoing a course of assisted reproduction (IVF

  9. Hysteroscopic hydrosalpinx occlusion with Essure device in IVF patients when salpingectomy or laparoscopy is contraindicated.

    Science.gov (United States)

    Matorras, Roberto; Rabanal, Aintzane; Prieto, Begoña; Diez, Santiago; Brouard, Iñaki; Mendoza, Rosario; Exposito, Antonia

    2013-07-01

    To evaluate, in patients with hydrosalpinges, the effect on in vitro fertilization (IVF) outcome of the insertion by hysteroscopy of an intratubal blocking device, in cases where laparoscopic salpingectomy or laparoscopy was contraindicated. A prospective interventional case series study was conducted in fifteen women with unilateral (N=6) or bilateral hydrosalpinges (N=9) submitted for IVF. In all of them, laparoscopic salpingectomy was contraindicated. Hysteroscopic insertion of the Essure intratubal device in a consultation room setting was performed. IVF results were compared with those of women where hydrosalpinx was treated by laparoscopic salpingectomy (48 women, 76 cycles). There were no complications during or immediately after the procedure in any of the patients. There were four pregnancies from 16 embryo-transfers with own oocytes, one spontaneous pregnancy after unilateral Essure insertion, and one pregnancy after oocyte donation. In one case the hydrosalpinx grew and pelvic inflammatory disease developed 6 months after the insertion, requiring bilateral adnexectomy. Although not of statistical significance, IVF pregnancy rates were somewhat lower than in the laparoscopic salpingectomy group, which was attributed to the lower ovarian reserve before Essure insertion. The hysteroscopic insertion of the Essure intratubal device prior to IVF is a reasonable option in cases where laparoscopic salpingectomy is contraindicated. Larger series are required to assess pregnancy outcome. Copyright © 2013. Published by Elsevier Ireland Ltd.

  10. Comparison of IVF/ICSI outcome in patients with polycystic ovarian ...

    African Journals Online (AJOL)

    Background: One of the recognized treatment options for patients with polycystic ovarian syndrome (PCOS) is in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Fears are however sometimes raised concerning the likely outcome of treatment in such patients compared with their counterparts with tubal factor ...

  11. Classification of Patients Treated for Infertility Using the IVF Method

    Directory of Open Access Journals (Sweden)

    Malinowski Paweł

    2015-12-01

    Full Text Available One of the most effective methods of infertility treatment is in vitro fertilization (IVF. Effectiveness of the treatment, as well as classification of the data obtained from it, is still an ongoing issue. Classifiers obtained so far are powerful, but even the best ones do not exhibit equal quality concerning possible treatment outcome predictions. Usually, lack of pregnancy is predicted far too often. This creates a constant need for further exploration of this issue. Careful use of different classification methods can, however, help to achieve that goal.

  12. Brokers, consumers and the internet: how North American consumers navigate their infertility journeys.

    Science.gov (United States)

    Speier, Amy R

    2011-11-01

    North Americans who suffer infertility often reach an end to treatment options at home, whether it is due to a lack of egg donors in Canada or the high cost of treatment in the USA. Patients navigate their way onto the internet, seeking support and other options. As women and couples 'do the research' online, they conduct endless Google searches, come across IVF brokers, join support groups, read blogs and meet others on the road of infertility. This paper considers the journeys that North American patients make to clinics in Moravia, Czech Republic. Along these travels, patients engage with support groups, other patients, IVF brokers and clinic co-ordinators. Since the distance travelled between North America and Europe is extensive, reproductive travels may be arranged by clinical staff, travel brokers and patients. Acting as consumers, North Americans make different 'choices' along their journeys – the use of a broker, if and when they should join online communities, which clinic to visit and where to stay. This study focuses on the question of how patient choices often determine the success of brokers and clinics, thus influencing the structure of cross-border reproductive care in the Czech Republic. Copyright © 2011 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  13. Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients.

    Science.gov (United States)

    Haahr, T; Jensen, J S; Thomsen, L; Duus, L; Rygaard, K; Humaidan, P

    2016-04-01

    What is the diagnostic performance of qPCR assays compared with Nugent scoring for abnormal vaginal microbiota and for predicting the success rate of IVF treatment? The vaginal microbiota of IVF patients can be characterized with qPCR tests which may be promising tools for diagnosing abnormal vaginal microbiota and for prediction of clinical pregnancy in IVF treatment. Bacterial vaginosis (BV) is a common genital disorder with a prevalence of approximately 19% in the infertile population. BV is often sub-clinical with a change of the vaginal microbiota from being Lactobacillus spp. dominated to a more heterogeneous environment with anaerobic bacteria, such as Gardnerella vaginalis and Atopobium vaginae. Few studies have been conducted in infertile women, and some have suggested a negative impact on fecundity in the presence of BV. A cohort of 130 infertile patients, 90% Caucasians, attending two Danish fertility clinics for in vitro fertilization (IVF) treatment from April 2014-December 2014 were prospectively enrolled in the trial. Vaginal swabs from IVF patients were obtained from the posterior fornix. Gram stained slides were assessed according to Nugent's criteria. PCR primers were specific for four common Lactobacillus spp., G. vaginalis and A. vaginae. Threshold levels were established using ROC curve analysis. The prevalence of BV defined by Nugent score was 21% (27/130), whereas the prevalence of an abnormal vaginal microbiota was 28% (36/130) defined by qPCR with high concentrations of Gardnerella vaginalis and/or Atopobium vaginae. The qPCR diagnostic approach had a sensitivity and specificity of respectively 93% and 93% for Nugent-defined BV. Furthermore, qPCR enabled the stratification of Nugent intermediate flora. Eighty-four patients completed IVF treatment. The overall clinical pregnancy rate was 35% (29/84). Interestingly, only 9% (2/22) with qPCR defined abnormal vaginal microbiota obtained a clinical pregnancy (P = 0.004). Although a total of 130

  14. Successful birth of an IVF baby in a patient with Parkinson′s disease

    Directory of Open Access Journals (Sweden)

    Asha Baxi

    2010-01-01

    Full Text Available Parkinson′s disease, although rare in young patients, may be encountered in the reproductive age group. We report a rare combination of this disease with infertility, which has not been previously reported. The case record of a 29-year-old woman with infertility and Parkinson′s disease are retrospectively reviewed. An IVF indicated for tubal factor infertility resulted in a successful singleton pregnancy. She delivered a healthy male baby without experiencing any worsening of her Parkinsonism. The course of pregnancy remained unaffected by the Parkinson′s disease and anti-Parkinsonian drugs. The details of the infertility management, antenatal and postnatal course, and medications are described. With careful evaluation, counseling, and monitoring, IVF may be safely used in women with Parkinson′s disease.

  15. Multiple thrombophilic single nucleotide polymorphisms lack a significant effect on outcomes in fresh IVF cycles: an analysis of 1717 patients.

    Science.gov (United States)

    Patounakis, George; Bergh, Eric; Forman, Eric J; Tao, Xin; Lonczak, Agnieszka; Franasiak, Jason M; Treff, Nathan; Scott, Richard T

    2016-01-01

    The aim of the study is to determine if thrombophilic single nucleotide polymorphisms (SNPs) affect outcomes in fresh in vitro fertilization (IVF) cycles in a large general infertility population. A prospective cohort analysis was performed at a university-affiliated private IVF center of female patients undergoing fresh non-donor IVF cycles. The effect of the following thrombophilic SNPs on IVF outcomes were explored: factor V (Leiden and H1299R), prothrombin (G20210A), factor XIII (V34L), β-fibrinogen (-455G → A), plasminogen activator inhibitor-1 (4G/5G), human platelet antigen-1 (a/b9L33P), and methylenetetrahydrofolate reductase (C677T and A1298C). The main outcome measures included positive pregnancy test, clinical pregnancy, embryo implantation, live birth, and pregnancy loss. Patients (1717) were enrolled in the study, and a total of 4169 embryos were transferred. There were no statistically significant differences in positive pregnancy test, clinical pregnancy, embryo implantation, live birth, or pregnancy loss in the analysis of 1717 patients attempting their first cycle of IVF. Receiver operator characteristics and logistic regression analyses showed that outcomes cannot be predicted by the cumulative number of thrombophilic mutations present in the patient. Individual and cumulative thrombophilic SNPs do not affect IVF outcomes. Therefore, initial screening for these SNPs is not indicated.

  16. Prediction of ovarian hyperstimulation syndrome in coasted patients in an IVF/ICSI program

    Directory of Open Access Journals (Sweden)

    Fatimah Y Aljawoan

    2012-01-01

    Full Text Available Aim: To determine why a subgroup of coasted patients developed moderate/severe ovarian hyperstimulation syndrome (OHSS in an assisted reproduction setting. Materials and Methods: Retrospective study of 2948 in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI treatment cycles with 327 patients requiring coasting. Long protocol gonadotrophin releasing hormone analogue (GnRH-a regimen was used and serum estradiol (E 2 checked when ≥20 follicles were noted on follicular tracking. Coasting was initiated when leading three follicles were ≥15mm with E 2 ≥1635pg/ml. Results: The incidence of moderate/severe OHSS was 10.4% in coasted patients (equivalent 1.15% of the total IVF/ICSI cycles in the Center. Coasted patients who subsequently developed OHSS showed a significantly higher number of retrieved oocytes, higher serum E 2 level on the day of human chorionic gonadotrophin (hCG administration, and multiple pregnancies. No significant differences were noted with female age, BMI, cause of infertility, gonadotrophin dosage, coasting duration, and % of E 2 drop. Conclusion: Moderate/severe OHSS might be predicted in coasted patients by a combination of total oocyte numbers and E 2 level on the day of hCG. Multiple pregnancies also significantly increased the risk.

  17. Lifestyle and IVF Outcomes.

    Science.gov (United States)

    Hornstein, Mark D

    2016-12-01

    Whereas much has been written about the prognostic factors associated with outcomes of in vitro fertilization (IVF) such as female age, diagnosis, and ovarian reserve, relatively little attention has been devoted to patient-oriented lifestyles that may influence IVF outcomes. Patients are particularly interested in this topic because many patients wish to partner with their physicians and want to know specific behaviors to improve their chances of IVF success. This brief review is not intended as an exhaustive literature search of all possible lifestyles that may influence assisted reproductive outcome nor is it intended to be a comprehensive review of individual topics. It does give, however, a brief overview of a number of areas in which patient-specific behaviors may influence outcomes in assisted reproduction. Specifically, this review will look at the effects of smoking, alcohol consumption, caffeine, diet, exercise, and exposure to the reproductive toxin bisphenol A on IVF outcomes. © The Author(s) 2016.

  18. Pregnancy derived from human zygote pronuclear transfer in a patient who had arrested embryos after IVF.

    Science.gov (United States)

    Zhang, John; Zhuang, Guanglun; Zeng, Yong; Grifo, Jamie; Acosta, Carlo; Shu, Yimin; Liu, Hui

    2016-10-01

    Nuclear transfer of an oocyte into the cytoplasm of another enucleated oocyte has shown that embryogenesis and implantation are influenced by cytoplasmic factors. We report a case of a 30-year-old nulligravida woman who had two failed IVF cycles characterized by all her embryos arresting at the two-cell stage and ultimately had pronuclear transfer using donor oocytes. After her third IVF cycle, eight out of 12 patient oocytes and 12 out of 15 donor oocytes were fertilized. The patient's pronuclei were transferred subzonally into an enucleated donor cytoplasm resulting in seven reconstructed zygotes. Five viable reconstructed embryos were transferred into the patient's uterus resulting in a triplet pregnancy with fetal heartbeats, normal karyotypes and nuclear genetic fingerprinting matching the mother's genetic fingerprinting. Fetal mitochondrial DNA profiles were identical to those from donor cytoplasm with no detection of patient's mitochondrial DNA. This report suggests that a potentially viable pregnancy with normal karyotype can be achieved through pronuclear transfer. Ongoing work to establish the efficacy and safety of pronuclear transfer will result in its use as an aid for human reproduction. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Live birth rates are satisfactory following multiple IVF treatment cycles in poor prognosis patients.

    Science.gov (United States)

    Mustafa, Kamarul B; Keane, Kevin N; Walz, Nikita L; Mitrovic, Katarina I; Hinchliffe, Peter M; Yovich, John L

    2017-03-01

    This seven-year retrospective study analysed the live birth rate (LBR) for women undergoing IVF treatment with various antral follicle counts (AFC). The LBR decreased with lower AFC ratings, and in 290 treatment cycles for women in the poorest AFC category, ≤4 follicles (group E), the LBR was the lowest at 10.7%. The pregnancy loss rate (PLR) significantly increased with poorer AFC categories, from 21.8% in AFC group A (≥20 follicles), to 54.4% in AFC group E (p<0.0001). This trend was repeated with advancing age, from 21.6% for younger women (<35years), to 32.9, 48.5 and 100% for ages 35-39, 40-44 and ≥45 years, respectively (p<0.0001). However, LBR within the specific AFC group E cohort was also age-dependent and decreased significantly from 30.0% for <35 years old, to 13.3, 3.9 and 0% for patients aged 35-39, 40-44 and ≥45 years, respectively. Most, importantly, LBR rates within these age groups were not dependent on the number of IVF attempts (1st, 2nd, 3rd or ≥4 cycles), which indicated that cycle number should not be the primary deciding factor for cessation of IVF treatment in responding women <45years old. Copyright © 2016 Society for Biology of Reproduction & the Institute of Animal Reproduction and Food Research of Polish Academy of Sciences in Olsztyn. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  20. Patient preference for a long-acting recombinant FSH product in ovarian hyperstimulation in IVF: a discrete choice experiment

    NARCIS (Netherlands)

    van den Wijngaard, L.; Rodijk, I. C. M.; van der Veen, F.; Gooskens-van Erven, M. H. W.; Koks, C. A. M.; Verhoeve, H. R.; Mol, B. W. J.; van Wely, M.; Mochtar, M. H.

    2015-01-01

    What factors or attributes of a long-acting recombinant FSH (rFSH) or daily-administrated rFSH influence women's preferences IVF? Patients' preferences for rFSH products are primary influenced by the attribute 'number of injections', but a low 'number of injections' is exchanged for a high 'number

  1. Ganirelix for luteolysis in poor responder patients undergoing IVF treatment: a Scandinavian multicenter 'extended pilot study'

    DEFF Research Database (Denmark)

    Nilsson, Lena; Andersen, A.N.; Lindenberg, Svend

    2010-01-01

    To enhance oocyte yield and pregnancy outcome in poor responder women undergoing IVF treatment, daily low dose GnRH antagonist administration was given during the late luteal phase to induce luteolysis and possibly secure a more synchronous cohort of recruitable follicles. An open extended pilot...... study in four Scandinavian fertility centers was done including 60 patients. Poor response was defined as when 2000 IU FSH. GnRH antagonist (ganirelix) was given, 0.25 mg s.c. daily, from days 3 to 5...... oocyte retrievals resulting in 5 pregnancies (4 delivered). Despite GnRH antagonist administration in the late luteal phase and menstrual bleeding, FSH was not sufficiently reduced to secure a more synchronic cohort of recruitable follicles. Novel GnRH antagonists more specifically targeting FSH release...

  2. An 'Honest Broker' mechanism to maintain privacy for patient care and academic medical research.

    Science.gov (United States)

    Boyd, Andrew D; Hosner, Charlie; Hunscher, Dale A; Athey, Brian D; Clauw, Daniel J; Green, Lee A

    2007-01-01

    From the Hippocratic Oath to the World Medical Association's Declaration of Geneva, physicians have sworn to protect patients' privacy. However, as systems move to more integrated architectures, protecting this medical data becomes more of a challenge. The increase in complexity of IT environments, the aggregation of data, and the desire of other entities to access this data, often 24 h/day x 7 day/week x 365 day/year, is putting serious strains on our ability to maintain its security. This problem cuts across all electronic record sources from patient care records to academic medical research records. In order to address this issue, we are rethinking the way we store, transmit, process, access, and federate patient data from clinical and research applications. Our groups at the University of Michigan are developing a system called the "Honest Broker" to help manage this problem. The Honest Broker will offload the burden of housing identifiable data elements of protected health information (PHI) (e.g., name and address) as well as manage data transfer between clinical and research systems. Lab results and other non-identifiable data will be stored in separate systems with either a research study ID or clinical ID number. This two-component architecture increases the burden on attackers who now need to compromise two systems, one of which is seriously hardened, in order to match health data with a patient's actual identity. While no security system is truly intrusion-proof, this architecture provides a high security choke point reducing the likelihood of a breach. By redesigning the method of integrating clinical care and research, we have enabled projects that would be cost prohibitive to conduct otherwise. The scalability of this mechanism is dependant on nature of the heterogenous nature of the clinical systems serving patients.

  3. Does local endometrial injury in the nontransfer cycle improve the IVF-ET outcome in the subsequent cycle in patients with previous unsuccessful IVF? A randomized controlled pilot study

    Directory of Open Access Journals (Sweden)

    Sachin A Narvekar

    2010-01-01

    Full Text Available Background: Management of repeated implantation failure despite transfer of good-quality embryos still remains a dilemma for ART specialists. Scrapping of endometrium in the nontransfer cycle has been shown to improve the pregnancy rate in the subsequent IVF/ET cycle in recent studies. Aim: The objective of this randomized controlled trial (RCT was to determine whether endometrial injury caused by Pipelle sampling in the nontransfer cycle could improve the probability of pregnancy in the subsequent IVF cycle in patients who had previous failed IVF outcome. Setting: Tertiary assisted conception center. Design: Randomized controlled study. Materials and Methods: 100 eligible patients with previous failed IVF despite transfer of good-quality embryos were randomly allocated to the intervention group and control groups. In the intervention group, Pipelle endometrial sampling was done twice: One in the follicular phase and again in the luteal phase in the cycle preceding the embryo transfer cycle. Outcome Measure: The primary outcome measure was live birth rate. The secondary outcome measures were implantation and clinical pregnancy rates. Results: The live birth rate was significantly higher in the intervention group compared to control group (22.4% and 9.8% P = 0.04. The clinical pregnancy rate in the intervention group was 32.7%, while that in the control group was 13.7%, which was also statistically significant ( P = 0.01. The implantation rate was significantly higher in the intervention group as compared to controls (13.07% vs 7.1% P = 0.04. Conclusions: Endometrial injury in nontransfer cycle improves the live birth rate,clinical pregnancy and implantation rates in the subsequent IVF-ET cycle in patients with previous unsuccessful IVF cycles.

  4. Cumulative live birth rates after IVF in patients with polycystic ovaries: phenotype matters.

    Science.gov (United States)

    De Vos, Michel; Pareyn, Stéphanie; Drakopoulos, Panagiotis; Raimundo, José M; Anckaert, Ellen; Santos-Ribeiro, Samuel; Polyzos, Nikolaos P; Tournaye, Herman; Blockeel, Christophe

    2018-05-07

    Do cumulative live birth rates (CLBR) vary among women with different polycystic ovary syndrome (PCOS) phenotypes who undergo IVF/intracytoplasmic sperm injection (ICSI) treatment? In this retrospective cohort study, data from 567 patients undergoing an assisted reproductive technology (ART) cycle between January 2010 and December 2015 were collected. Demographical traits, cycle characteristics and clinical and laboratory data were analysed. After conventional ovarian stimulation using a gonadotrophin-releasing hormone antagonist protocol, the median number of oocytes retrieved ranged between 11 and 13.5 and did not differ significantly among the studied groups. Live birth rate (LBR) after fresh embryo transfer and CLBR after transfer of all fresh and vitrified embryos were significantly lower in women with hyperandrogenic PCOS phenotypes A (LBR 16.7%, CLBR 25.8%) and C (LBR 18.5%, CLBR 27.8%) compared with women with normoandrogenic PCOS phenotype D (LBR 33.7%, CLBR 48%) (P-value for LBR 0.01 and 0.03, respectively; P-value for CLBR 0.002 and 0.01, respectively) and controls with a polycystic ovarian morphology (LBR 37.1%, CLBR 53.3%) (P-value for LBR 0.002 and 0.01, respectively; P-value for CLBR counselling and tailored approaches when treating PCOS patients with hyperandrogenism who require ART. Copyright © 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  5. Psychological IVF

    DEFF Research Database (Denmark)

    Adrian, Stine Willum

    2015-01-01

    ’. This theoretical work has three aims. First, it seeks to illustrate how the story of psychological IVF offers a rich range of materializations of emotions. Secondly, this work proposes a feminist materialist conceptualization of emotions that is both non-representational and posthuman. This conceptualization draws...

  6. An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?

    Science.gov (United States)

    Waring, Justin; Currie, Graeme; Crompton, Amanda; Bishop, Simon

    2013-12-01

    This paper reports on an exploratory study of intra-organisational knowledge brokers working within three large acute hospitals in the English National Health Services. Knowledge brokering is promoted as a strategy for supporting knowledge sharing and learning in healthcare, especially in the diffusion of research evidence into practice. Less attention has been given to brokers who support knowledge sharing and learning within healthcare organisations. With specific reference to the need for learning around patient safety, this paper focuses on the structural position and role of four types of intra-organisational brokers. Through ethnographic research it examines how variations in formal role, location and relationships shape how they share and support the use of knowledge across organisational and occupational boundaries. It suggests those occupying hybrid organisational roles, such as clinical-managers, are often best positioned to support knowledge sharing and learning because of their 'ambassadorial' type position and legitimacy to participate in multiple communities through dual-directed relationships. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. [Clinical outcomes and economic analysis of two ovulation induction protocols in patients undergoing repeated IVF/ICSI cycles].

    Science.gov (United States)

    Chen, Xiao; Geng, Ling; Li, Hong

    2014-04-01

    To compare the clinical outcomes and cost-effectiveness of luteal phase down-regulation with gonadotrophin-releasing hormone (GnRH) agonist protocol and GnRH antagonist protocol in patients undergoing repeated in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) cycles. A retrospective analysis of clinical outcomes and costs was conducted among 198 patients undergoing repeated IVF-ICSI cycles, including 109 receiving luteal phase down-regulation with GnRH agonist protocol (group A) and 89 receiving GnRH antagonist protocol (group B). The numbers of oocytes retrieved and good embryos, clinical pregnancy rate, abortion rate, the live birth rate, mean total cost, and the cost-effective ratio were compared between the two groups. In patients undergoing repeated IVF-ICSI cycles, the two protocols produced no significant differences in the number of good embryos, clinical pregnancy rate, abortion rate, or twin pregnancy rate. Compared with group B, group A had better clinical outcomes though this difference was not statistically significant. The number of retrieved oocytes was significantly greater and live birth rate significantly higher in group A than in group B (9.13=4.98 vs 7.11=4.74, and 20.2% vs 9.0%, respectively). Compared with group B, group A had higher mean total cost per cycle but lower costs for each oocyte retrieved (2729.11 vs 3038.60 RMB yuan), each good embryo (8867.19 vs 9644.85 RMB yuan), each clinical pregnancy (77598.06 vs 96139.85 RMB yuan). For patients undergoing repeated IVF/ICSI cycle, luteal phase down-regulation with GnRH agonist protocol produces good clinical outcomes with also good cost-effectiveness in spite an unsatisfactory ovarian reserve.

  8. Egg donation for stem cell research: ideas of surplus and deficit in Australian IVF patients' and reproductive donors' accounts.

    Science.gov (United States)

    Waldby, Catherine; Carroll, Katherine

    2012-05-01

    We report on a study undertaken with an Australian in vitro fertilisation (IVF) clinic to understand IVF patients' and reproductive donors' perceptions of oocyte (egg) donation for stem cell research. Such perspectives are particularly valuable because IVF patients form a major recruitment group for oocyte donation for research, and because patients and donors have direct experience of the medical procedures involved. Similar studies of oocyte donation have been carried out elsewhere in the world, but to date very little social science research has been published that reports on donation for research, as distinct from donation for reproduction. Our respondents expressed a distinct unwillingness to donate viable oocytes for stem cell research. In our analysis we consider a number of factors that explain this unwillingness. These include the labour of oocyte production, the inscrutability of oocytes (the lack of a test to identify degrees of fertility) and the extent to which the oocytes' fertility sets the parameters for all downstream reproductive possibilities. We draw on the science studies literature on affordances to make sense of the social intractability of oocytes, and compare them with the respondents' much greater willingness to donate frozen embryos for human embryonic stem cells research. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  9. Modified natural cycle IVF and mild IVF: a 10 year Swedish experience.

    Science.gov (United States)

    Aanesen, Arthur; Nygren, Karl-Gösta; Nylund, Lars

    2010-01-01

    Modified natural cycle IVF (mnc-IVF) or mild IVF (m-IVF) was offered to selected patients between 1996 and 2007; 43 patients during 129 cycles were treated with mnc-IVF and 145 couples during 250 cycles were treated with m-IVF. Comparison with outcome from conventional IVF cycles during the same time period and in the same clinic was performed. Although 53.5 and 39.6% of started cycles respectively never reached embryo transfer, the ongoing pregnancy rates per embryo transfer were 26.7% for mnc-IVF and 27.2% for m-IVF. During the same time period, cancellation rate for conventional IVF was 13.7% and the ongoing pregnancy rate per embryo transfer was 34.3%. For patients > or =38years of age, the ongoing pregnancy rate per embryo transfer was 17.5% in the m-IVF group. None of the patients aged > or =38years in the mnc-IVF group achieved an ongoing pregnancy. For patients treated with conventional IVF, the > or =38years of age pregnancy rate per embryo transfer was 27.0%. Costs of medication for m-IVF and mnc-IVF were 96.3 and 97.5% less than for the least expensive conventional IVF cycle respectively. Pregnancy rates per embryo transfer are acceptable for these treatment modalities, the cost for medication is low, risks for complications are dramatically reduced, and the treatments may be more psychologically acceptable to the patients. Copyright (c) 2009 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Dietary supplementation of antioxidants improves semen quality of IVF patients in terms of motility, sperm count, and nuclear vacuolization.

    Science.gov (United States)

    Wirleitner, Barbara; Vanderzwalmen, Pierre; Stecher, Astrid; Spitzer, Dietmar; Schuff, Maximilian; Schwerda, Delf; Bach, Magnus; Schechinger, Birgit; Herbert Zech, Nicolas

    2012-12-01

    This study aimed to investigate the influence of an oral antioxidative supplementation on sperm quality of in vitro fertilization (IVF) patients, as analyzed by sperm motility according to the WHO criteria and motile sperm organelle morphology examination (MSOME). Semen samples were collected from 147 patients before undergoing an IVF/intracytoplasmic morphologically-selected sperm injection (IMSI) cycle and 2 - 12 months after an antioxidative supplementation. Semen analysis was evaluated according to WHO and MSOME criteria. Spermatozoa were grouped according to the size of nuclear vacuoles within the sperm's heads. Patients were divided into oligoasthenoteratozoospermic (OAT) and non-OAT men. Between first and second semen analysis, patients were supplemented orally with an antioxidative preparation. After the antioxidative therapy we observed a significant reduction in the percentage of immotile sperm cells in the patients. Additionally, the percentage of class I spermatozoa according to MSOME criteria was significantly higher after antioxidative supplementation. In OAT patients the percentage of class I sperm was found to be increased, although not significantly. However, we observed a drastic improvement in sperm motility as well as in total sperm count in this group. The results demonstrated a considerable improvement in semen quality, notably in OAT patients. Considering the putative relationship between semen quality on the one hand and reactive oxygen species on the other, the observed changes in the sperm parameters indicate that a decline in semen quality, and even subtle morphological changes, might be associated with oxidative stress. Our findings suggest that an antioxidative and micronutrient supplementation has a remarkable benefit for IVF patients having restricted sperm parameters, in particular.

  11. Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients

    Directory of Open Access Journals (Sweden)

    Sills E

    2012-08-01

    Full Text Available Abstract Background During in vitro fertilization (IVF, fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. Methods Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. Results Completed questionnaires (n = 71 revealed a mean +/− SD patient age of 34 +/− 4.1 yrs. Most (83.1% had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s. When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/− 11.75 and $654.55 +/− 106.34, respectively (p  Conclusions This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs

  12. Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients.

    Science.gov (United States)

    Sills, E Scott; Collins, Gary S; Salem, Shala A; Jones, Christopher A; Peck, Alison C; Salem, Rifaat D

    2012-08-30

    During in vitro fertilization (IVF), fertility patients are expected to self-administer many injections as part of this treatment. While newer medications have been developed to substantially reduce the number of these injections, such agents are typically much more expensive. Considering these differences in both cost and number of injections, this study compared patient preferences between GnRH-agonist and GnRH-antagonist based protocols in IVF. Data were collected by voluntary, anonymous questionnaire at first consultation appointment. Patient opinion concerning total number of s.c. injections as a function of non-reimbursed patient cost associated with GnRH-agonist [A] and GnRH-antagonist [B] protocols in IVF was studied. Completed questionnaires (n = 71) revealed a mean +/- SD patient age of 34 +/- 4.1 yrs. Most (83.1%) had no prior IVF experience; 2.8% reported another medical condition requiring self-administration of subcutaneous medication(s). When out-of-pocket cost for [A] and [B] were identical, preference for [B] was registered by 50.7% patients. The tendency to favor protocol [B] was weaker among patients with a health occupation. Estimated patient costs for [A] and [B] were $259.82 +/- 11.75 and $654.55 +/- 106.34, respectively (p cost difference increased. This investigation found consistently higher non-reimbursed direct medication costs for GnRH-antagonist IVF vs. GnRH-agonist IVF protocols. A conditional preference to minimize downregulation (using GnRH-antagonist) was noted among some, but not all, IVF patient sub-groups. Compared to IVF patients with a health occupation, the preference for GnRH-antagonist was weaker than for other patients. While reducing total number of injections by using GnRH-antagonist is a desirable goal, it appears this advantage is not perceived equally by all IVF patients and its utility is likely discounted heavily by patients when nonreimbursed medication costs reach a critical level.

  13. Ganirelix for luteolysis in poor responder patients undergoing IVF treatment: a Scandinavian multicenter 'extended pilot study'

    DEFF Research Database (Denmark)

    Nilsson, Lena; Andersen, A.N.; Lindenberg, Svend

    2010-01-01

    To enhance oocyte yield and pregnancy outcome in poor responder women undergoing IVF treatment, daily low dose GnRH antagonist administration was given during the late luteal phase to induce luteolysis and possibly secure a more synchronous cohort of recruitable follicles. An open extended pilot...

  14. Effect of overweight/obesity on IVF-ET outcomes in chinese patients with polycystic ovary syndrome

    OpenAIRE

    Huang, Kai; Liao, Xiuhua; Dong, Xiyuan; Zhang, Hanwang

    2014-01-01

    The purpose of this study was to investigate the impact of body mass index (BMI) on the outcomes of IVF/ICSI treatment cycles in Chinese patients with polycystic ovary syndrome (PCOS). Women with PCOS (n = 128) and tubal factor (n = 128) underwent a conventional long GnRH agonist suppressive protocol. Women with PCOS had significantly more oocytes retrieved (P < 0.05) and available embryos (P < 0.05), as compared to patients with tubal infertility. No significant differences were observed in ...

  15. Knowledge brokering:

    DEFF Research Database (Denmark)

    Bergenholtz, Carsten

    2010-01-01

    -organizational search strategy that spans technological boundaries and involves the formation and search among weak ties. The findings show how knowledge brokering is influenced by the make-up of the technology involved, the technological distance between the two parties and why weak ties are less likely to collaborate...

  16. LOAN BROKERS

    Directory of Open Access Journals (Sweden)

    Adela IONESCU

    2014-05-01

    Full Text Available A loan is probably the most important financial decision we make in life. In a time when lack of time affects us in every way, including financially, we can only appeal to specialists if we want fast, reliable and quality long-term services. „The notion of “creditor” includes all legal entities, branches of credit institution and nonbankingfinancial institutions that operate in Romania and grant or undertake to grant loans in itscommercial of professional activity”. In the case of loans, the "specialist" has been called loan broker. Loan broker is a person trained in intermediating bank loans who offers advice on choosing the best financial solutions for each client. Through partnerships with banks in Romania, the broker has access to their credit products and assist customers in choosing the loan that best suits their financial needs and possibilities. Moreover, the broker will help in preparing loan application to be submitted to the bank and pursue it to its completion. Loan broker can be defined as the person authorized by the bank or non-bank financial institutions to promote their products through direct contact with natural or legal persons wishing to contract a loan, without any of the parties to have exclusivity. There can be defined as an independent bank or non-bank financial institution, as an intermediary between customers and banks. Through its financial advisors , the company helps customers overcome the difficulty of understanding the credit products, difficulties arising from the multitude of factors that compose such a product, especially in the case of a housing loan or mortgage. Each financial institution is doing everything possible through such partnerships to attract the largest possible portfolio of clients, therefore is developing a real network of brokers to be partners for local or national level (depending on the sites coverage of the branches of each institution on one or more types of credit products. The

  17. Follicular and endocrine dose responses according to anti-Müllerian hormone levels in IVF patients treated with a novel human recombinant FSH (FE 999049)

    DEFF Research Database (Denmark)

    Bosch, Ernesto; Nyboe Andersen, Anders; Barri, Pedro

    2015-01-01

    OBJECTIVE: To study the association between serum anti-Müllerian hormone (AMH) levels and follicular development and endocrine responses induced by increasing doses (5·2-12·1 μg/day) of a novel recombinant human FSH (rhFSH, FE 999049) in patients undergoing in vitro fertilization (IVF)/intracytop......OBJECTIVE: To study the association between serum anti-Müllerian hormone (AMH) levels and follicular development and endocrine responses induced by increasing doses (5·2-12·1 μg/day) of a novel recombinant human FSH (rhFSH, FE 999049) in patients undergoing in vitro fertilization (IVF...... for these hormones, and no clear dose-related increase was observed for the number of follicles in these patients. CONCLUSIONS: Dose-response relationships between rhFSH and follicular development and endocrine parameters are significantly different for IVF/ICSI patients with lower and higher serum AMH levels...

  18. Who abandons embryos after IVF?

    LENUS (Irish Health Repository)

    Walsh, A P H

    2010-04-01

    This investigation describes features of in vitro fertilisation (IVF) patients who never returned to claim their embryos following cryopreservation. Frozen embryo data were reviewed to establish communication patterns between patient and clinic; embryos were considered abandoned when 1) an IVF patient with frozen embryo\\/s stored at our facility failed to make contact with our clinic for > 2 yrs and 2) the patient could not be located after a multi-modal outreach effort was undertaken. For these patients, telephone numbers had been disconnected and no forwarding address was available. Patient, spouse and emergency family contact\\/s all escaped detection efforts despite an exhaustive public database search including death records and Internet directory portals. From 3244 IVF cycles completed from 2000 to 2008, > or = 1 embryo was frozen in 1159 cases (35.7%). Those without correspondence for > 2 yrs accounted for 292 (25.2%) patients with frozen embryos; 281 were contacted by methods including registered (signature involving abandoned embryos did not differ substantially from other patients. The goal of having a baby was achieved by 10\\/11 patients either by spontaneous conception, adoption or IVF. One patient moved away with conception status unconfirmed. The overall rate of embryo abandonment was 11\\/1159 (< 1%) in this IVF population. Pre-IVF counselling minimises, but does not totally eliminate, the problem of abandoned embryos. As the number of abandoned embryos from IVF accumulates, their fate urgently requires clarification. We propose that clinicians develop a policy consistent with relevant Irish Constitutional provisions to address this medical dilemma.

  19. Knowledge brokering

    DEFF Research Database (Denmark)

    Bergenholtz, Carsten

    2011-01-01

    Purpose – The purpose of this paper is to examine how the spanning of inter-organizational weak ties and technological boundaries influences knowledge brokering. Design/methodology/approach – The paper is based on original fieldwork and employs a case study research design, investigating a Danish...... HTSF’s inter-organizational activities. Findings – The findings show how an inter-organizational search that crosses technological boundaries and is based on a network structure of weak ties can imply a reduced risk of unwanted knowledge spill-over. Research limitations/implications – By not engaging...... in strong tie collaborations a knowledge brokering organization can reduce the risk of unwanted knowledge spill-over. The risks and opportunities of knowledge spill-over furthermore rely on the nature of the technology involved and to what extent technological boundaries are crossed. Practical implications...

  20. Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study

    DEFF Research Database (Denmark)

    Lossl, Kristine; Loft, Anne; Freiesleben, Nina L C

    2009-01-01

    and delivery rate, and endocrine response. The paired T test and Wilcoxon Signed Rank test were used to analyse paired differences. RESULTS: During the combined down-regulation, the endometriomal volume and the serum CA125 level decreased by 29% (3-39%) and 61% (21-74%), respectively (median (95%CI), P=0....... The aim of this study was to test the concept of combined down-regulation prior to IVF in patients with endometriomas. STUDY DESIGN: Prospective pilot study in a university-based tertiary fertility clinic including 20 infertile patients with endometriomas undergoing IVF/ICSI. The patients received...

  1. Predicting IVF outcome

    NARCIS (Netherlands)

    van Loendersloot, L.L.

    2013-01-01

    On 25 July 1978 at 11.47 PM Louise Brown was born as the first IVF baby ever. Since its introduction more than 5 million babies have been born worldwide using IVF. In contrast to patients’ perception, IVF does not guarantee success; almost 50% of couples that start with IVF will not achieve a

  2. Understanding reproducibility of human IVF traits to predict next IVF cycle outcome.

    Science.gov (United States)

    Wu, Bin; Shi, Juanzi; Zhao, Wanqiu; Lu, Suzhen; Silva, Marta; Gelety, Timothy J

    2014-10-01

    Evaluating the failed IVF cycle often provides useful prognostic information. Before undergoing another attempt, patients experiencing an unsuccessful IVF cycle frequently request information about the probability of future success. Here, we introduced the concept of reproducibility and formulae to predict the next IVF cycle outcome. The experimental design was based on the retrospective review of IVF cycle data from 2006 to 2013 in two different IVF centers and statistical analysis. The reproducibility coefficients (r) of IVF traits including number of oocytes retrieved, oocyte maturity, fertilization, embryo quality and pregnancy were estimated using the interclass correlation coefficient between the repeated IVF cycle measurements for the same patient by variance component analysis. The formulae were designed to predict next IVF cycle outcome. The number of oocytes retrieved from patients and their fertilization rate had the highest reproducibility coefficients (r = 0.81 ~ 0.84), which indicated a very close correlation between the first retrieval cycle and subsequent IVF cycles. Oocyte maturity and number of top quality embryos had middle level reproducibility (r = 0.38 ~ 0.76) and pregnancy rate had a relative lower reproducibility (r = 0.23 ~ 0.27). Based on these parameters, the next outcome for these IVF traits might be accurately predicted by the designed formulae. The introduction of the concept of reproducibility to our human IVF program allows us to predict future IVF cycle outcomes. The traits of oocyte numbers retrieved, oocyte maturity, fertilization, and top quality embryos had higher or middle reproducibility, which provides a basis for accurate prediction of future IVF outcomes. Based on this prediction, physicians may counsel their patients or change patient's stimulation plans, and laboratory embryologists may improve their IVF techniques accordingly.

  3. Patient preference for a long-acting recombinant FSH product in ovarian hyperstimulation in IVF: a discrete choice experiment.

    Science.gov (United States)

    van den Wijngaard, L; Rodijk, I C M; van der Veen, F; Gooskens-van Erven, M H W; Koks, C A M; Verhoeve, H R; Mol, B W J; van Wely, M; Mochtar, M H

    2015-02-01

    What factors or attributes of a long-acting recombinant FSH (rFSH) or daily-administrated rFSH influence women's preferences IVF? Patients' preferences for rFSH products are primary influenced by the attribute 'number of injections', but a low 'number of injections' is exchanged for a high 'number of injections' at a 6.2% decrease in 'risk of cycle cancellation due to low response' and at a 4.5% decrease in 'chance of OHSS'. Injections of long-acting rFSH have been claimed to be preferred over daily-administrated rFSH injections, but patient preference studies to underpin this assumption have not been performed. A discrete choice experiment (DCE) was created to assess women's preference for long-acting or daily-administrated rFSH under varying attributes of efficiency, safety and burden. The selected attributes were the 'total number of injections', 'chance of ovarian hyperstimulation syndrome (OHSS)' and the 'risk of cycle cancellation due to low response'. Questionnaires were handed out during information gathering sessions in one academic hospital and two teaching hospitals in The Netherlands between April 2011 and April 2012. Women at the start of their first IVF treatment were asked to participate in this patient preference study. Participation was voluntary. We analysed the data by using mixed logit models to estimate the utility of each attribute. Questionnaires (n = 125) were handed out with a response rate of 77% (97/125). Four respondents did not complete the questionnaire. Hence, there were 93 questionnaires available for analysis. All attributes significantly influenced women's preference. Overall, the lower 'number of injections' was preferred above the higher 'number of injections' (mean coefficient 1.25; P lower 'number of injections' for a higher 'number of injections' when gaining a 6.2% reduction in 'cycle cancellation due to low response', or a 4.5% reduction in 'chance of OHSS'. The generalizability of this DCE is limited in time-span. Women may

  4. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type

    NARCIS (Netherlands)

    Lambalk, C. B.; Banga, F. R.; Huirne, J. A.; Toftager, M.; Pinborg, A.; Homburg, R.; van der Veen, F.; van Wely, M.

    2017-01-01

    Most reviews of IVF ovarian stimulation protocols have insufficiently accounted for various patient populations, such as ovulatory women, women with polycystic ovary syndrome (PCOS) or women with poor ovarian response, and have included studies in which the agonist or antagonist was not the only

  5. Risk charts to identify low and excessive responders among first-cycle IVF/ICSI standard patients

    DEFF Research Database (Denmark)

    la Cour Freiesleben, N; Gerds, Thomas Alexander; Forman, Julie Lyng

    2011-01-01

    Ovarian stimulation carries a risk of either low or excessive ovarian response. The aim was to develop prognostic models for identification of standard (ovulatory and normal basal FSH) patients’ risks of low and excessive response to conventional stimulation for IVF/intracytoplasmic sperm injection....... Prospectively collected data on 276 first-cycle patients treated with 150 IU recombinant FSH (rFSH)/day in a long agonist protocol were analysed. Logistic regression analysis was applied to the outcome variables:low (seven or less follicles) and excessive (20 or more follicles) response. Variables were woman......’s age, menstrual cycle length, weight or body mass index, ovarian volume, antral follicle count (AFC) and basal FSH. The predictive performance of the models was evaluated from the prediction error (Brier score, %) where zero corresponds to a perfect prediction. Model stability was assessed using 1000...

  6. The impact of introducing patient co-payments in Germany on the use of IVF and ICSI: a price-elasticity of demand assessment.

    Science.gov (United States)

    Connolly, M P; Griesinger, G; Ledger, W; Postma, M J

    2009-11-01

    Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact of this pricing policy on the utilization of reproductive treatments in Germany. Using aggregated annual in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycle data in Germany, we evaluated the relationship between changes in the number of cycles in relation to changes in costs faced by consumers following the introduction of a patient co-payment from 'no fees' to 1500-2000 euros by estimating the short-run price-elasticity of demand. The impact of introducing patient co-payments for IVF/ICSI on the likelihood of switching to other low-cost fertility treatments was evaluated using the cross-price elasticity methodology. RESULTS The reduction in demand for IVF and ICSI cycles in the year following the introduction of patient co-payments resulted in elasticities of -0.41 and -0.34, respectively. The price-elasticity for the combined reduction of IVF/ICSI in relation to the co-payment was estimated to be -0.36. The cross-price elasticity for clomifene was close to zero (-0.01) suggesting that demand for these interventions are independent of each other and no substitution occurred. We report price elasticities for IVF and ICSI of -0.41 and -0.34 after introducing a 500-2000 euros co-payment. These findings likely represent short-run elasticities that are likely to vary over time as factors that influence the supply and demand for fertility treatments change.

  7. Cumulative pregnancy rates after sequential treatment with modified natural cycle IVF followed by IVF with controlled ovarian stimulation

    NARCIS (Netherlands)

    Pelinck, M. J.; Knol, H. M.; Vogel, N. E. A.; Arts, E. G. J. M.; Simons, A. H. M.; Heineman, M. J.; Hoek, A.

    BACKGROUND: In modified natural cycle IVF (MNC-IVF), treatment is aimed at using the one follicle that spontaneously develops to dominance, using a GnRH-antagonist together with gonadotrophins in the late follicular phase only. The MNC-IVF is of interest because of its low-risk and patient-friendly

  8. Cumulative pregnancy rates after sequential treatment with modified natural cycle IVF followed by IVF with controlled ovarian stimulation

    NARCIS (Netherlands)

    Pelinck, M. J.; Knol, H. M.; Vogel, N. E. A.; Arts, E. G. J. M.; Simons, A. H. M.; Heineman, M. J.; Hoek, A.

    2008-01-01

    BACKGROUND: In modified natural cycle IVF (MNC-IVF), treatment is aimed at using the one follicle that spontaneously develops to dominance, using a GnRH-antagonist together with gonadotrophins in the late follicular phase only. The MNC-IVF is of interest because of its low-risk and patient-friendly

  9. A randomized study comparing IVF in the unstimulated cycle with IVF-following clomiphene citrate

    DEFF Research Database (Denmark)

    Ingerslev, Hans Jakob; Højgaard, A.; Hindkjær, Johnny Juhl

    2001-01-01

    The efficiency of IVF in unstimulated cycles was compared with that following ovarian stimulation with clomiphene citrate in a simple protocol with ultrasound monitoring only. A total of 132 couples with no previous IVF attempts, selected by female age ... protocol, but not IVF in unstimulated cycles, seems compatible with the concept of `friendly IVF', yielding a fair pregnancy rate both per cycle started and per embryo transfer in selected patients. The results do not substantiate any important negative anti-oestrogenic effects of clomiphene....

  10. Encouraging post-stroke patients to be active seems possible: results of an intervention study with knowledge brokers.

    Science.gov (United States)

    Willems, Mia; Schröder, Carin; van der Weijden, Trudy; Post, Marcel W; Visser-Meily, Anne M

    2016-08-01

    Although physical activity and exercise for stroke patients is highly recommended for fast recovery, patients in hospitals and rehabilitation centres are insufficiently encouraged to be physically active. In this study, we investigated the impact of knowledge brokers (KBs), enterprising nurses and therapists, on health professionals' (HP) performance to encourage stroke inpatients to be physically active. This multicenter intervention study used a pre-post test design. Two or three KBs were trained in each stroke unit of 12 hospitals and 10 rehabilitation centres in The Netherlands. Questionnaires were completed by patients and HPs before and after the KB-intervention. The primary outcome was encouragement given by HPs to their patients to be physically active, as reported by patients and HPs. After the KB-intervention, many more patients (48%; N=217) reported at least some encouragement by HPs to be physically active than before (26%; N=243, pbrokers (KBs), since the KB-intervention was shown to increase the encouragement felt by stroke patients to be physically active. It seems worthwhile to involve physicians, nurses and patients' families more frequently in efforts to encourage stroke patients to be physically active.

  11. Predicting ongoing pregnancy chances after IVF and ICSI: A national prospective study

    OpenAIRE

    Lintsen, Bea; Eijkemans, René; Hunault, C.C.; Bouwmans-Frijters, Clazien; Hakkaart-van Roijen, Leona; Habbema, Dik; Braat, Didi

    2007-01-01

    textabstractBackground: The Dutch IVF guideline suggests triage of patients for IVF based on diagnostic category, duration of infertility and female age. There is no evidence for the effectiveness of these criteria. We evaluated the predictive value of patient characteristics that are used in the Dutch IVF guideline and developed a model that predicts the IVF ongoing pregnancy chance within 12 months. Methods: In a national prospective cohort study, pregnancy chances after IVF and ICSI treatm...

  12. GnRH antagonist versus long agonist protocols in IVF: a systematic review and meta-analysis accounting for patient type.

    Science.gov (United States)

    Lambalk, C B; Banga, F R; Huirne, J A; Toftager, M; Pinborg, A; Homburg, R; van der Veen, F; van Wely, M

    2017-09-01

    Most reviews of IVF ovarian stimulation protocols have insufficiently accounted for various patient populations, such as ovulatory women, women with polycystic ovary syndrome (PCOS) or women with poor ovarian response, and have included studies in which the agonist or antagonist was not the only variable between the compared study arms. The aim of the current study was to compare GnRH antagonist protocols versus standard long agonist protocols in couples undergoing IVF or ICSI, while accounting for various patient populations and treatment schedules. The Cochrane Menstrual Disorders and Subfertility Review Group specialized register of controlled trials and Pubmed and Embase databases were searched from inception until June 2016. Eligible trials were those that compared GnRH antagonist protocols and standard long GnRH agonist protocols in couples undergoing IVF or ICSI. The primary outcome was ongoing pregnancy rate. Secondary outcomes were: live birth rate, clinical pregnancy rate, number of oocytes retrieved and safety with regard to ovarian hyperstimulation syndrome (OHSS). Separate comparisons were performed for the general IVF population, women with PCOS and women with poor ovarian response. Pre-planned subgroup analyses were performed for various antagonist treatment schedules. We included 50 studies. Of these, 34 studies reported on general IVF patients, 10 studies reported on PCOS patients and 6 studies reported on poor responders. In general IVF patients, ongoing pregnancy rate was significantly lower in the antagonist group compared with the agonist group (RR 0.89, 95% CI 0.82-0.96). In women with PCOS and in women with poor ovarian response, there was no evidence of a difference in ongoing pregnancy between the antagonist and agonist groups (RR 0.97, 95% CI 0.84-1.11 and RR 0.87, 95% CI 0.65-1.17, respectively). Subgroup analyses for various antagonist treatment schedules compared to the long protocol GnRH agonist showed a significantly lower ongoing

  13. Comparison of follicular fluid and serum levels of Inhibin A and Inhibin B with calculated indices used as predictive markers of ovarian hyperstimulation syndrome in IVF patients

    Directory of Open Access Journals (Sweden)

    Pavelkova Jana

    2009-08-01

    Full Text Available Abstract Background Ovarian Hyperstimulation Syndrome (OHSS is a severe health complication observed in some patients undergoing hormonal stimulation during IVF. Presence of OHSS is often associated with a high count of growing follicles responding to FSH hyperstimulation. However, the number of responding follicles may not be sufficient enough to predict the onset and severity of OHSS. The aim of this study was to find whether follicular fluid (FF and serum concentrations of Inhibin A and Inhibin B in patients undergoing IVF treatment may serve as a predictor of OHSS status independent of the growing follicles count. Methods Serum and follicular fluid of fifty-three women undertaking the IVF program were separated into four groups according to their OHSS status and growing follicles count and analyzed for serum and FF concentrations of Inhibin A and Inhibin B. The resulting data were combined with clinical and demographic data to calculate indices independent of the growing follicles count. Results Serum Inhibin A and Inhibin B concentrations showed no significant difference between the severe OHSS group and the control group without OHSS. Moreover, the serum concentrations of Inhibin A and Inhibin B were strongly correlated with the growing follicles count. Their concentrations in the high responders group (>18 follicles were significantly higher (p Conclusion These observations demonstrated that while neither serum nor FF concentrations of Inhibin A nor Inhibin B can be used as an OHSS predictor independent of the growing follicle count, calculated indices may meet the criteria.

  14. In vitro fertilization (IVF) versus gonadotropins followed by IVF as treatment for primary infertility: a cost-based decision analysis.

    Science.gov (United States)

    Kansal-Kalra, Suleena; Milad, Magdy P; Grobman, William A

    2005-09-01

    To compare the economic consequences of proceeding directly to IVF to those of proceeding with gonadotropins followed by IVF in patients cost and success of each infertility regimen as well as the pregnancy-associated costs of singleton or multiple gestations and the risk and cost of cerebral palsy. Cost per live birth. Both treatment arms resulted in a >80% chance of birth. The gonadotropin arm was over four times more likely to result in a high-order multiple pregnancy (HOMP). Despite this, when the base case estimates were utilized, immediate IVF emerged as more costly per live birth. In sensitivity analysis, immediate IVF became less costly per live birth when IVF was more likely to achieve birth (55.1%) or cheaper (11,432 dollars) than our base case assumptions. After considering the risk and cost of HOMP, immediate IVF is more costly per live birth than a trial of gonadotropins prior to IVF.

  15. Juggling on a rollercoaster? Gains, loss and uncertainties in IVF patients' accounts of volunteering for a U.K. ‘egg sharing for research’ scheme

    Science.gov (United States)

    Haimes, Erica

    2013-01-01

    The past decade has seen a growth in demand for human eggs for stem cell related research and, more recently, for mitochondrial research. That demand has been accompanied by global debates over whether women should be encouraged, by offers of payments, in cash or kind, to provide eggs. Few of these debates have been informed by empirical evidence, let alone by the views of women themselves. This article addresses that gap in knowledge by presenting findings from a UK investigation, conducted 2008–2011, which is the first systematic study of women volunteering to provide eggs under such circumstances. This article focuses on the views and experiences of 25 IVF patients who volunteered for the Newcastle ‘egg sharing for research’ scheme (NESR), in exchange for reduced IVF fees. This was an interview based study, designed to gain understandings of volunteers' perspectives and reasoning. The interviews show that volunteers approached the scheme as a way of accessing more treatment in pursuit of their goal of having a baby, against a landscape of inadequate state provision of treatment and expensive private treatment. The process of deciding to volunteer raised a wide range of uncertainties about the consequent gains and losses, for women already in the uncertain world of the ‘IVF rollercoaster’. However, interviewees preferred to have the option of the NESR, than not, and they juggled the numerous uncertainties with skill and resilience. The article is as revealing of the ongoing challenges of the UK IVF bio-economy as it is of egg provision. This article adds to the growing body of knowledge of the contributions of tissue providers to the global bio-economy. It also contributes to several areas of wider sociological interest, including debates on the social management of ‘uncertainty’ and discussions at the interface of sociology and ethics. PMID:23608093

  16. Selective use of corifollitropin for controlled ovarian stimulation for IVF in patients with low anti-Müllerian hormone

    DEFF Research Database (Denmark)

    Nielsen, Anna Pors; Korsholm, Anne-Sofie; Lemmen, Josephine G.

    2016-01-01

    Corifollitropin, a long-acting follicle-stimulating hormone (FSH) analogue used for in vitro fertilization (IVF), does not allow individualization of dosage, and the ovarian response is similar to around 300 IU of daily recombinant FSH. This has raised concerns about the risk of ovarian hyperstim......Corifollitropin, a long-acting follicle-stimulating hormone (FSH) analogue used for in vitro fertilization (IVF), does not allow individualization of dosage, and the ovarian response is similar to around 300 IU of daily recombinant FSH. This has raised concerns about the risk of ovarian...

  17. Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004

    Science.gov (United States)

    Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

    2010-01-01

    BACKGROUND Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. METHODS A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of patient selection were assessed by questionnaires and interviews developed for this study. RESULTS More than 500 couples enquired about surrogacy by telephone or e-mail. More than 200 couples applied for surrogacy in the Centre, of which, after extensive screening, 35 couples actually entered the IVF programme and 24 completed the treatment, resulting in 16 children being born to 13 women. Recommendations for non-commercial surrogacy are given, including abandoning the 1-year waiting period before adoption, currently dictated by law, avoiding a period of unnecessary psychological distress. CONCLUSIONS Our study has shown that non-commercial IVF surrogacy is feasible, with good results in terms of pregnancy outcome and psychological outcome for all parents, and with no legal problems relating to the adoption procedures arising. The extensive screening of medical, psychological and legal aspects was a key element in helping to ensure the safety and success of the procedure. PMID:19945960

  18. Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004.

    Science.gov (United States)

    Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

    2010-02-01

    Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of patient selection were assessed by questionnaires and interviews developed for this study. More than 500 couples enquired about surrogacy by telephone or e-mail. More than 200 couples applied for surrogacy in the Centre, of which, after extensive screening, 35 couples actually entered the IVF programme and 24 completed the treatment, resulting in 16 children being born to 13 women. Recommendations for non-commercial surrogacy are given, including abandoning the 1-year waiting period before adoption, currently dictated by law, avoiding a period of unnecessary psychological distress. Our study has shown that non-commercial IVF surrogacy is feasible, with good results in terms of pregnancy outcome and psychological outcome for all parents, and with no legal problems relating to the adoption procedures arising. The extensive screening of medical, psychological and legal aspects was a key element in helping to ensure the safety and success of the procedure.

  19. Controlled ovarian stimulation with r-FSH plus r-LH vs. HMG plus r-FSH in patients candidate for IVF/ICSI cycles: An RCT

    Directory of Open Access Journals (Sweden)

    Ensieh Shahrokh Tehraninejad

    2017-08-01

    Full Text Available Background: Different combination of gonadotropin preparation has been introduced with no definite superiority of one over others in in vitro fertilization (IVF, but individualized regimens for each patient are needed. Objective: The aim of the present study was to investigate the effect of controlled ovarian stimulation with recombinant- follicle stimulating hormone (r-FSH plus recombinant-luteinizing hormone (rLH versus human menopausal gonadotropin (HMG plus r-FSH on fertility outcomes in IVF patients. Materials and Methods: This is a randomized clinical trial study that was performed from October 2014-April 2016 on 140 infertile patients with a set of inclusion criteria that referred to infertility clinics in Vali- asr and Gandhi Hospital in Tehran. The women were randomly divided into two treatment groups. The first group (n=70 received rFSH from the second day of cycle and was added HMG in 6th day and the 2nd group (n=70, received rFSH from the second day of cycle and was added recombinant-LH in 6th day. Then ovum Pick-Up and embryo transfer were performed. In this study, we assessed the outcomes such as; chemical and clinical pregnancy rate, live birth and abortion rate. Results: Number of follicles in ovaries, total number of oocytes or M2 oocytes and quality of fetuses has no significant differences between two groups (p>0.05. Total number of fetuses were significantly higher in patients who received rFSH + HMG (p=0.02. Fertility outcomes consisted of: live birth rate, chemical pregnancy and clinical pregnancy rate were higher in rFSH + HMG group in comparison to rFSH +r-LH group (p<0.05. Conclusion: It seems that in IVF patients, HMG + rFSH used for controlled ovarian hyperstimulation have better effects on fertility outcomes, but in order to verify the results, it is recommended to implement studies on more patients.

  20. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study

    Directory of Open Access Journals (Sweden)

    Yang Zhihong

    2012-05-01

    Full Text Available Abstract Background Single embryo transfer (SET remains underutilized as a strategy to reduce multiple gestation risk in IVF, and its overall lower pregnancy rate underscores the need for improved techniques to select one embryo for fresh transfer. This study explored use of comprehensive chromosomal screening by array CGH (aCGH to provide this advantage and improve pregnancy rate from SET. Methods First-time IVF patients with a good prognosis (age Results For patients in Group A (n = 55, 425 blastocysts were biopsied and analyzed via aCGH (7.7 blastocysts/patient. Aneuploidy was detected in 191/425 (44.9% of blastocysts in this group. For patients in Group B (n = 48, 389 blastocysts were microscopically examined (8.1 blastocysts/patient. Clinical pregnancy rate was significantly higher in the morphology + aCGH group compared to the morphology-only group (70.9 and 45.8%, respectively; p = 0.017; ongoing pregnancy rate for Groups A and B were 69.1 vs. 41.7%, respectively (p = 0.009. There were no twin pregnancies. Conclusion Although aCGH followed by frozen embryo transfer has been used to screen at risk embryos (e.g., known parental chromosomal translocation or history of recurrent pregnancy loss, this is the first description of aCGH fully integrated with a clinical IVF program to select single blastocysts for fresh SET in good prognosis patients. The observed aneuploidy rate (44.9% among biopsied blastocysts highlights the inherent imprecision of SET when conventional morphology is used alone. Embryos randomized to the aCGH group implanted with greater efficiency, resulted in clinical pregnancy more often, and yielded a lower miscarriage rate than those selected without aCGH. Additional studies are needed to verify our pilot data and confirm a role for on-site, rapid aCGH for IVF patients contemplating fresh SET.

  1. The outcome of assisted hatching and defragmentation in patients with poor quality embryos on IVF outcome

    Directory of Open Access Journals (Sweden)

    Ahmet Zeki Işık

    2013-09-01

    Full Text Available Objective: To evaluate the effects of assisted hatching in combination with defragmentation applied to day 3 poor quality human embryos, on implantation and pregnancy rates. Materials and Methods: A retrospective analysis was performed in patients (n=168 of all ages with no good quality transferable embryos (Veeck classification embryos >grade 1 and/or >10% fragmentation. The first group was consisted of cycles in which mAHA was performed to all transferred grade 2 embryos. The second group included transfer cycles where all the embryos were highly fragmented (between 10-50% fragmentations, grade 3 and aAHA and microsurgical fragment removal were applied to all of them. Results: In first group positive βhCG was 33%, clinical pregnancy (fetal heart beat rate was 27% and implantation rate was 11,28%. These rates were 37, 1%; 28, 8% and %16,19 respectively in the aAHA plus defragmentation group. In cases over 35 years of age in aAHA plus defragmentation group acceptable implantation (14,46% and clinical pregnancy (31,58% rates were achieved. Conclusion: In patients with no good quality transferable embryos AHA combined with defragmentation can be utilised with acceptable success rates in laboratories where there are experienced personnel available for this procedure otherwise only AHA can be the best option.

  2. Circulating LH/hCG receptor (LHCGR may identify pre-treatment IVF patients at risk of OHSS and poor implantation

    Directory of Open Access Journals (Sweden)

    Chambers Anne E

    2011-12-01

    Full Text Available Abstract Background Successful pregnancy via in vitro fertilization (IVF depends on the recovery of an adequate number of healthy oocytes and on blastocyst implantation following uterine transfer. Two hormones, LH and hCG, utilize a common LH/hCG receptor (LHCGR, variations in which have profound implications in human reproduction. Soluble LHCGR (sLHCGR is released from experimental cell lines and placental explants and it can be detected in the follicular fluid and serum. Methods To evaluate the impact of circulating soluble LHCGR (sLHCGR in fertility treatment, we measured sLHCGR and LH-sLHCGR complex in serum from women seeking IVF using specifically developed quantitative enzyme-linked immunosorbent assays (ELISA. Following an IVF cycle of treatment, patients were grouped according to oocyte yield into low (lower than or equal to 7 oocytes, intermediate (8-14 oocytes and high (greater than or equal to 15 oocytes responders and pregnancy outcome noted. Results Pre-treatment sLHCGR identified many women at risk of ovarian hyperstimulation. Low levels of sLHCGR were associated with pregnancy in both high and low responders but sLHCGR did not significantly affect the treatment outcome of intermediate responders. Low responders who failed to become pregnant had high levels of circulating sLHCGR bound to LH (LH-sLHCGR. Conclusions Pre-treatment measurement of sLHCGR could be used to tailor individual fertility treatment programs and improve outcomes by avoiding ovarian hyperstimulation and poor embryo implantation.

  3. FRDS.Broker Library

    DEFF Research Database (Denmark)

    2018-01-01

    The FRDS.Broker library is a teaching oriented implementation of the Broker architectural pattern for distributed remote method invocation. It defines the central roles of the pattern and provides implementations of those roles that are not domain/use case specific. It provides a JSON based (GSon...... library) Requestor implementation, and implementations of the ClientRequestHandler and ServerRequestHandler roles in both a Java socket based and a Http/URI tunneling based variants. The latter us based upon the UniRest and Spark-Java libraries. The Broker pattern and the source code is explained...

  4. Intelligent Electricity Broker

    DEFF Research Database (Denmark)

    Grode, Jesper Nicolai Riis; Væggemose, Poul Erik; Kulik, Tomas

    The Intelligent Electricity Broker (IEB) is a new energy storage and energy broker facility that serves two purposes. Firstly, it allows for storing excessive energy in the Smart Grid [1, 2, 3] it is connected to. Secondly, it runs a broker-algorithm that ensures that energy is purchased and sold...... when feasible to the system owner. This paper describes how the IEB can be used by house owners, in building clusters, and/or by energy providers to take advantage of electricity stock market prices and weather forecasts to control energy surplus storage suffers as well as to lower electricity bills...

  5. Effects of EG-VEGF, VEGF and TGF-β1 on pregnancy outcome in patients undergoing IVF-ET treatment.

    Science.gov (United States)

    Gao, Min-zhi; Zhao, Xiao-ming; Lin, Yi; Sun, Zhao-gui; Zhang, Hui-qin

    2012-10-01

    To investigate the correlation of endocrine gland-derived vascular endothelial growth factor (EG-VEGF), vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-β1) with the corresponding reproductive outcome in patients who received in vitro fertilization-embryo transfer (IVF-ET). Sixty-seven women undergoing IVF-ET at a university tertiary hospital were recruited for a prospective study. Concentrations of EG-VEGF, VEGF and TGF-β1 were measured by enzyme-linked immunosorbent assay (ELISA) in follicular fluid (FF) collected during oocyte retrieval (OR) and in serum collected 2 days after OR. In FF, concentrations of both EG-VEGF and VEGF were negatively correlated with peak E2 and the number of MII oocytes retrieved, and positively correlated with each other. In serum, concentrations of all the three growth factors were positively correlated with the rate of good quality embryo, and with one another. Patients in the pregnancy group had lower peak E2 concentrations and higher serum EG-VEGF concentrations than those in the non-pregnancy group, but such tendency was not observed in the case of VEGF and TGF-β1. Both concentrations of EG-VEGF and VEGF in FF were negatively correlated with ovarian response and oocyte maturation. Concentrations of all the three growth factors in serum were positively correlated with embryo quality, but only serum concentrations of EG-VEGF were associated with the pregnancy outcome.

  6. Prenatal screening for chromosomal abnormalities in IVF patients that opted for preimplantation genetic screening/diagnosis (PGS/D): a need for revised algorithms in the era of personalized medicine.

    Science.gov (United States)

    Takyi, Afua; Santolaya-Forgas, Joaquin

    2017-06-01

    Obstetricians offer prenatal screening for most common chromosomal abnormalities to all pregnant women including those that had in vitro fertilization (IVF) and preimplantation genetic screening/diagnosis (PGS/D). We propose that free fetal DNA in maternal circulation together with the second trimester maternal serum alfa feto protein (MSAFP) and ultrasound imaging is the best prenatal screening test for chromosomal abnormalities and congenital anomalies in IVF-PGD/S patients because risk estimations from all other prenatal screening algorithms for chromosomal abnormalities depend heavily on maternal age which is irrelevant in PGS/D patients.

  7. Pregnancy chances on an IVF/ICSI waiting list: a national prospective cohort study.

    NARCIS (Netherlands)

    Eijkemans, M.J.; Lintsen, A.M.E.; Hunault, C.C.; Bouwmans, C.A.; Hakkaart, L.; Braat, D.D.M.; Habbema, J.D.F.

    2008-01-01

    BACKGROUND: The effectiveness of IVF over expectant management has been proven only for bilateral tubal occlusion. We aimed to estimate the chance of pregnancy without treatment for IVF patients, using data on the waiting period before the start of IVF. METHODS: A prospective cohort study included

  8. Brokers and Competitive Advantage

    OpenAIRE

    Michael D. Ryall; Olav Sorenson

    2007-01-01

    The broker profits by intermediating between two (or more) parties. Using a biform game, we examine whether such a position can confer a competitive advantage, as well as whether any such advantage could persist if actors formed relations strategically. Our analysis reveals that, if one considers exogenous the relations between actors, brokers can enjoy an advantage but only if (1) they do not face substitutes either for the connections they offer or the value they can create, (2) they interm...

  9. Eight years' experience with an IVF surrogate gestational pregnancy programme.

    Science.gov (United States)

    Raziel, Arieh; Schachter, Morey; Strassburger, Deborah; Komarovsky, Dafna; Ron-El, Raphael; Friedler, Shevach

    2005-08-01

    The aim of this study was to retrospectively audit eight years' experience of an IVF surrogate gestational programme and to compare the outcome of surrogacy due to absence of the uterus with surrogacy indicated for repeated IVF failure and recurrent abortions. A total of 60 cycles of IVF surrogate pregnancy were initiated in 19 treated couples. Absence of the uterus was the indication for surrogacy in 10 cases: Rokitansky syndrome (eight cases) and post-hysterectomy (two cases) designated as group A. The indications in the remaining nine patients (group B) were: IVF implantation failure (three cases), habitual abortions (four cases) and deteriorating maternal diseases (two cases). IVF performance and subsequent pregnancy outcome of groups A and B were compared. There was no difference in ovarian stimulation parameters and in IVF performance between the groups A and B. The overall pregnancy rate per transfer was 10/60 (17%). The pregnancy rates per patient and per transfer were 7/10 (70%) and 7/35 (20%) in group A compared with 3/9 (33%) and 3/25 (12%) in group B. A median number of three treatment cycles were needed to achieve pregnancy. In conclusion, the existence or absence of the uterus in the commissioning mothers is irrelevant for their IVF performance and conception rates. In patients who conceived after more than three IVF cycles, an additional 'oocyte factor' might be present.

  10. Aromatase inhibitors in stimulated IVF cycles

    DEFF Research Database (Denmark)

    Papanikolaou, Evangelos G; Polyzos, Nikolaos P; Al Humaidan, Peter Samir Heskjær

    2011-01-01

    are available regarding their efficacy in IVF stimulated cycles. Current available evidence support that letrozole may have a promising role in stimulated IVF cycles, either when administered during the follicular phase for ovarian stimulation. Especially for women with poor ovarian response, letrozole appears...... to have the potential to increase clinical pregnancy rates when combined with gonadotropins, whereas at the same time reduces the total gonadotropin dose required for ovarian stimulation. However, given that in all of the trials letrozole has been administered in GnRH antagonist cycles, it is intriguing...... to test in the future how it may perform when used in GnRH agonist cycles. Finally administration of letrozole during luteal phase in IVF cycles offers another treatment modality for patients at high risk for OHSS taking into account that it drastically reduces estradiol levels....

  11. In vitro fertilization (IVF)

    Science.gov (United States)

    ... the vagina Blood in the urine Outlook (Prognosis) Statistics vary from one clinic to another and must be looked at carefully. Pregnancy rates reflect the number of women who became pregnant after IVF. But not all pregnancies result in a live birth. Live birth rates reflect the number of women ...

  12. IVF global histories, USA: between Rock and a marketplace

    Directory of Open Access Journals (Sweden)

    Charis Thompson

    2016-06-01

    Full Text Available The USA has played, and continues to play, a distinctive and significant part in the history of IVF and assisted reproductive technology worldwide. American IVF emerged in the scientific context of contraceptive and fertility research, in the social context of a wealthy nation without universal healthcare, and in the political context of the abortion debate and its impact on federal versus state funding and regulation. IVF had its first clinical success in the USA in 1981. Since then, IVF in the USA has become known for procedures involving third, fourth and fifth parties as gamete donors and surrogates. The USA has also been one of the pioneers in domestic and transnational deployment of IVF for lesbian, gay, bisexual, transgender (LGBT parenthood, and a pioneer of the social egg-freezing revolution. US IVF has been marked by professional and patient advocacy for such things as the honest reporting of success rates, recognition of the risks of postponed childbearing, and the need for insurance coverage. Certain landmark legal custody disputes over IVF embryos and offspring, as well as media attention to gendered, racialized, and class-based access to and pricing of assisted reproductive technology, have also driven the development of IVF in the USA.

  13. The problem of IVF cost in developing countries: has natural cycle IVF a place?

    Science.gov (United States)

    Shahin, Ahmed Y

    2007-07-01

    Infertility represents a national health problem in some African countries. Limited financial health resources in developing countries are a major obstacle facing infertility management. IVF is the definitive line of treatment for many couples. Stimulation cycles are associated with risks of ovarian hyperstimulation syndrome and multiple pregnancy. This study evaluates the client acceptability of stimulated versus natural cycle IVF among couples attending one infertility clinic, with respect to cost and pregnancy outcome. Of the patients who were indicated for IVF, 15% (16/107) cancelled, due mostly (12/16, 75%) to financial reasons. The majority of patients who completed their IVF treatment (82/91, 90.1%) felt the price of the medical service offered was high, and 68.1% (62/91) accepted the idea of having cheaper drugs with fewer side effects but with possibly lower chances of pregnancy. Natural cycle IVF has emerged as a potential option that might be suitable for patients worldwide, especially in developing countries.

  14. Axiomatic Characterizations of IVF Rough Approximation Operators

    Directory of Open Access Journals (Sweden)

    Guangji Yu

    2014-01-01

    Full Text Available This paper is devoted to the study of axiomatic characterizations of IVF rough approximation operators. IVF approximation spaces are investigated. The fact that different IVF operators satisfy some axioms to guarantee the existence of different types of IVF relations which produce the same operators is proved and then IVF rough approximation operators are characterized by axioms.

  15. Cost-effectiveness of 'immediate IVF' versus 'delayed IVF': a prospective study.

    Science.gov (United States)

    Eijkemans, M J C; Kersten, F A M; Lintsen, A M E; Hunault, C C; Bouwmans, C A M; Roijen, L Hakkaart-van; Habbema, J D F; Braat, D D M

    2017-05-01

    How does the cost-effectiveness (CE) of immediate IVF compared with postponing IVF for 1 year, depend on prognostic characteristics of the couple? The CE ratio, i.e. the incremental costs of immediate versus delayed IVF per extra live birth, is the highest (range of €15 000 to >€60 000) for couples with unexplained infertility and for them depends strongly on female age and the duration of infertility, whilst being lowest for endometriosis (range 8000-23 000) and, for such patients, only slightly dependent on female age and duration of infertility. A few countries have guidelines for indications of IVF, using the diagnostic category, female age and duration of infertility. The CE of these guidelines is unknown and the evidence base exists only for bilateral tubal occlusion, not for the other diagnostic categories. A modelling approach was applied, based on the literature and data from a prospective cohort study among couples eligible for IVF or ICSI treatment, registered in a national waiting list in The Netherlands between January 2002 and December 2003. A total of 5962 couples was included. Chances of natural ongoing pregnancy were estimated from the waiting list observations and chances of ongoing pregnancy after IVF from follow-up data of couples with primary infertility that began treatment. Prognostic characteristics considered were female age, duration of infertility and diagnostic category. Costs of IVF were assessed from a societal perspective and determined on a representative sample of patients. A cost-effectiveness comparison was made between two scenarios: (I) wait one more year and then undergo IVF for 1 year and (II) immediate IVF during 1 year, and try to conceive naturally in the following year. Comparisons were made for strata determined by the prognostic factors. The final outcome was a live birth. The gain in live birth rate of the immediate IVF scenario versus postponed IVF increased with female age, and was independent from diagnostic

  16. The IVF Outcome Counseling Based on the Model Combining DHEAS and Age in Patients with Low AMH Prior to the First Cycle of GnRH Antagonist Protocol of Ovarian Stimulation

    Directory of Open Access Journals (Sweden)

    Miro Šimun Alebić

    2013-01-01

    Full Text Available Objective. To investigate the endocrine and/or clinical characteristics of women with low anti-Müllerian hormone (AMH that could improve the accuracy of IVF outcome prediction based on the female age alone prior to the first GnRH antagonist IVF cycle. Methods. Medical records of 129 patients with low AMH level (<6.5 pmol/L who underwent their first GnRH antagonist ovarian stimulation protocol for IVF/ICSI were retrospectively analyzed. The main outcome measure was the area under the ROC curve (AUC-ROC for the models combining age and other potential predictive factors for the clinical pregnancy. Results. Clinical pregnancy rate (CPR per initiated cycles was 11.6%. For the prediction of clinical pregnancy, DHEAS and age showed AUC-ROC of 0.726 (95%CI 0.641–0.801 and 0.662 (95%CI 0.573–0.743, respectively (. The predictive accuracy of the model combining age and DHEAS (AUC-ROC 0.796; 95%CI 0.716–0.862 was significantly higher compared to that of age alone (. In patients <37.5 years with DHEAS  pmol/L, 60% (9/15 of all pregnancies were achieved with CPR of 37.5%. Conclusions. DHEAS appears to be predictive for clinical pregnancy in younger women (<37.5 years with low AMH after the first GnRH antagonist IVF cycle. Therefore, DHEAS-age model could refine the pretreatment counseling on pregnancy prospects following IVF.

  17. Mild ovarian stimulation for IVF: 10 years later

    DEFF Research Database (Denmark)

    Fauser, Bart C J M; Nargund, Geeta; Andersen, Anders Nyboe

    2010-01-01

    Ovarian stimulation to achieve multiple follicle development has been an integral part of IVF treatment. In the context of improved laboratory performance, the need for a large number of oocytes as an integral part of a successful IVF programme may be questioned. The aim of the current debate...... is to summarize the studies performed during the last decade to develop the concept of mild stimulation aiming to obtain fewer than eight oocytes. Here we examine the balance between IVF success and patient discomfort, and complications and cost, and how these might improve by simpler ovarian stimulation...

  18. Imprinting diseases and IVF: Danish National IVF cohort study

    DEFF Research Database (Denmark)

    Lidegaard, Ojvind; Pinborg, Anja; Andersen, Anders Nyboe

    2005-01-01

    The aim of this study was to compare the frequency of imprinting diseases in children born after IVF with the incidence in naturally conceived children.......The aim of this study was to compare the frequency of imprinting diseases in children born after IVF with the incidence in naturally conceived children....

  19. Current trends of reproductive immunology practices in in vitro fertilization (IVF) - a first world survey using IVF-Worldwide.com.

    Science.gov (United States)

    Kwak-Kim, Joanne; Han, Ae Ra; Gilman-Sachs, Alice; Fishel, Simon; Leong, Milton; Shoham, Zeev

    2013-01-01

    Reproductive immunology has evolved from basic research studies to clinical applications. In this study, we aim to investigate the actual application of reproductive immunology concepts and findings in clinical reproductive medicine such as recurrent pregnancy losses (RPL), repeated implantation failures (RIF), and failed in vitro fertilization (IVF) cycles. A web-based survey was performed on IVF-Worldwide.com. Collected data were analyzed by the computerized software. A significant proportion of physicians recommend thrombophilia workups (86%), parental genetic study (79%), and immunologic evaluations (69%) to IVF candidates who have a history of RPL or chemical pregnancy losses. IVF physicians consider an immunologic workup when patients have two (30%) or three (21%) failed IVF cycles. Assays for anticardiolipin antibody, lupus anticoagulant, thyroid peroxidase antibody, and antinuclear antibody are the four most commonly ordered immunologic tests for RPL (88, 84, 50, 47% each) and RIF (68, 63, 38, 38% each). Cellular immune evaluations, such as NK assay, human leukocyte antigen study, Th1/Th2 study or immunophenotype assay, are less commonly ordered. Reproductive immunology principles have been applied to the clinical management of RPL, RIF, and failed IVF cycles, and a significant proportion of IVF physicians acknowledge the importance of immunologic alterations with reproductive outcomes. © 2012 John Wiley & Sons A/S.

  20. GnRH antagonist versus long agonist protocols in IVF

    DEFF Research Database (Denmark)

    Lambalk, C B; Banga, F R; Huirne, J A

    2017-01-01

    BACKGROUND: Most reviews of IVF ovarian stimulation protocols have insufficiently accounted for various patient populations, such as ovulatory women, women with polycystic ovary syndrome (PCOS) or women with poor ovarian response, and have included studies in which the agonist or antagonist...... was not the only variable between the compared study arms. OBJECTIVE AND RATIONALE: The aim of the current study was to compare GnRH antagonist protocols versus standard long agonist protocols in couples undergoing IVF or ICSI, while accounting for various patient populations and treatment schedules. SEARCH...... in couples undergoing IVF or ICSI. The primary outcome was ongoing pregnancy rate. Secondary outcomes were: live birth rate, clinical pregnancy rate, number of oocytes retrieved and safety with regard to ovarian hyperstimulation syndrome (OHSS). Separate comparisons were performed for the general IVF...

  1. Comet: Multifunction VOEvent broker

    Science.gov (United States)

    Swinbank, John

    2014-04-01

    Comet is a Python implementation of the VOEvent Transport Protocol (VTP). VOEvent is the IVOA system for describing transient celestial events. Details of transients detected by many projects, including Fermi, Swift, and the Catalina Sky Survey, are currently made available as VOEvents, which is also the standard alert format by future facilities such as LSST and SKA. The core of Comet is a multifunction VOEvent broker, capable of receiving events either by subscribing to one or more remote brokers or by direct connection from authors; it can then both process those events locally and forward them to its own subscribers. In addition, Comet provides a tool for publishing VOEvents to the global VOEvent backbone.

  2. Conceiving IVF in Iran

    Directory of Open Access Journals (Sweden)

    Soraya Tremayne

    2016-06-01

    Full Text Available Since the 19th century the Iranian state has been concerned with the size of its population, and policies directed to its increase or decrease have been closely involved with the purpose of nation building. None of these policies have been particularly successful, except for the effective family planning campaign of the 1980s that led to a remarkable drop in population growth, which currently stands at 1.3 per annum, below the replacement level. However, all the policies have failed to address the issue of infertility, which is widespread in Iran. It was against the background of such oversight that, from 1987, some pioneering physicians introduced IVF practices to the country and engaged with the Islamic jurists, whose endorsement of infertility treatment through IVF was deemed crucial to give the practices legitimacy. This article explores the process by which assisted reproductive technologies were legitimized in Iran in all their forms and which have placed the country in the lead among the Muslim countries in the Middle East in this respect. Within Iran, following the state’s latest pronatalist policies, assisted reproductive technologies have been acknowledged as a means to help the state meet its new ambition of higher population growth.

  3. Fertilization failure after IVF in 304 couples

    DEFF Research Database (Denmark)

    Krog, Maria; Prior, Maria; Carlsen, Elisabeth

    2015-01-01

    OBJECTIVES: To identify predictors of total fertilization failure (TFF) and thereby optimize the primary allocation of patients with no well-defined male factor to either IVF or intracytoplasmatic sperm injection (ICSI). Further, to evaluate the long-term fertility prognosis of couples experiencing...... TFF. STUDY DESIGN: A retrospective case-control study including 304 couples with TFF and 304 controls with fertilization after IVF during a 10-year period from year 2000-2010. The controls were the patients with minimum one fertilized oocyte just prior to the cases. Multiple logistic regression...... analysis was used to evaluate the predictors of TFF. RESULTS: The multiple regression analysis identified the following independent predictors of TFF: female smoking, adjusted odds ratio (AOR) 1.7 (95% CI 1.1-2.3), non-tubal factor AOR 2.2 (95% CI 1.5-3.4), progressive motile spermatozoa after preparation...

  4. First Irish birth following IVF therapy using antagonist protocol.

    LENUS (Irish Health Repository)

    Mocanu, E V

    2012-02-01

    BACKGROUND: During in vitro fertilization (IVF), the prevention of a premature LH surge was traditionally achieved using a gonadotrophin releasing hormone agonist (GnRH-a), and more recently, a GnRH antagonist. AIMS: We report a case of a 37 year old treated using the GnRH antagonist in a second completed cycle of IVF. METHODS: IVF was performed for primary infertility of 5-year duration due to frozen pelvis secondary to endometriosis. RESULTS: Following controlled ovarian hyperstimulation, oocyte recovery and fertilization, cleavage and transfer of two zygotes, a pregnancy established. A twin gestation was diagnosed at 7-weeks scan and pregnancy ended with the delivery of twin girls by emergency caesarean section. CONCLUSION: This is a first report of a delivery following IVF using the antagonist protocol in Ireland. Such therapy is patient friendly and its use should be introduced on a larger scale in clinical practice.

  5. Developments in IVF warrant the adoption of new performance indicators for ART clinics, but do not justify the abandonment of patient-centred measures.

    Science.gov (United States)

    Wilkinson, J; Roberts, S A; Vail, A

    2017-06-01

    Recent advances in embryo freezing technology together with growing concerns over multiple births have shifted the paradigm of appropriate IVF. This has led to the adoption of new performance indicators for ART clinics by national reporting schemes, such as those curated by the Society for Assisted Reproductive Technology (SART) and the Human Fertilization and Embryology Authority (HFEA). Using these organizations as case studies, we review several outcome measures from a statistical perspective. We describe several denominators that are used to calculate live birth rates. These include cumulative birth rates calculated from all fresh and frozen transfer procedures arising from a particular egg collection or cycle initiation, and live birth rates calculated per embryo transferred. Using data from both schemes, we argue that all cycles should be included in the denominator, regardless of whether or not egg collection and fertilization were successful. Excluding cancelled cycles reduces the impact of confounding due to patient characteristics but also removes policy and performance differences which we argue represent relevant sources of variation. It may be misleading to present prospective patients with essentially hypothetical measures of performance predicated on parity of ovarian stimulation and transfer policies. Although live birth per embryo has the advantage of encouraging single embryo transfer, we argue that it is prone to misinterpretation. This is because the likelihood of live birth is not proportional to the number of embryos transferred. We conclude that it is not possible to present a single measure that encompasses both effectiveness and safety. Instead, we propose that a set of clear, relevant outcome indicators is necessary to enable subfertile patients to make informed choices regarding whether and where to be treated. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology

  6. Aromatase inhibitors in stimulated IVF cycles

    Directory of Open Access Journals (Sweden)

    Tournaye Herman

    2011-06-01

    Full Text Available Abstract Aromatase inhibitors have been introduced as a new treatment modality that could challenge clomiphene citrate as an ovulation induction regiment in patients with PCOS. Although several randomized trials have been conducted regarding their use as ovulation induction agents, only few trials are available regarding their efficacy in IVF stimulated cycles. Current available evidence support that letrozole may have a promising role in stimulated IVF cycles, either when administered during the follicular phase for ovarian stimulation. Especially for women with poor ovarian response, letrozole appears to have the potential to increase clinical pregnancy rates when combined with gonadotropins, whereas at the same time reduces the total gonadotropin dose required for ovarian stimulation. However, given that in all of the trials letrozole has been administered in GnRH antagonist cycles, it is intriguing to test in the future how it may perform when used in GnRH agonist cycles. Finally administration of letrozole during luteal phase in IVF cycles offers another treatment modality for patients at high risk for OHSS taking into account that it drastically reduces estradiol levels

  7. Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004

    NARCIS (Netherlands)

    Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

    2010-01-01

    Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997

  8. Non-commercial surrogacy : an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004

    NARCIS (Netherlands)

    Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

    Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997

  9. Does the use of gonadotropin-releasing hormone antagonists in natural IVF cycles for poor responder patients cause more harm than benefit?

    Science.gov (United States)

    Aksoy, Senai; Yakin, Kayhan; Seyhan, Ayse; Oktem, Ozgur; Alatas, Cengiz; Ata, Baris; Urman, Bulent

    2016-06-01

    Poor ovarian response to controlled ovarian stimulation (COS) is one of the most critical factors that substantially limits the success of assisted reproduction techniques (ARTs). Natural and modified natural cycle IVF are two options that could be considered as a last resort. Blocking gonadotropin-releasing hormone (GnRH) actions in the endometrium via GnRH receptor antagonism may have a negative impact on endometrial receptivity. We analysed IVF outcomes in 142 natural (n = 30) or modified natural (n = 112) IVF cycles performed in 82 women retrospectively. A significantly lower proportion of natural cycles reached follicular aspiration compared to modified natural cycles (56.7% vs. 85.7%, p cycles ending in embryo transfer (26.7% vs. 44.6%) was not statistically significant between natural cycle and modified natural IVF cycles. Clinical pregnancy (6.7% vs. 7.1%) and live birth rates per initiated cycle (6.7% vs. 5.4%) were similar between the two groups. Notably, the implantation rate was slightly lower in modified natural cycles (16% vs. 25%, p > 0.05). There was a trend towards higher clinical pregnancy (25% vs. 16%) and live birth (25% vs. 12%) rates per embryo transfer in natural cycles compared to modified natural cycles, but the differences did not reach statistical significance.

  10. Ultrasound guided aspiration of hydrosalpinx fluid versus salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET: a randomized controlled trial.

    Science.gov (United States)

    Fouda, Usama M; Sayed, Ahmed M; Abdelmoty, Hatem I; Elsetohy, Khaled A

    2015-01-01

    The aim of this study was to compare the efficacy of ultrasound guided aspiration of hydrosalpinx fluid at the time of oocyte retrieval with salpingectomy in the management of patients with ultrasound visible hydrosalpinx undergoing IVF-ET. One hundred and sixty patients with ultrasound visible hydrosalpinx were randomized into salpingectomy group and aspiration group using computer generated randomization list and sequentially numbered sealed envelopes containing allocation information written on a card. The clinical pregnancy rate per started cycle and the implantation rate were non- significantly higher in the salpingectomy group compared with the aspiration group [40% vs. 27.5% (p value = 0.132) and 18.95% vs. 12.82% (p value =0.124), respectively]. In the aspiration group, 34.21% of patients had rapid re-accumulation of the hydrosalpinx fluid (i.e. within first two weeks after embryo transfer). Whereas, the clinical pregnancy rate per transfer cycle and the implantation rate were significantly higher in salpingectomy group compared with the subgroup of patients with rapid re-accumulation of hydrosalpinx fluid [42.67% vs. 19.23% (p value = 0.036) and 18.95% vs. 7.58% (p value = 0.032), respectively], no significant differences were detected between the salpingectomy group and the subgroup of patients with no re-accumulation of hydrosalpinx fluid (42.67% vs. 34% (p value = 0.356) and 18.95% vs. 15.5% (p value = 0.457), respectively). The small sample size could be the cause of failure of detecting significant increase in implantation and pregnancy rates in salpingectomy group compared with aspiration group. Further larger randomized controlled trials are needed to determine whether salpingectomy is more effective than aspiration of hydrosalpinx fluid or not. Moreover, the data presented in this study suggested that rapid re-accumulation of hydrosalpinx fluid is an obstacle against successful implantation and the cause of lower success rate

  11. Value of ovarian reserve testing before IVF: a clinical decision analysis

    NARCIS (Netherlands)

    Mol, Ben W.; Verhagen, Tamara E. M.; Hendriks, Dave J.; Collins, John A.; Coomarasamy, Arri; Opmeer, Brent C.; Broekmans, Frank J.

    2006-01-01

    BACKGROUND: To assess the value of testing for ovarian reserve prior to a first cycle IVF incorporating patient and doctor valuation of mismatches between test results and treatment outcome. METHODS: A decision model was developed for couples who were considering participation in an IVF programme.

  12. Non-commercial surrogacy: an account of patient management in the first Dutch Centre for IVF Surrogacy, from 1997 to 2004

    OpenAIRE

    Dermout, Sylvia; van de Wiel, Harry; Heintz, Peter; Jansen, Kees; Ankum, Willem

    2009-01-01

    BACKGROUND Surrogacy was prohibited in the Netherlands until 1994, at which time the Dutch law was changed from the general prohibition of surrogacy to the prohibition of commercial surrogacy. This paper describes the results from the first and only Dutch Centre for Non-commercial IVF Surrogacy between 1997 and 2004. METHODS A prospective study was conducted of all intended parents, and surrogate mothers and their partners (if present), in which medical, psychological and legal aspects of pat...

  13. 3P: Personalized Pregnancy Prediction in IVF Treatment Process

    Science.gov (United States)

    Uyar, Asli; Ciray, H. Nadir; Bener, Ayse; Bahceci, Mustafa

    We present an intelligent learning system for improving pregnancy success rate of IVF treatment. Our proposed model uses an SVM based classification system for training a model from past data and making predictions on implantation outcome of new embryos. This study employs an embryo-centered approach. Each embryo is represented with a data feature vector including 17 features related to patient characteristics, clinical diagnosis, treatment method and embryo morphological parameters. Our experimental results demonstrate a prediction accuracy of 82.7%. We have obtained the IVF dataset from Bahceci Women Health, Care Centre, in Istanbul, Turkey.

  14. Cost-effectiveness of seven IVF strategies: results of a Markov decision-analytic model.

    Science.gov (United States)

    Fiddelers, Audrey A A; Dirksen, Carmen D; Dumoulin, John C M; van Montfoort, Aafke P A; Land, Jolande A; Janssen, J Marij; Evers, Johannes L H; Severens, Johan L

    2009-07-01

    A selective switch to elective single embryo transfer (eSET) in IVF has been suggested to prevent complications of fertility treatment for both mother and infants. We compared seven IVF strategies concerning their cost-effectiveness using a Markov model. The model was based on a three IVF-attempts time horizon and a societal perspective using real world strategies and data, comparing seven IVF strategies, concerning costs, live births and incremental cost-effectiveness ratios (ICERs). In order to increase pregnancy probability, one cycle of eSET + one cycle of standard treatment policy [STP, i.e. eSET in patients IVF treatment, combining several transfer policies was not cost-effective. A choice has to be made between three cycles of eSET, STP or DET. It depends, however, on society's willingness to pay which strategy is to be preferred from a cost-effectiveness point of view.

  15. Altered gene expression in human placentas after IVF/ICSI.

    Science.gov (United States)

    Nelissen, Ewka C M; Dumoulin, John C M; Busato, Florence; Ponger, Loïc; Eijssen, Lars M; Evers, Johannes L H; Tost, Jörg; van Montfoort, Aafke P A

    2014-12-01

    Is gene expression in placental tissue of IVF/ICSI patients altered when compared with a spontaneously conceived group, and are these alterations due to loss of imprinting (LOI) in the case of imprinted genes? An altered imprinted gene expression of H19 and Pleckstrin homology-like domain family A member 2 (PHLDA2), which was not due to LOI, was observed in human placentas after IVF/ICSI and several biological pathways were significantly overrepresented and mostly up-regulated. Genomic imprinting plays an important role in placental biology and in placental adaptive responses triggered by external stimuli. Changes in placental development and function can have dramatic effects on the fetus and its ability to cope with the intrauterine environment. An increased frequency of placenta-related problems as well as an adverse perinatal outcome is seen in IVF/ICSI derived pregnancies, but the role of placental epigenetic deregulation is not clear yet. In this prospective cohort study, a total of 115 IVF/ICSI and 138 control couples were included during pregnancy. After applying several exclusion criteria (i.e. preterm birth or stillbirth, no placental samples, pregnancy complications or birth defects), respectively, 81 and 105 placentas from IVF/ICSI and control pregnancies remained for analysis. Saliva samples were collected from both parents. We quantitatively analysed the mRNA expression of several growth-related imprinted genes [H19, insulin-like growth factor 2 (IGF2), PHLDA2, cyclin-dependent kinase inhibitor 1C (CDKN1C), mesoderm-specific transcript homolog (MEST) isoform α and β by quantitative PCR] after standardization against three housekeeping genes [Succinate dehydrogenase A (SDHA), YWHAZ and TATA-binding protein (TBP)]. A quantitative allele-specific expression analysis of the differentially expressed imprinted genes was performed to investigate LOI, independent of the mechanism of imprinting. Furthermore, a microarray analysis was carried out (n = 10 in

  16. Comparison of clinical outcomes between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in IVF-ICSI split insemination cycles.

    Science.gov (United States)

    Lee, Sun Hee; Lee, Jae Hyun; Park, Yong-Seog; Yang, Kwang Moon; Lim, Chun Kyu

    2017-06-01

    This study aimed to compare the clinical outcomes between in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in sibling oocytes. Additionally, we evaluated whether the implementation of split insemination contributed to an increase in the number of ICSI procedures. A total of 571 cycles in 555 couples undergoing split insemination cycles were included in this study. Among them, 512 cycles (89.7%) were a couple's first IVF cycle. The patients were under 40 years of age and at least 10 oocytes were retrieved in all cycles. Sibling oocytes were randomly allocated to IVF or ICSI. Total fertilization failure was significantly more common in IVF cycles than in ICSI cycles (4.0% vs. 1.4%, p cycles than in IVF cycles (17.2% vs. 11.4%, p cycle and the second cycle, split insemination or ICSI was performed in 18 of the 95 cycles in which a second IVF cycle was performed. The clinical outcomes did not differ between IVF and ICSI in split insemination cycles. Split insemination can decrease the risk of total fertilization failure. However, unnecessary ICSI is carried out in most split insemination cycles and the use of split insemination might make ICSI more common.

  17. 7 CFR 1955.129 - Business brokers.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 14 2010-01-01 2009-01-01 true Business brokers. 1955.129 Section 1955.129 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... Dispose of Inventory Property § 1955.129 Business brokers. The services of business brokers or business...

  18. Data brokers facing the new GDPR

    OpenAIRE

    Bui, Jade Ngoc Bich

    2017-01-01

    A legal analysis of the material effects of the GDPR on the Processing of personal data by data brokers for online marketing purposes. This thesis tackles the questions of how the GDPR's rules on extended applicability on data brokers outside the EU, the lawfulness criteria, and the rights of data subjects will impact data brokers' operations.

  19. 31 CFR 10.8 - Customhouse brokers.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Customhouse brokers. 10.8 Section 10... REVENUE SERVICE Rules Governing Authority to Practice § 10.8 Customhouse brokers. Nothing contained in the regulations in this part will affect or limit the right of a customhouse broker, licensed as such by the...

  20. Network brokers in the periphery

    DEFF Research Database (Denmark)

    Leick, Birgit; Gretzinger, Susanne; Ingstrup, Mads Bruun

    in a way that both enterprise development and regional competitiveness in rural-peripheral regions are supported. Based on a case study of four network brokers from peripheral regions in Germany, we shed light on the activities of brokers with regard to networking among local businesses and the effects...... on knowledge sharing. The paper will also critically discuss governance implications of network brokers in the periphery, which are associated with the (lack of) integration of such actors with established local and regional governance infrastructures.......Research on rural-peripheral regions stresses that such environments face multiple challenges in a globalised world, which, from a policy perspective, should be addressed to enhance regional competitiveness. These challenges are typically associated with a prevalence of small and medium...

  1. Revised guidelines for good practice in IVF laboratories (2015).

    Science.gov (United States)

    De los Santos, Maria José; Apter, Susanna; Coticchio, Giovanni; Debrock, Sophie; Lundin, Kersti; Plancha, Carlos E; Prados, Fernando; Rienzi, Laura; Verheyen, Greta; Woodward, Bryan; Vermeulen, Nathalie

    2016-04-01

    Which recommendations can be provided by the European Society of Human Reproduction and Embryology Special Interest Group (ESHRE SIG) Embryology to support laboratory specialists in the organization and management of IVF laboratories and the optimization of IVF patient care? Structured in 13 sections, the guideline development group formulated recommendations for good practice in the organization and management of IVF laboratories, and for good practice of the specific procedures performed within the IVF laboratory. NA. The guideline was produced by a group of 10 embryologists representing different European countries, settings and levels of expertise. The group evaluated the document of 2008, and based on this assessment, each group member rewrote one or more sections. Two 2-day meetings were organized during which each of the recommendations was discussed and rewritten until consensus within the guideline group was reached. After finalizing the draft, the members of the ESHRE SIG embryology were invited to review the guideline. NA. The guideline provides recommendations on the general organization of an IVF laboratory (staffing and direction, quality management, laboratory safety), and on the specific aspects of the procedures performed in IVF laboratories (Identification of patients and traceability of their reproductive cells, consumables, handling of biological material, oocyte retrieval, sperm preparation, insemination of oocytes, scoring for fertilization, embryo culture and transfer, and cryopreservation). A last section provides recommendations regarding an Emergency plan for IVF laboratories. Evidence on most of the issues described is scarce, and therefore it was decided not to perform a formal search for and assessment of scientific evidence. However, recommendations published in the EUTCD and relevant and recent documents, manuals and consensus papers were taken into account when formulating the recommendations. Despite the limitations, the guideline

  2. Brokering leadership in complex environments

    Directory of Open Access Journals (Sweden)

    Peter M. Miller

    2016-06-01

    Full Text Available This qualitative study, set in the United States, presents an in-depth analysis of leadership in schools and community-based organizations that helped connect students and families to vital education resources. Data were collected from 132 interviews with those who experienced the social and organizational complexities of homelessness. The findings suggest that brokering leadership supports learning, symbolism, identity development, and responsibility. The study indicates that brokering leadership has promise for cultivating opportunities for those who are traditionally disconnected from important resources and relationships.

  3. Early history of IVF in Australia

    Directory of Open Access Journals (Sweden)

    Kristina Janežič

    2014-08-01

    Full Text Available Background: The 1970s and 1980s represent the early era of in vitro fertilization (IVF research. This article is a concise review of the early history of IVF, focusing on the contributions made by Australian pioneers.Objectives: To research the history of the early days of IVF in Australia.Search Strategy: ‘IVF history’ was used as a search criteria in PubMed.Selection criteria: We selected articles that were dealing with Australian research on IVF in 1970–1980s and were also statistically sound where applicable.Data collection and analysis: We collected, processed, and analyzed the data, and summed up two decades of IVF research in Australia.Main results: The first ideas about introducing IVF research in Australia started in 1970. Years of trials and hard work bore success and the first baby was born in 1980. IVF procedures then spread quickly across Australia.Conclusions: Australia was a leading force in the early days of IVF and with many innovative approaches contributed greatly to the development of IVF as we know it today.

  4. Twins conceived using IVF: a follow-up of the family environment and psychosocial adjustment in adolescence.

    Science.gov (United States)

    Anderson, K N; Connor, J J; Koerner, A F; Rueter, M A

    2016-12-01

    Compared to families with IVF singletons, what are parental depressive, parent-adolescent interaction and adolescent adjustment outcomes in families with 11-17-year-old IVF twins? No differences were detected for any measured outcome between families with 11-17-year-old IVF twins and those with IVF singletons, despite high statistical power. When IVF twins are younger than 5-years-old, parents tend to have more mental health difficulties and poorer parent-child interactions relative to IVF singletons. By middle childhood, these differences may no longer exist and available studies with middle childhood-aged IVF twins challenge the expected long-term implications of the early concerns. IVF twins may even have more optimum adjustment than IVF singletons in middle childhood. Study of 280, 11-17-year-old IVF children (n = 122 twins and n = 158 singletons) from 195 families at a US reproductive endocrinology clinic. At Wave 1, clinic patients with an IVF child born between 1998 and 2004 were invited to participate in an online survey. In this follow-up study, mothers and fathers provided information on each of their 11-17-year-old IVF adolescents. There were no differences between 11- and 17-year-old IVF twins and IVF singletons in parent depressive symptoms, parent-adolescent interactions or adolescent adjustment outcomes. Although the family demographics are representative of IVF patients, participants were drawn from one US clinic. Study results provide reassurance that by adolescence IVF twins and their families function as well as IVF singletons and their families. University of Minnesota (UMN) Agriculture Experiment Station (MN-52-107), UMN Grant-in-Aid of Research, Artistry and Scholarship, UMN College of Education and Human Development Research Development Investment Grant, UMN Women's Philosophic Leadership Circle Award, UMN Eva Miller Endowed Fellowship. The authors have no conflicts of interest to declare. © The Author 2016. Published by Oxford

  5. Can IVF influence human evolution?

    Science.gov (United States)

    Hanevik, Hans Ivar; Hessen, Dag O; Sunde, Arne; Breivik, Jarle

    2016-07-01

    IVF, a procedure in which pharmacological and technological manipulation is used to promote pregnancy, offers help to infertile couples by circumventing selection at the most fundamental level. Fertility is clearly one of the key fitness-promoting drivers in all forms of sexually reproducing life, and fertilization and pregnancy are fundamental evolutionary processes that involve a range of pre- and post-zygotic screening mechanisms. Here, we discuss the various selection and screening factors involved in fertilization and pregnancy and assess IVF practices in light of these factors. We then focus on the possible consequences of these differences in selection pressures, mainly at the individual but also at the population level, to evaluate whether changes in the reproducing genotype can affect human evolution. The aim of the article is not to argue for or against IVF, but to address aspects of assisted reproduction in an evolutionary context. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. Cultural influences for college student language brokers.

    Science.gov (United States)

    Weisskirch, Robert S; Kim, Su Yeong; Zamboanga, Byron L; Schwartz, Seth J; Bersamin, Melina; Umaña-Taylor, Adriana J

    2011-01-01

    Children from immigrant families often translate communication for parents, a process known as language brokering (LB). LB begins in childhood, but may continue through emerging adulthood, even when individuals are in college. We surveyed 1,222 university students with two immigrant parents and compared non-language brokers, infrequent language brokers, and frequent language brokers on a variety of ethnic, cultural, and identity measures. Significant differences emerged for cultural heritage value orientation, ethnic identity, and dimensions of acculturation with frequent language brokers scoring highest, infrequent language brokers scoring in the middle, and non-language brokers scoring the lowest on these measures. There were no significant differences on acculturative stress among these three groups. These results suggest that LB experiences may contribute to the development of psychological assets for ethnic minority, emerging adults from immigrant families.

  7. e-Learning Resource Brokers

    NARCIS (Netherlands)

    Retalis, Symeon; Papasalouros, Andreas; Avgeriou, Paris; Siassiakos, Kostas

    2004-01-01

    There is an exponentially increasing demand for provisioning of high-quality learning resources, which is not satisfied by current web technologies and systems. E-Learning Resource Brokers are a potential solution to this problem, as they represent the state-of-the-art in facilitating the exchange

  8. Not All Brokers Are Alike

    DEFF Research Database (Denmark)

    Stea, Diego; Pedersen, Torben

    2017-01-01

    of brokerage, which raises important questions about when and how brokering between otherwise disconnected colleagues leads to individual creativity. We advance the relational perspective on individual creativity by adopting a contingency view, and showing that a curvilinear (inverted U-shape) specification...

  9. 78 FR 41299 - Customs Brokers

    Science.gov (United States)

    2013-07-10

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection DEPARTMENT OF THE TREASURY 19 CFR Part 111 Customs Brokers CFR Correction In Title 19 of the Code of Federal Regulations, Parts 0 to 140, revised as of April 1, 2013, on page 684, in Sec. 111.13, in paragraph (b), reinstate the second...

  10. The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment.

    Science.gov (United States)

    An, Yuan; Sun, Zhuangzhuang; Zhang, Yajuan; Liu, Bin; Guan, Yuanyuan; Lu, Meisong

    2014-03-01

    Previous studies have indicated that berberine is an effective insulin sensitizer with comparable activity to metformin (Diabetes 2006, 55, 2256). Reduced insulin sensitivity is reportedly a factor adversely affecting the outcome of IVF in patients with polycystic ovary syndrome (PCOS) (Human Reproduction 2006, 21, 1416). Our objective was to evaluate the clinical, metabolic and endocrine effects of berberine vs metformin in PCOS women scheduled for IVF treatment and to explore the potential benefits to the IVF process. We performed a prospective study in 150 infertile women with PCOS undergoing IVF treatment. Patients were randomized to receive berberine, metformin or placebo tablets for 3 months before ovarian stimulation. The clinical, endocrine, metabolic parameters and the outcome of IVF. Compared with placebo, greater reductions in total testosterone, free androgen index, fasting glucose, fasting insulin and HOMA-IR, and increases in SHBG, were observed in the berberine and metformin groups. Three months of treatment with berberine or metformin before the IVF cycle increased the pregnancy rate and reduced the incidence of severe ovarian hyperstimulation syndrome. Furthermore, treatment with berberine, in comparison with metformin, was associated with decreases in BMI, lipid parameters and total FSH requirement, and an increase in live birth rate with fewer gastrointestinal adverse events. Berberine and metformin treatments prior to IVF improved the pregnancy outcome by normalizing the clinical, endocrine and metabolic parameters in PCOS women. Berberine has a more pronounced therapeutic effect and achieved more live births with fewer side effects than metformin. © 2013 John Wiley & Sons Ltd.

  11. Cost-effectiveness of 'immediate IVF' versus 'delayed IVF': a prospective study

    NARCIS (Netherlands)

    Eijkemans, M.J.; Kersten, F.A.M.; Lintsen, A.M.E.; Hunault, C.C.; Bouwmans, C.A.; Roijen, L.H.; Habbema, J.D.; Braat, D.D.M.

    2017-01-01

    STUDY QUESTION: How does the cost-effectiveness (CE) of immediate IVF compared with postponing IVF for 1 year, depend on prognostic characteristics of the couple? SUMMARY ANSWER: The CE ratio, i.e. the incremental costs of immediate versus delayed IVF per extra live birth, is the highest (range of

  12. Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

    Science.gov (United States)

    Tjon-Kon-Fat, R I; Bensdorp, A J; Bossuyt, P M M; Koks, C; Oosterhuis, G J E; Hoek, A; Hompes, P; Broekmans, F J; Verhoeve, H R; de Bruin, J P; van Golde, R; Repping, S; Cohlen, B J; Lambers, M D A; van Bommel, P F; Slappendel, E; Perquin, D; Smeenk, J; Pelinck, M J; Gianotten, J; Hoozemans, D A; Maas, J W M; Groen, H; Eijkemans, M J C; van der Veen, F; Mol, B W J; van Wely, M

    2015-10-01

    What is the cost-effectiveness of in vitro fertilization (IVF) with conventional ovarian stimulation, single embryo transfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) as a first-line treatment in couples with unexplained subfertility and an unfavourable prognosis on natural conception?. Both IVF strategies are significantly more expensive when compared with IUI-COH, without being significantly more effective. In the comparison between IVF-MNC and IUI-COH, the latter is the dominant strategy. Whether IVF-SET is cost-effective depends on society's willingness to pay for an additional healthy child. IUI-COH and IVF, either after conventional ovarian stimulation or in a MNC, are used as first-line treatments for couples with unexplained or mild male subfertility. As IUI-COH is less invasive, this treatment is usually offered before proceeding to IVF. Yet, as conventional IVF with SET may lead to higher pregnancy rates in fewer cycles for a lower multiple pregnancy rate, some have argued to start with IVF instead of IUI-COH. In addition, IVF in the MNC is considered to be a more patient friendly and less costly form of IVF. We performed a cost-effectiveness analysis alongside a randomized noninferiority trial. Between January 2009 and February 2012, 602 couples with unexplained infertility and a poor prognosis on natural conception were allocated to three cycles of IVF-SET including frozen embryo transfers, six cycles of IVF-MNC or six cycles of IUI-COH. These couples were followed until 12 months after randomization. We collected data on resource use related to treatment, medication and pregnancy from the case report forms. We calculated unit costs from various sources. For each of the three strategies, we calculated the mean costs and effectiveness. Incremental cost-effectiveness ratios (ICER) were calculated for IVF-SET compared with IUI-COH and

  13. Optimization of IVF pregnancy outcomes with donor spermatozoa.

    Science.gov (United States)

    Wang, Jeff G; Douglas, Nataki C; Prosser, Robert; Kort, Daniel; Choi, Janet M; Sauer, Mark V

    2009-03-01

    To identify risk factors for suboptimal IVF outcomes using insemination with donor spermatozoa and to define a lower threshold that may signal a conversion to fertilization by ICSI rather than insemination. Retrospective, age-matched, case-control study of women undergoing non-donor oocyte IVF cycles using either freshly ejaculated (N=138) or cryopreserved donor spermatozoa (N=69). Associations between method of fertilization, semen sample parameters, and pregnancy rates were analyzed. In vitro fertilization of oocytes with donor spermatozoa by insemination results in equivalent fertilization and pregnancy rates compared to those of freshly ejaculated spermatozoa from men with normal semen analyses when the post-processing motility is greater than or equal to 88%. IVF by insemination with donor spermatozoa when the post-processing motility is less than 88% is associated with a 5-fold reduction in pregnancy rates when compared to those of donor spermatozoa above this motility threshold. When the post-processing donor spermatozoa motility is low, fertilization by ICSI is associated with significantly higher pregnancy rates compared to those of insemination. While ICSI does not need to be categorically instituted when using donor spermatozoa in IVF, patients should be counseled that conversion from insemination to ICSI may be recommended based on low post-processing motility.

  14. Universal coverage of IVF pays off.

    Science.gov (United States)

    Vélez, M P; Connolly, M P; Kadoch, I-J; Phillips, S; Bissonnette, F

    2014-06-01

    What was the clinical and economic impact of universal coverage of IVF in Quebec, Canada, during the first calendar year of implementation of the public IVF programme? Universal coverage of IVF increased access to IVF treatment, decreased the multiple pregnancy rate and decreased the cost per live birth, despite increased costs per cycle. Public funding of IVF assures equality of access to IVF and decreases multiple pregnancies resulting from this treatment. Public IVF programmes usually mandate a predominant SET policy, the most effective approach for reducing the incidence of multiple pregnancies. This prospective comparative cohort study involved 7364 IVF cycles performed in Quebec during 2009 and 2011 and included an economic analysis. IVF cycles performed in the five centres offering IVF treatment in Quebec during 2009, before implementation of the public IVF programme, were compared with cycles performed at the same centres during 2011, the first full calendar year following implementation of the programme. Data were obtained from the Canadian Assisted Reproductive Technologies Register (CARTR). Comparisons were made between the two periods in terms of utilization, pregnancy rates, multiple pregnancy rates and costs. The number of IVF cycles performed in Quebec increased by 192% after the new policy was implemented. Elective single-embryo transfer was performed in 1.6% of the cycles during Period I (2009), and increased to 31.6% during Period II (2011) (P IVF programme increased government costs per IVF treatment cycle from CAD$3730 to CAD$4759. Despite increased costs per cycle, the efficiency defined by the cost per live birth, which factored in downstream health costs up to 1 year post delivery, decreased from CAD$49 517 to CAD$43 362 per baby conceived by either fresh and frozen cycles. The costs described in the economic model are likely an underestimate as they do not factor in many of the long-term costs that can occur after 1 year of age. The

  15. Incorporating Brokers within Collaboration Environments

    Science.gov (United States)

    Rajasekar, A.; Moore, R.; de Torcy, A.

    2013-12-01

    A collaboration environment, such as the integrated Rule Oriented Data System (iRODS - http://irods.diceresearch.org), provides interoperability mechanisms for accessing storage systems, authentication systems, messaging systems, information catalogs, networks, and policy engines from a wide variety of clients. The interoperability mechanisms function as brokers, translating actions requested by clients to the protocol required by a specific technology. The iRODS data grid is used to enable collaborative research within hydrology, seismology, earth science, climate, oceanography, plant biology, astronomy, physics, and genomics disciplines. Although each domain has unique resources, data formats, semantics, and protocols, the iRODS system provides a generic framework that is capable of managing collaborative research initiatives that span multiple disciplines. Each interoperability mechanism (broker) is linked to a name space that enables unified access across the heterogeneous systems. The collaboration environment provides not only support for brokers, but also support for virtualization of name spaces for users, files, collections, storage systems, metadata, and policies. The broker enables access to data or information in a remote system using the appropriate protocol, while the collaboration environment provides a uniform naming convention for accessing and manipulating each object. Within the NSF DataNet Federation Consortium project (http://www.datafed.org), three basic types of interoperability mechanisms have been identified and applied: 1) drivers for managing manipulation at the remote resource (such as data subsetting), 2) micro-services that execute the protocol required by the remote resource, and 3) policies for controlling the execution. For example, drivers have been written for manipulating NetCDF and HDF formatted files within THREDDS servers. Micro-services have been written that manage interactions with the CUAHSI data repository, the Data

  16. The new Italian IVF legislation.

    Science.gov (United States)

    Benagiano, Giuseppe; Gianaroli, Luca

    2004-08-01

    Last February, the Italian Parliament gave final approval to a new Law regulating assisted reproduction technology. The new legislation fell short of the expectations of infertile couples and of all specialists in the field. There are three problems with the new Italian law; they involve social issues, human rights and the application of technology. The present paper focuses on the fact that the new rules infringe upon basic human rights and the proper application of IVF technology, because they mandate procedures that are against the best interest of the woman seeking pregnancy. The main point of controversy is the combination of a mandatory limit of three embryos for transfer, and an obligation to reimplant all produced embryos; cryopreservation of excess embryos is prohibited. Obviously, this decreases the chances of most women to achieve pregnancy, while at the same time it increases the number and complexity of procedures they need to undergo and may expose some to an unacceptable increase in the risk of multiple pregnancy. The new law is inspired by the desire to protect every newly produced embryo; this is a commendable aim, although it is in total opposition to a law passed over 25 years ago that liberalized voluntary termination of first trimester pregnancies. This means that today Italy has a law that protects every early, pre-implantation embryo, and another that allows the 'suppression' of every post-implantation one. From a technical point of view, given the low level of human fecundity, the only way to prevent the 'loss' of even one preimplantation embryo is to simply ban IVF altogether, an option that Italian legislators obviously did not have the courage to opt for. The tragedy is that Italian infertile couples are now confronted with new rules that not only severely limit the ability of physicians to correctly apply IVF technology, but are so confused that, depending on the interpretation, anyone may try to nullify the main ideological premise upon

  17. The comparision of effect of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients.

    Science.gov (United States)

    Ozcan Cenksoy, Pinar; Ficicioglu, Cem; Kizilkale, Ozge; Suhha Bostanci, Mehmet; Bakacak, Murat; Yesiladali, Mert; Kaspar, Cigdem

    2014-07-01

    To compare the effects of microdose GnRH-a flare-up, GnRH antagonist/aromatase inhibitor letrozole and GnRH antagonist/clomiphene citrate protocols on IVF outcomes in poor responder patients. Of 225 patients, 83 patients were in microdose flare-up group (Group 1), 70 patients were in GnRH antagonist/letrozole group (Group 2) and 72 patients were in GnRH antagonist/clomiphene citrate group (Group 3). Demographic and endocrine characteristics, the total number of oocytes retrieved, cancellation rate and clinical pregnancy rate were collected Results: Total dosage of gonadotropins (p=0.002) and serum E2 levels on the day of hCG administration (p=0.010) were significantly higher and duration of stimulations (p=0.03) was significantly longer in group 1. The number of oocytes retrieved was significantly greater in group 1 and 2 when compare to those of group 3 (p=0,000). There was a trend towards increasing cycle cancellation rates with GnRH antagonist/clomiphene citrate and GnRH antagonist/letrozole. Our finding suggest that the results of microdose flare-up protocol are better than other two used treatment protocols, in terms of maximum estradiol levels, number of mature oocytes retrieved, and cancellation rate and it still seems to be superior the ovarian stimulation regime for the poor responder patients.

  18. IVF for premature ovarian failure: first reported births using oocytes donated from a twin sister.

    LENUS (Irish Health Repository)

    Sills, Eric Scott

    2010-01-01

    BACKGROUND: Premature ovarian failure (POF) remains a clinically challenging entity because in vitro fertilisation (IVF) with donor oocytes is currently the only treatment known to be effective. METHODS: A 33 year-old nulligravid patient with a normal karyotype was diagnosed with POF; she had a history of failed fertility treatments and had an elevated serum FSH (42 mIU\\/ml). Oocytes donated by her dizygotic twin sister were used for IVF. The donor had already completed a successful pregnancy herself and subsequently produced a total of 10 oocytes after a combined FSH\\/LH superovulation regime. These eggs were fertilised with sperm from the recipient\\'s husband via intracytoplasmic injection and two fresh embryos were transferred to the recipient on day three. RESULTS: A healthy twin pregnancy resulted from IVF; two boys were delivered by caesarean section at 39 weeks\\' gestation. Additionally, four embryos were cryopreserved for the recipient\\'s future use. The sister-donor achieved another natural pregnancy six months after oocyte retrieval, resulting in a healthy singleton delivery. CONCLUSION: POF is believed to affect approximately 1% of reproductive age females, and POF patients with a sister who can be an oocyte donor for IVF are rare. Most such IVF patients will conceive from treatment using oocytes from an anonymous oocyte donor. This is the first report of births following sister-donor oocyte IVF in Ireland. Indeed, while sister-donor IVF has been successfully undertaken by IVF units elsewhere, this is the only known case where oocyte donation involved twin sisters. As with all types of donor gamete therapy, pre-treatment counselling is important in the circumstance of sister oocyte donation.

  19. Live birth after IVF in a 46-year-old woman.

    Science.gov (United States)

    Dal Prato, Luca; Borini, Andrea; Cattoli, Monica; Preti, Maria Serena; Serrao, Lucia; Flamigni, Carlo

    2005-10-01

    Pregnancies after IVF have been reported in women aged > or =44 years, but nobody older than 45 years at oocyte retrieval delivered. We report a case of birth of a healthy child after IVF in a 46-year-old infertile woman. Ovarian stimulation was performed with clomiphene citrate, 150 mg daily for 5 days. Three oocytes were retrieved and one embryo was replaced. The patient delivered a healthy male infant after Caesarean section at 39 weeks. A successful pregnancy after IVF with homologous oocytes can be achieved in women older than 45 years. At this age IVF is not a cost-effective treatment compared with oocyte donation, but it may be offered in countries in which gamete donation is forbidden.

  20. Efficacy of natural cycle IVF: a review of the literature

    NARCIS (Netherlands)

    Pelinck, M. J.; Hoek, A.; Simons, A. H. M.; Heineman, M. J.

    2002-01-01

    Since the introduction of IVF treatments, natural cycle IVF has been largely replaced by IVF with ovarian stimulation. However, natural cycle IVF has several advantages. It is associated with a close to zero multiple pregnancy rate, and a zero risk of ovarian hyperstimulation syndrome. Per cycle,

  1. Efficacy of natural cycle IVF : a review of the literature

    NARCIS (Netherlands)

    Pelinck, MJ; Hoek, A; Simons, AHM; Heineman, MJ

    2002-01-01

    Since the introduction of IVF treatments, natural cycle IVF has been largely replaced by IVF with ovarian stimulation. However, natural cycle IVF has several advantages. It is associated with a close to zero multiple pregnancy rate, and a zero risk of ovarian hyperstimulation syndrome. Per cycle,

  2. Parenthood motives in IVF-mothers.

    Science.gov (United States)

    Colpin, H; De Munter, A; Vandemeulebroecke, L

    1998-03-01

    This is an exploratory study to answer two questions: (1) does in-vitro fertilization (IVF)-mothers' motivation for parenthood differ from the naturally conceiving mothers' motivation for parenthood? and (2) are IVF-mothers' parenthood motives correlated with their adjustment to parenthood (in the same way as they are for naturally conceiving mothers)? The study sample consisted of 31 mothers with a 24-30 month old, single-born child conceived by homologous IVF and a comparison group of 31 mothers with a naturally conceived child. Self-rating questionnaires were used. Overall, the parenthood motivation pattern was quite similar for IVF-mothers and mothers by natural conception. However, 'identity', 'motherhood' and 'social control' were significantly more important motives for IVF-mothers than for the naturally conceiving mothers. The two former motives remained more important for IVF-mothers when findings were adjusted for the influence of the mothers' age and educational level. Possible explanations for these findings refer to the infertility history. Overall, few correlations between parenthood motives and the adjustment to parenthood were significant, both for the IVF-mothers and for the mothers by natural conception. Further (hypothesis-testing) research is needed to support these findings.

  3. Recipient screening in IVF: First data from women undergoing anonymous oocyte donation in Dublin

    Directory of Open Access Journals (Sweden)

    Salma Umme

    2011-04-01

    Full Text Available Abstract Background Guidelines for safe gamete donation have emphasised donor screening, although none exist specifically for testing oocyte recipients. Pre-treatment assessment of anonymous donor oocyte IVF treatment in Ireland must comply with the European Union Tissues and Cells Directive (Directive 2004/23/EC. To determine the effectiveness of this Directive when applied to anonymous oocyte recipients in IVF, we reviewed data derived from selected screening tests performed in this clinical setting. Methods Data from tests conducted at baseline for all women enrolling as recipients (n = 225 in the anonymous oocyte donor IVF programme at an urban IVF referral centre during a 24-month period were analysed. Patient age at programme entry and clinical pregnancy rate were also tabulated. All recipients had at least one prior negative test for HIV, Hepatitis B/C, chlamydia, gonorrhoea and syphilis performed by her GP or other primary care provider before reproductive endocrinology consultation. Results Mean (±SD age for donor egg IVF recipients was 40.7 ± 4.2 yrs. No baseline positive chlamydia, gonorrhoea or syphilis screening results were identified among recipients for anonymous oocyte donation IVF during the assessment interval. Mean pregnancy rate (per embryo transfer in this group was 50.5%. Conclusion When tests for HIV, Hepatitis B/C, chlamydia, gonorrhoea and syphilis already have been confirmed to be negative before starting the anonymous donor oocyte IVF sequence, additional (repeat testing on the recipient contributes no new clinical information that would influence treatment in this setting. Patient safety does not appear to be enhanced by application of Directive 2004/23/EC to recipients of anonymous donor oocyte IVF treatment. Given the absence of evidence to quantify risk, this practice is difficult to justify when applied to this low-risk population.

  4. Recipient screening in IVF: First data from women undergoing anonymous oocyte donation in Dublin

    LENUS (Irish Health Repository)

    Walsh, Anthony PH

    2011-04-20

    Abstract Background Guidelines for safe gamete donation have emphasised donor screening, although none exist specifically for testing oocyte recipients. Pre-treatment assessment of anonymous donor oocyte IVF treatment in Ireland must comply with the European Union Tissues and Cells Directive (Directive 2004\\/23\\/EC). To determine the effectiveness of this Directive when applied to anonymous oocyte recipients in IVF, we reviewed data derived from selected screening tests performed in this clinical setting. Methods Data from tests conducted at baseline for all women enrolling as recipients (n = 225) in the anonymous oocyte donor IVF programme at an urban IVF referral centre during a 24-month period were analysed. Patient age at programme entry and clinical pregnancy rate were also tabulated. All recipients had at least one prior negative test for HIV, Hepatitis B\\/C, chlamydia, gonorrhoea and syphilis performed by her GP or other primary care provider before reproductive endocrinology consultation. Results Mean (±SD) age for donor egg IVF recipients was 40.7 ± 4.2 yrs. No baseline positive chlamydia, gonorrhoea or syphilis screening results were identified among recipients for anonymous oocyte donation IVF during the assessment interval. Mean pregnancy rate (per embryo transfer) in this group was 50.5%. Conclusion When tests for HIV, Hepatitis B\\/C, chlamydia, gonorrhoea and syphilis already have been confirmed to be negative before starting the anonymous donor oocyte IVF sequence, additional (repeat) testing on the recipient contributes no new clinical information that would influence treatment in this setting. Patient safety does not appear to be enhanced by application of Directive 2004\\/23\\/EC to recipients of anonymous donor oocyte IVF treatment. Given the absence of evidence to quantify risk, this practice is difficult to justify when applied to this low-risk population.

  5. 76 FR 37571 - Broker-Dealer Reports

    Science.gov (United States)

    2011-06-27

    ... ``review'' and appropriate tests of the broker-dealer's accounting system, internal accounting control and... further states that the scope of the audit and review of the accounting system, internal accounting... Accounting Oversight Board (the ``PCAOB'') to implement oversight of independent public accountants of broker...

  6. 7 CFR 926.14 - Broker.

    Science.gov (United States)

    2010-01-01

    ... of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE DATA COLLECTION, REPORTING AND RECORDKEEPING REQUIREMENTS APPLICABLE TO CRANBERRIES NOT SUBJECT TO THE CRANBERRY MARKETING ORDER § 926.14 Broker. Broker...

  7. Effectiveness of brokering within account management organizations

    NARCIS (Netherlands)

    Dekker, D.J.; Stokman, F.N.; Franses, P.H.B.F.

    2004-01-01

    We present a model that integrates the contradicting Burtian and Krackhardtian broker theories to explain effectiveness of brokering for individuals within account management organizations. Using data on a network of 55 individuals in a financial account management organization, we test how

  8. Recurrent IVF failure and hereditary thrombophilia.

    Science.gov (United States)

    Safdarian, Leila; Najmi, Zahra; Aleyasin, Ashraf; Aghahosseini, Marzieh; Rashidi, Mandana; Asadollah, Sara

    2014-07-01

    The largest percentage of failed invitro fertilization (IVF (cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure. Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures. Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase (MTHFR) mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III (AT-III) deficiency and plasminogen activator inhibitor-1 (PAI-1) mutation. Presence of thrombophilia was compared between groups. Having at least one thrombophilia known as a risk factor for recurrent IVF failure (95% CI=1.74-5.70, OR=3.15, p=0.00). Mutation of factor V Leiden (95% CI=1.26-10.27, OR=3.06, P=0.01) and homozygote form of MTHFR mutation (95% CI=1.55-97.86, OR=12.33, p=0.05) were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia's. Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failure.

  9. 17 CFR 240.16c-1 - Brokers.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Brokers. 240.16c-1 Section 240... Act of 1934 Exemption of Certain Transactions from Section 16(c) § 240.16c-1 Brokers. Any transaction... a broker of an order for an account in which the broker has no direct or indirect interest. ...

  10. 49 CFR 371.10 - Duties and obligations of brokers.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Duties and obligations of brokers. 371.10 Section... SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS BROKERS OF PROPERTY § 371.10 Duties and obligations of brokers. Where the broker acts on behalf of a person bound by...

  11. Costs and outcomes associated with IVF using recombinant FSH.

    Science.gov (United States)

    Ledger, W; Wiebinga, C; Anderson, P; Irwin, D; Holman, A; Lloyd, A

    2009-09-01

    Cost and outcome estimates based on clinical trial data may not reflect usual clinical practice, yet they are often used to inform service provision and budget decisions. To expand understanding of assisted reproduction treatment in clinical practice, an economic evaluation of IVF/intracytoplasmic sperm injection (ICSI) data from a single assisted conception unit (ACU) in England was performed. A total of 1418 IVF/ICSI cycles undertaken there between October 2001 and January 2006 in 1001 women were analysed. The overall live birth rate was 22% (95% CI: 19.7-24.2), with the 30- to 34-year age group achieving the highest rate (28%). The average recombinant FSH (rFSH) dose/cycle prescribed was 1855 IU. Average cost of rFSH/cycle was 646 pound(SD: 219 pound), and average total cost/cycle was 2932 pound (SD: 422 pound). Economic data based on clinical trials informing current UK guidance assumes higher doses of rFSH dose/cycle (1750-2625 IU), higher average cost of drugs/cycle (1179 pound), and higher average total cost/cycle (3266 pound). While the outcomes in this study matched UK averages, total cost/cycle was lower than those cited in UK guidelines. Utilizing the protocols and (lower) rFSH dosages reported in this study may enable other ACU to provide a greater number of IVF/ICSI cycles to patients within given budgets.

  12. Health Information Brokers in the General Population: An Analysis of the Health Information National Trends Survey 2013-2014.

    Science.gov (United States)

    Cutrona, Sarah L; Mazor, Kathleen M; Agunwamba, Amenah A; Valluri, Sruthi; Wilson, Patrick M; Sadasivam, Rajani S; Finney Rutten, Lila J

    2016-06-03

    Health information exchanged between friends or family members can influence decision making, both for routine health questions and for serious health issues. A health information broker is a person to whom friends and family turn for advice or information on health-related topics. Characteristics and online behaviors of health information brokers have not previously been studied in a national population. The objective of this study was to examine sociodemographic characteristics, health information seeking behaviors, and other online behaviors among health information brokers. Data from the Health Information National Trends Survey (2013-2014; n=3142) were used to compare brokers with nonbrokers. Modified Poisson regression was used to examine the relationship between broker status and sociodemographics and online information seeking. Over half (54.8%) of the respondents were consulted by family or friends for advice or information on health topics (ie, they acted as health information brokers). Brokers represented 54.1% of respondents earning brokers (PR 1.34, 95% CI 1.23-1.47) as were those with education past high school (PR 1.42, CI 1.22-1.65). People aged ≥75 were less likely to be brokers as compared to respondents aged 35-49 (PR 0.81, CI 0.67-0.99). Brokers used the Internet more frequently for a variety of online behaviors such as seeking health information, creating and sharing online content, and downloading health information onto a mobile device; and also reported greater confidence in obtaining health information online. More than 50% of adults who responded to this national survey, including those with low income and those born abroad, were providing health information or advice to friends and family. These individuals may prove to be effective targets for initiatives supporting patient engagement and disease management, and may also be well-positioned within their respective social networks to propagate health messages.

  13. Lessons from elective in vitro fertilization (IVF in, principally, non-infertile women

    Directory of Open Access Journals (Sweden)

    Gleicher Norbert

    2012-06-01

    Full Text Available Abstract Background We here report the first investigation of exclusively elective in vitro fertilization (IVF cycles in women with no apparent history of infertility. Since IVF outcome in women with infertility are always influenced by underlying causes of infertility, a study on non-infertile women may offer new insights. Methods We investigated 88 females without history of infertility in 109 consecutive elective IVF cycles, almost exclusively performed for purposes of preimplantation genetic screening (PGS; i.e., elective gender selection. The following questions were addressed: (i impact of PGS on IVF pregnancy chances; (ii impact of transfer of 1 vs. ≥2 embryos on IVF pregnancy chances; (iii correlation of anti-Müllerian hormone (AMH levels to embryo ploidy (iv effect of gonadotropin dosage used in stimulation on available embryos for transfer; and (v in form of a 1:1 case control study, compared 33 elective PGS cycles with matched control cycles without PGS, performed in couples with either prior tubal ligations and/or severe male factor infertility as indication of IVF. Results The overall clinical pregnancy rate for the group was 36.7%; pregnancy was associated with number of euploid (P = 0.009 and number of embryos transferred (P = 0.001. Odds of pregnancy were 3.4-times higher if ≥4 euploid embryos were produced in comparison to Conclusions This study suggests that outcomes of elective IVF cycles may significantly deviate from infertility-associated cycles. Affirming proof of concept for PGS, utilizing day-3 embryo biopsy and fluorescence in-situ hybridization (FISH, both widely held responsible for earlier failures to establish such proof, suggests that the principal cause of prior failures were likely not insufficient laboratory techniques but poor patient selection for PGS. Such a conclusion questions the current reintroduction of PGS with improved techniques and technologies in absence of prior determination of suited

  14. Effect of metformin and oral contraceptives on polycystic ovary syndrome and IVF cycles.

    Science.gov (United States)

    Kalem, M N; Kalem, Z; Gurgan, T

    2017-07-01

    The aim of this study is to investigate the effect of metformin and/or OC added to the treatment of PCOS patients at our clinic on IVF outcome. This study is a retrospective study that assesses the data of PCOS patients who received IVF between 2005 and 2015 at a private IVF center. The study included 496 PCOS cases aged between 24 and 40. Participants diagnosed with PCOS were divided into 4 groups according to the use of metformin and OC prior to the IVF cycle: 11.1% were in the metformin group, 31.3% in the OC group, 14.9% in the Metformin + OC group, and 42.7% in the control group. No difference was found in the total gonadotropin dose and duration of stimulation between the groups. Clinical pregnancy rates and implantation rates were similar in all groups, although the numbers of oocytes, mature oocytes, fertilized oocytes, and transferred embryos were lower in the treatment groups received metformin compared to the OC group and control group. There was no significant difference in the presence of OHSS and the singleton and multiple pregnancies between the four groups. The present study established no positive role of metformin and OC use in increasing the treatment success in IVF/ICSI cycles in PCOS patients. It would be appropriate to limit the use of these agents with special indications such as decreasing insulin resistance or synchronizing follicular cohort.

  15. Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF) services.

    Science.gov (United States)

    Yildiz, M Said; Khan, M Mahmud

    2016-08-12

    The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

  16. Opportunities for reproductive tourism: cost and quality advantages of Turkey in the provision of in-vitro Fertilization (IVF services

    Directory of Open Access Journals (Sweden)

    M. Said Yildiz

    2016-08-01

    Full Text Available Abstract Background The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and large comparative cost advantage. Methods This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used. Results Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation. Conclusions Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.

  17. Can laparoscopic removal of Essure device before embryo transfer correct poor reproductive outcome pattern in IVF? A case report.

    Science.gov (United States)

    Salem, S A; Peck, A C; Salem, R D; Sills, E Scott

    2014-01-01

    This report describes a successful surgical approach to multiple in vitro fertilization (IVF) failures in the setting of hydrosalpinges, which had been previously treated with Essure inserts. A non-smoking 33-year-old Caucasian G2 P0020 (body mass index: BMI = 22) attended for second opinion. Her history was significant for bilateral hydrosalpinges having been noted on hysterosalpingogram two years earlier. This was managed by hysteroscopic placement of Essure inserts bilaterally. One year later, and now with Essure in situ, the patient completed three IVF cycles elsewhere. Her first and third IVF attempts resulted in biochemical pregnancy, while human chorionic gonadotropin (hCG) was negative after the second cycle. Upon presentation at the authors' center and before beginning a fourth IVF cycle, further testing and surgical removal of the Essure devices was recommended. Repeat hysteroscopy was unremarkable; laparoscopic bilateral salpingectomy and extirpation of Essure implants was accomplished without difficulty. Following menses, the patient initiated IVF with three embryos transferred. At day 60, a single intrauterine pregnancy was identified with positive cardiac activity (rate > 100/min). Her obstetrical course was uneventful; a healthy 4,195 gram male infant was delivered (breech) by Cesarean at 40 weeks' gestation. Essure inserts comprise inner fibers of polyethylene terephthalate, a stainless steel coil, and a nickel-titanium coil. The product received FDA approval as a contraceptive in 2002 although its use for hydrosalpinx remains off-label. While successful outcomes with IVF following Essure placement have been reported, this is the first description of pregnancy and delivery from IVF after Essure removal. Essure may be considered for sterilization when laparoscopy is contraindicated, but experience with its use specifically for treating hydrosalpinges before IVF is limited. This observed association between prior poor IVF outcomes and Essure with

  18. IVF twins: buy one get one free?

    Science.gov (United States)

    Ismail, Laura; Mittal, Monica; Kalu, Emmanuel

    2012-10-01

    There has been an overall increase in the incidence of multiple pregnancies and assisted reproduction technology is largely responsible for this rise. Although twins may appeal to couples undergoing in vitro fertilisation (IVF), they have been associated with serious health consequences to the babies, their mothers and the family unit, as well as having massive financial implications for the National Health Service. Transfer of more than one embryo during IVF is mainly responsible for IVF twins, and elective transfer of a single embryo at a time with cryopreservation of surplus embryos for later transfer has been shown to be an effective strategy to minimise the risk of twins without compromising IVF success rates. Factors that will impact on the success of the policy of elective single embryo transfer (eSET) include improvement in embryo selection for transfer, better cryopreservation techniques and adequate state funding for IVF. However, in implementing the policy of eSET it is important that each case is assessed on an individual basis since in some situations (e.g. in older women) the transfer of two embryos may be more cost effective. Adequate and continuous education of all stakeholders is essential if the policy of eSET is to be successful in the UK.

  19. Do Asian women do as well as their Caucasian counterparts in IVF treatment: Cohort study.

    Science.gov (United States)

    Kan, Andrew; Leung, Peter; Luo, Kehui; Fay, Louise; Tan, Chunyan Leeann

    2015-06-01

    To evaluate if there is a difference in pregnancy rate between Asian and Caucasian women when they undergo in vitro fertilization (IVF). This was a retrospective cohort study set in a private reproductive medicine clinic. The study consisted of a total of 2594 patients (Asian, n = 522; Caucasian, n = 2072) undergoing IVF managed by a single doctor over a 10 year period. The main outcome measures were clinical pregnancy rate and live birth rate. Logistic regression was used to control for confounding factors. Asian women achieved a significantly lower clinical pregnancy and live birth rate than their Caucasian counterparts, despite replacement of more embryos. This difference was not significant after controlling for age and duration of infertility. Despite higher doses of gonadotrophin, they achieved fewer oocytes and had resultant fewer embryos for transfer or cryopreservation. In a study designed to reduce the effect of confounding factors by looking at a large number of patients from a single IVF unit under the care of a single doctor, there does not appear to be a difference in IVF pregnancy rate as a result of race. Asian women tend to present for IVF treatment at a later age after having tried for a longer period of time and this contributes significantly to their lower pregnancy rate. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  20. Do Different Stimulation Protocols Effect Oocyte Quality and IVF Outcomes in IVF-ET?

    Directory of Open Access Journals (Sweden)

    Nafiye Yilmaz

    2016-04-01

    Full Text Available Aim: This study was planned to compare the effect of different stimulation protocols (hMG and uFSH on oocyte maturation and in vitro fertilization outcomes. Material and Method: Eighty-two patients admitted Ankara University Obstetrics and Gynecology Clinic- IVF Department were included in this retrospective study. All patients used long GnRH agonist protocol. Fifty-nine patients used human menopausal gonadotropin (hMG (Group 1 and 23 patients used urine derived follicle-stimulating hormone (uFSH (Group 2 for ovulation induction. Maximum follicle diameter, dominant follicle number, endometrial thickness at human chorionic gonadotropin day, duration of induction, dose of gonadotropin, oocyte number and quality, fertilization rate, embryo number and quality, pregnancy rate per cycles and transfer were reported. Results: Maximum follicle diameter, dominant follicle number, immature oocyte number were significantly higher in hMG group vs. uFSH group (p0.05. Discussion: Clinical pregnancy rate was not significantly different in hMG vs. uFSH group. In developing countries, ovarian stimulation agents should be chosen based on patient characteristics and cost.

  1. Bivariate analysis of basal serum anti-Mullerian hormone measurements and human blastocyst development after IVF

    LENUS (Irish Health Repository)

    Sills, E Scott

    2011-12-02

    Abstract Background To report on relationships among baseline serum anti-Müllerian hormone (AMH) measurements, blastocyst development and other selected embryology parameters observed in non-donor oocyte IVF cycles. Methods Pre-treatment AMH was measured in patients undergoing IVF (n = 79) and retrospectively correlated to in vitro embryo development noted during culture. Results Mean (+\\/- SD) age for study patients in this study group was 36.3 ± 4.0 (range = 28-45) yrs, and mean (+\\/- SD) terminal serum estradiol during IVF was 5929 +\\/- 4056 pmol\\/l. A moderate positive correlation (0.49; 95% CI 0.31 to 0.65) was noted between basal serum AMH and number of MII oocytes retrieved. Similarly, a moderate positive correlation (0.44) was observed between serum AMH and number of early cleavage-stage embryos (95% CI 0.24 to 0.61), suggesting a relationship between serum AMH and embryo development in IVF. Of note, serum AMH levels at baseline were significantly different for patients who did and did not undergo blastocyst transfer (15.6 vs. 10.9 pmol\\/l; p = 0.029). Conclusions While serum AMH has found increasing application as a predictor of ovarian reserve for patients prior to IVF, its roles to estimate in vitro embryo morphology and potential to advance to blastocyst stage have not been extensively investigated. These data suggest that baseline serum AMH determinations can help forecast blastocyst developmental during IVF. Serum AMH measured before treatment may assist patients, clinicians and embryologists as scheduling of embryo transfer is outlined. Additional studies are needed to confirm these correlations and to better define the role of baseline serum AMH level in the prediction of blastocyst formation.

  2. Emotions and Ethical Considerations of Women Undergoing IVF-Treatments

    NARCIS (Netherlands)

    Kaliarnta, S.; Nihlén-Fahlquist, J.; Roeser, S.

    2011-01-01

    Women who suffer from fertility issues often use in vitro fertilization (IVF) to realize their wish to have children. However, IVF has its own set of strict administration rules that leave the women physically and emotionally exhausted. Feeling alienated and frustrated, many IVF users turn to

  3. IVF culture media: past, present and future.

    Science.gov (United States)

    Chronopoulou, Elpiniki; Harper, Joyce C

    2015-01-01

    The advances in the world of IVF during the last decades have been rapid and impressive and culture media play a major role in this success. Until the 1980s fertility centers made their media in house. Nowadays, there are numerous commercially available culture media that contain various components including nutrients, vitamins and growth factors. This review goes through the past, present and future of IVF culture media and explores their composition and quality assessment. A computerized search was performed in PubMed regarding IVF culture media including results from 1929 until March 2014. Information was gathered from the websites of companies who market culture media, advertising material, instructions for use and certificates of analysis. The regulation regarding IVF media mainly in the European Union (EU) but also in non-European countries was explored. The keyword 'IVF culture media' gave 923 results in PubMed and 'embryo culture media' 12 068 results dating from 1912 until March 2014, depicting the increased scientific activity in this field. The commercialization of IVF culture media has increased the standards bringing a great variety of options into clinical practice. However, it has led to reduced transparency and comparisons of brand names that do not facilitate the scientific dialogue. Furthermore, there is some evidence suggesting that suboptimal culture conditions could cause long-term reprogramming in the embryo as the periconception period is particularly susceptible to epigenetic alterations. IVF media are now classified as class III medical devices and only CE (Conformité Européene)-marked media should be used in the EU. The CE marking of IVF culture media is a significant development in the field. However, the quality and efficiency of culture media should be monitored closely. Well-designed randomized controlled trials, large epidemiological studies and full transparency should be the next steps. Reliable, standardized models assessing

  4. Gazetteer Brokering through Semantic Mediation

    Science.gov (United States)

    Hobona, G.; Bermudez, L. E.; Brackin, R.

    2013-12-01

    A gazetteer is a geographical directory containing some information regarding places. It provides names, location and other attributes for places which may include points of interest (e.g. buildings, oilfields and boreholes), and other features. These features can be published via web services conforming to the Gazetteer Application Profile of the Web Feature Service (WFS) standard of the Open Geospatial Consortium (OGC). Against the backdrop of advances in geophysical surveys, there has been a significant increase in the amount of data referenced to locations. Gazetteers services have played a significant role in facilitating access to such data, including through provision of specialized queries such as text, spatial and fuzzy search. Recent developments in the OGC have led to advances in gazetteers such as support for multilingualism, diacritics, and querying via advanced spatial constraints (e.g. search by radial search and nearest neighbor). A challenge remaining however, is that gazetteers produced by different organizations have typically been modeled differently. Inconsistencies from gazetteers produced by different organizations may include naming the same feature in a different way, naming the attributes differently, locating the feature in a different location, and providing fewer or more attributes than the other services. The Gazetteer application profile of the WFS is a starting point to address such inconsistencies by providing a standardized interface based on rules specified in ISO 19112, the international standard for spatial referencing by geographic identifiers. The profile, however, does not provide rules to deal with semantic inconsistencies. The USGS and NGA commissioned research into the potential for a Single Point of Entry Global Gazetteer (SPEGG). The research was conducted by the Cross Community Interoperability thread of the OGC testbed, referenced OWS-9. The testbed prototyped approaches for brokering gazetteers through use of semantic

  5. Individualized decision-making in IVF: calculating the chances of pregnancy.

    Science.gov (United States)

    van Loendersloot, L L; van Wely, M; Repping, S; Bossuyt, P M M; van der Veen, F

    2013-11-01

    Are we able to develop a model to calculate the chances of pregnancy prior to the start of the first IVF cycle as well as after one or more failed cycles? Our prediction model enables the accurate individualized calculation of the probability of an ongoing pregnancy with IVF. To improve counselling, patient selection and clinical decision-making in IVF, a number of prediction models have been developed. These models are of limited use as they were developed before current clinical and laboratory protocols were established. This was a cohort study. The development set included 2621 cycles in 1326 couples who had been treated with IVF or ICSI between January 2001 and July 2009. The validation set included additional data from 515 cycles in 440 couples treated between August 2009 and April 2011. The outcome of interest was an ongoing pregnancy after transfer of fresh or frozen-thawed embryos from the same stimulated IVF cycle. If a couple became pregnant after an IVF/ICSI cycle, the follow-up was at a gestational age of at least 11 weeks. Women treated with IVF or ICSI between January 2001 and April 2011 in a university hospital. IVF/ICSI cycles were excluded in the case of oocyte or embryo donation, surgically retrieved spermatozoa, patients positive for human immunodeficiency virus, modified natural IVF and cycles cancelled owing to poor ovarian stimulation, ovarian hyperstimulation syndrome or other unexpected medical or non-medical reasons. Thirteen variables were included in the final prediction model. For all cycles, these were female age, duration of subfertility, previous ongoing pregnancy, male subfertility, diminished ovarian reserve, endometriosis, basal FSH and number of failed IVF cycles. After the first cycle: fertilization, number of embryos, mean morphological score per Day 3 embryo, presence of 8-cell embryos on Day 3 and presence of morulae on Day 3 were also included. In validation, the model had moderate discriminative capacity (c-statistic 0

  6. Is the birthweight of singletons born after IVF reduced by ovarian stimulation or by IVF laboratory procedures?

    NARCIS (Netherlands)

    Pelinck, M. J.; Hadders-Algra, M.; Haadsma, M. L.; Nijhuis, W. L.; Kiewiet, S. M.; Hoek, A.; Heineman, M. J.; Middleburg, K. J.

    Singletons born after IVF are at risk of adverse pregnancy outcome, the cause of which is unknown. The present study investigated the influence of ovarian stimulation and IVF laboratory procedure on birthweight. Birthweight of singleton pregnancies resulting from IVF treatment with (n = 161) and

  7. Is the birthweight of singletons born after IVF reduced by ovarian stimulation or by IVF laboratory procedures?

    NARCIS (Netherlands)

    Pelinck, M. J.; Hadders-Algra, M.; Haadsma, M. L.; Nijhuis, W. L.; Kiewiet, S. M.; Hoek, A.; Heineman, M. J.; Middelburg, K. J.

    2010-01-01

    Singletons born after IVF are at risk of adverse pregnancy outcome, the cause of which is unknown. The present study investigated the influence of ovarian stimulation and IVF laboratory procedure on birthweight. Birthweight of singleton pregnancies resulting from IVF treatment with (n = 161) and

  8. Risk of postpartum psychosis after IVF treatment: a nationwide case-control study.

    Science.gov (United States)

    Vikström, Josefin; Josefsson, Ann; Hammar, Mats; Bladh, Marie; Sydsjö, Gunilla

    2017-01-01

    Is the risk of postpartum psychosis (PPP) increased in women who give birth after IVF treatment compared to after spontaneous conception? The risk of PPP is not higher in the group of women who give birth after IVF treatment compared with women who give birth after spontaneous conception. Women who conceive using IVF treatment can experience higher levels of pregnancy-specific distress and are at increased risk of pre-eclampsia, an immune-related condition which in turn has been linked to PPP, as well as other pregnancy and delivery complications, which also serve as PPP risk factors. It is not known whether the risk of PPP is increased in women who have conceived using IVF treatment. A nationwide, register-based, case-control study of all primiparous women who had given birth after IVF treatment between 1988 and 2012. Information about 10 412 women was collected from the Swedish IVF register. A control group of women who had given birth after spontaneous conception was selected from the Swedish Medical Birth Register (n = 18 624). PPP diagnoses, identified using ICD-10 diagnostic codes F20-31 and F531 the first year postpartum, were collected from the National Patient Register. Associations between PPP and IVF/spontaneous conception were evaluated using chi-square tests and logistic regression analyses while controlling for known risk factors of PPP. There were no differences in PPP prevalence between the IVF group and the control group (0.3%, n = 29 versus 0.4%, n = 77) in the chi-square analysis (P = 0.169) or the multiple logistic regression analyses (P = 0.646; odds ratio (OR): 1.178; 95% CI: 586-2.365). No associations between pregnancy or delivery complications and PPP were found. A history of any psychiatric disorder (P IVF treatment, more studies are needed to verify these results. The generalizability is restricted to primiparous women in western countries. This study confirms the results of previous studies in showing a history of mental illness to be

  9. The Psychological Impact of IVF Treatment

    NARCIS (Netherlands)

    C. de Klerk (Cora)

    2008-01-01

    textabstractIVF treatment requires the woman to undergo several invasive procedures, which are repeated in subsequent treatment cycles. In addition to the physical burden, the threat of treatment failure confronts the couple with the possibility that they have to give up hope to have a child of

  10. The impact of introducing patient co-payments in Germany on the use of IVF and ICSI : a price-elasticity of demand assessment

    NARCIS (Netherlands)

    Connolly, M. P.; Griesinger, G.; Ledger, W.; Postma, M. J.

    BACKGROUND: Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact

  11. The impact of introducing patient co-payments in Germany on the use of IVF and ICSI : a price-elasticity of demand assessment

    NARCIS (Netherlands)

    Connolly, M. P.; Griesinger, G.; Ledger, W.; Postma, M. J.

    2009-01-01

    BACKGROUND: Authorities concerned by rising healthcare costs have a tendency to target reproductive treatments because of the perception that infertility is a low priority. In 2004 German health authorities introduced a 50% co-payment for patients, in an effort to save cost. We explored the impact

  12. BCube: Building a Geoscience Brokering Framework

    Science.gov (United States)

    Jodha Khalsa, Siri; Nativi, Stefano; Duerr, Ruth; Pearlman, Jay

    2014-05-01

    BCube is addressing the need for effective and efficient multi-disciplinary collaboration and interoperability through the advancement of brokering technologies. As a prototype "building block" for NSF's EarthCube cyberinfrastructure initiative, BCube is demonstrating how a broker can serve as an intermediary between information systems that implement well-defined interfaces, thereby providing a bridge between communities that employ different specifications. Building on the GEOSS Discover and Access Broker (DAB), BCube will develop new modules and services including: • Expanded semantic brokering capabilities • Business Model support for work flows • Automated metadata generation • Automated linking to services discovered via web crawling • Credential passing for seamless access to data • Ranking of search results from brokered catalogs Because facilitating cross-discipline research involves cultural and well as technical challenges, BCube is also addressing the sociological and educational components of infrastructure development. We are working, initially, with four geoscience disciplines: hydrology, oceans, polar and weather, with an emphasis on connecting existing domain infrastructure elements to facilitate cross-domain communications.

  13. Increased circulating cell-derived microparticle count is associated with recurrent implantation failure after IVF and embryo transfer.

    Science.gov (United States)

    Martínez-Zamora, M Angeles; Tàssies, Dolors; Reverter, Juan Carlos; Creus, Montserrat; Casals, Gemma; Cívico, Salvadora; Carmona, Francisco; Balasch, Juan

    2016-08-01

    Cell-derived microparticles (cMPs) are small membrane vesicles that are released from many different cell types in response to cellular activation or apoptosis. Elevated cMP counts have been found in almost all thrombotic diseases and pregnancy wastage, such as recurrent spontaneous abortion and in a number of conditions associated with inflammation, cellular activation and angiogenesis. cMP count was investigated in patients experiencing unexplained recurrent implantation failure (RIF). The study group was composed of 30 women diagnosed with RIF (RIF group). The first control group (IVF group) (n = 30) comprised patients undergoing a first successful IVF cycle. The second control group (FER group) included 30 healthy women who had at least one child born at term and no history of infertility or obstetric complications. cMP count was significantly higher in the RIF group compared with the IVF and FER groups (P < 0.05 and P < 0.01, respectively) (RIF group: 15.8 ± 6.2 nM phosphatidylserine equivalent [PS eq]; IVF group: 10.9 ± 5.3 nM PS eq; FER group: 9.6 ± 4.0 nM PS eq). No statistical difference was found in cMP count between the IVF and FER groups. Increased cMP count is, therefore, associated with RIF after IVF and embryo transfer. Copyright © 2016. Published by Elsevier Ltd.

  14. In-vitro maturation versus IVF with GnRH antagonist for women with polycystic ovary syndrome: treatment outcome and rates of ovarian hyperstimulation syndrome.

    Science.gov (United States)

    Das, Mausumi; Son, Weon-Young; Buckett, William; Tulandi, Togas; Holzer, Hananel

    2014-11-01

    In-vitro maturation (IVM) treatment has gained popularity for decreasing the incidence of ovarian hyperstimulation syndrome (OHSS) by eliminating or minimizing the use of gonadotrophins in women with polycystic ovary syndrome (PCOS). Studies have shown that IVF with GnRH-antagonist protocol is associated with a lower incidence of OHSS. Data comparing the relative success of these two treatments is, however, lacking. Treatment outcome and rates of OHSS were compared in patients with PCOS who underwent assisted conception with either IVM or IVF with GnRH-antagonist protocol between 2006 and 2011. The number of oocytes retrieved was higher in the IVM group, whereas the number of mature oocytes, fertilization rate and number of embryos cleaved were comparable. The implantation rate was higher in the IVF group. The clinical pregnancy rates per embryo transfer were not statistically different (IVF: 45.8% versus IVM: 32.4%). The live-birth rate was higher in the IVF group (IVF: 40.7% versus IVM: 23.5%; P = 0.04). Five women developed moderate or severe OHSS in the IVF group, whereas none did in the IVM group. Both IVM and IVF with GnRH-antagonist protocol seem to be effective treatment regimens in women with PCOS, although IVM is associated with a lower risk of OHSS. Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  15. 17 CFR 155.4 - Trading standards for introducing brokers.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Trading standards for introducing brokers. 155.4 Section 155.4 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION TRADING STANDARDS § 155.4 Trading standards for introducing brokers. (a) Each introducing broker...

  16. 77 FR 74201 - Customs Brokers User Fee Payment for 2013

    Science.gov (United States)

    2012-12-13

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Customs Brokers User Fee...: General notice. SUMMARY: This document provides notice to customs brokers that the annual fee of $138 that... of the 2013 Customs Broker User Fee is due February 15, 2013. FOR FURTHER INFORMATION CONTACT: Craig...

  17. 76 FR 65741 - Customs Brokers User Fee Payment for 2012

    Science.gov (United States)

    2011-10-24

    ... DEPARTMENT OF HOMELAND SECURITY Customs and Border Protection Customs Brokers User Fee Payment for.... SUMMARY: This document provides notice to customs brokers that the annual fee of $138 that is assessed for... 2012 in accordance with the Tax Reform Act of 1986. DATES: Payment of the 2012 Customs Broker User Fee...

  18. Insurance brokers market dynamics in Poland before deregulation

    Directory of Open Access Journals (Sweden)

    Jarosław Krajewski

    2014-12-01

    Full Text Available The article focus on insurance broker profession in connection with second part of professions deregulations. It briefly presents modifications in polish law in this domain. Next part concerns the insurance brokers market dynamics analysis. The results shows permanent increase in brokers quantity in spite of existing regulations. Presented paper makes start point to following analysis.

  19. 78 FR 48460 - Notice of Revocation of Customs Broker License

    Science.gov (United States)

    2013-08-08

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Revocation of Customs Broker License AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION: Notice of revocation of a customs broker license. SUMMARY: Notice is hereby given that a customs broker...

  20. 78 FR 48456 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2013-08-08

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION: Customs broker license cancellations. SUMMARY: Notice is hereby given that the customs broker...

  1. 78 FR 48458 - Notice of Reinstatement of Customs Broker License

    Science.gov (United States)

    2013-08-08

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Reinstatement of Customs Broker License AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION: Reinstatement of customs broker license. SUMMARY: Notice is hereby given that a customs broker's license has...

  2. 12 CFR 221.125 - Credit to brokers and dealers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Credit to brokers and dealers. 221.125 Section... SYSTEM CREDIT BY BANKS AND PERSONS OTHER THAN BROKERS OR DEALERS FOR THE PURPOSE OF PURCHASING OR CARRYING MARGIN STOCK (REGULATION U) Interpretations § 221.125 Credit to brokers and dealers. (a) The...

  3. 76 FR 1626 - Customs Brokers User Fee Payment for 2011

    Science.gov (United States)

    2011-01-11

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Customs Brokers User Fee... notice. SUMMARY: This document provides notice to customs brokers that the annual fee of $138 that is assessed for each permit held by a broker, whether it may be an individual, partnership, association, or...

  4. 12 CFR 221.103 - Loans to brokers or dealers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Loans to brokers or dealers. 221.103 Section... SYSTEM CREDIT BY BANKS AND PERSONS OTHER THAN BROKERS OR DEALERS FOR THE PURPOSE OF PURCHASING OR CARRYING MARGIN STOCK (REGULATION U) Interpretations § 221.103 Loans to brokers or dealers. Questions have...

  5. 78 FR 77140 - Customs Brokers User Fee Payment for 2014

    Science.gov (United States)

    2013-12-20

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Customs Brokers User Fee...: General notice. SUMMARY: This document provides notice to customs brokers that the annual fee of $138 that is assessed for each permit held by a broker, whether it may be an individual, partnership...

  6. 12 CFR 220.132 - Credit to brokers and dealers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Credit to brokers and dealers. 220.132 Section 220.132 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM CREDIT BY BROKERS AND DEALERS (REGULATION T) Interpretations § 220.132 Credit to brokers and...

  7. A Case with Severe Endometriosis, Ovarian Hyperstimulation Syndrome, and Isolated Unilateral Pleural Effusion after IVF

    DEFF Research Database (Denmark)

    Sopa, Negjyp; Larsen, Elisabeth Clare; Andersen, Anders Nyboe

    2017-01-01

    We present a very rare case of right-sided isolated pleural effusion in a patient with severe endometriosis who, in relation to in vitro fertilization (IVF), developed ovarian hyperstimulation syndrome (OHSS). Earlier laparotomy showed grade IV endometriosis including endometriotic implants...

  8. Influence of female bodyweight on IVF outcome: a longitudinal multicentre cohort study of 487 infertile couples

    DEFF Research Database (Denmark)

    Pinborg, A; Gaarslev, C; Hougaard, C O

    2011-01-01

    This study investigated the impact of women's body mass index (BMI) on the outcome after consecutive IVF/intracytoplasmic sperm injection cycles in 487 patients initiating treatment with 5-year follow-up. The total number of cycles was 1417. In total 103 (21.1%) were overweight (BMI 25-29.9 kg...

  9. Outcome in clients with positive pregnancy test following IVF/ICSI ...

    African Journals Online (AJOL)

    Background: A retrospective analysis of the outcome of all patients who have recorded a positive pregnancy test following IVF/ICSI treatment from June 1999 to December 2002 was done. Materials and Methods: A total of 1256 treatment cycles were carried out using the long day 1 (early follicular phase) or day 21 ...

  10. IVF versus ICSI for the fertilization of in-vitro matured human oocytes.

    Science.gov (United States)

    Walls, M; Junk, S; Ryan, J P; Hart, R

    2012-12-01

    Traditional dogma suggests that intracytoplasmic sperm injection (ICSI) should be performed to ensure successful oocyte fertilization in an in-vitro maturation (IVM) cycle. This study postulated that there would be no difference in the fertilization rate when ICSI was compared with IVF. This hypothesis was tested in a randomized trial of IVF versus ICSI in IVM. A total of 150 immature oocytes were collected in eight cycles of IVM for patients diagnosed with polycystic ovarian syndrome (PCOS). Patients were primed with minimal FSH before transvaginal oocyte aspiration. Sibling oocytes were inseminated by 50% IVF and 50% ICSI. There was no significant difference in fertilization, useable or total blastocyst development between the two insemination technique groups. Clinical pregnancy results for combined fresh and cryopreserved transfers were identical between the two insemination techniques with a total of two fresh and five cryopreserved IVF-inseminated embryos resulting in three clinical pregnancies (42.9%) and five fresh and two cryopreserved ICSI-derived embryos resulting in three clinical pregnancies (42.9%). This research has shown IVF to be a legitimate fertilization technique for IVM oocytes in PCOS patients and provides a greater awareness of the use of a fertilization method previously not utilized with IVM. In-vitro maturation (IVM) is an alternative treatment method to traditional IVF. Due to the minimal use of stimulating hormones in this treatment, IVM has a lower risk of ovarian hyperstimulation syndrome, it can be used for fertility preservation in cancer patients and it is more cost conservative. Early research into the effects of IVM showed a hardening effect on the membrane surrounding the egg (the zona pellucida). It was initially believed that, to overcome this hardening in order to allow the egg to be fertilized, spermatozoa would need to be injected into the egg using intracytoplasmic sperm injection. Due to recent advances in hormonal

  11. Adolescents conceived by IVF: parenting and psychosocial adjustment.

    Science.gov (United States)

    Colpin, H; Bossaert, G

    2008-12-01

    A follow-up study was conducted in mid-adolescence on parenting and the child's psychosocial development after in vitro fertilization (IVF). The first phase of the study had compared 31 IVF families and 31 families with a naturally conceived child when the children were 2 years old (Colpin et al., 1995). Of these, 24 IVF families and 21 control families participated again when the children were 15-16 years old. Fathers, mothers and adolescents completed questionnaires assessing parenting style and stress, and adolescent psychosocial adjustment. No significant differences were found in self- or adolescent-reported parenting style, or in parenting stress between IVF mothers and mothers in the control group, nor between IVF fathers and fathers in the control group. Neither did we find significant differences in self- or parent-reported behavioural problems between adolescents conceived by IVF and those conceived naturally. Comparison of behavioural problems between IVF adolescents informed or not informed about the IVF conception did not reveal significant differences. Parenting and 15-16-year-old adolescents' psychosocial adjustment did not differ significantly between IVF families and control families. This study is, to the best of our knowledge, the first psychosocial follow-up in mid-adolescence, and adds to the evidence that IVF children and their parents are well-adjusted. Large-scale studies in adolescence are needed to support these findings.

  12. Effects of triploidy incidence on clinical outcomes for IVF-ET cycles in different ovarian stimulation protocols.

    Science.gov (United States)

    Li, Mingzhao; Xue, Xia; Zhang, Silin; Li, Wei; Zhao, Xiaoli; Ren, Wenjuan; Shi, Juanzi

    2015-10-01

    To discuss the relationship between triploidy incidence and clinical outcomes of embryos derived from normally fertilized oocytes from the same cohort for in vitro fertilization-embryo transfer (IVF-ET) cycles in different ovarian stimulation protocol. This study included 2070 in vitro fertilization (IVF) cycles with long-term protocol, 802 IVF cycles with ultra short-term protocol and 508 IVF-D (in vitro fertilization by donor semen) cycles with long-term protocol from January 2013 to September 2014. According to the different 3PN rate, patients were divided into three groups as follows: Group 1 included patients with 0% 3PN zygotes, Group 2 included patients with 1-25% 3PN zygotes and Group 3 included patients with >25% 3PN zygotes. female age, no. of retrieved oocytes, normal fertilization rate, day-3 grade I + II embryos rate, day-3 grade I + II + III embryos rate, implantation rate, pregnancy rate and early abortion rate. Triploidy cycle incidence rate in IVF and IVF-D cycles with long-term protocol were significantly higher than in IVF cycles with ultra short-term protocol (p  0.05). In three protocols, normal fertilization rate in 3PN = 0% and 3PN = 1-25% groups were significantly higher compared to 3PN > 25% group (p cycles with long-term protocol, the day-3 grade I + II embryos, implantation and pregnancy rate in 3PN > 25% group were significantly lower than other two groups (p  0.05). In IVF cycles with ultra short-term protocol, there were no significant differences found in day-3 grade I + II embryos, day-3 grade I + II + III embryos, implantation, pregnancy and early abortion rate (p > 0.05). In IVF-D cycles with long-term protocol, the day-3 grade I + II embryos, day-3 grade I + II + III embryos and implantation rate in 3PN > 25% group were significantly lower than other two groups (p  0.05). We observed that high proportion of triploid zygotes made a negative effect on

  13. The effect of G-CSF on infertile women undergoing IVF treatment: A meta-analysis.

    Science.gov (United States)

    Li, Jie; Mo, Sien; Chen, Yang

    2017-08-01

    Evidence for the effect of granulocyte colony stimulating factor (G-CSF) on infertile women undergoing in vitro fertilization (IVF) remains inconsistent. This study aimed to evaluate the effectiveness of G-CSF on infertile women undergoing IVF. PubMed and EMBASE databases were searched before August 2016. Comparing the transvaginal perfusion of G-CSF and placebo or no treatment, the available studies were considered. The pooled risk ratio (RR) with 95% confidence intervals (CIs) was used in the analysis and six studies were included. Transvaginal perfusion of G-CSF was significantly associated with a higher clinical pregnancy rate versus the placebo (RR=1.563, 95%CI: 1.122, 2.176), especially for the Asian population. Among patients with a thin endometrium or repeated IVF failure, the implantation and biochemical pregnancy rates were also significantly increased in patients with the use of G-CSF (implantation rate: RR = 1.887, 95% CI: 1.256, 2.833; biochemical pregnancy rate: RR = 2.385, 95% CI: 1.414, 4.023). However, no statistical significance in increasing endometrial thickness was detected. Transvaginal perfusion of G-CSF for infertile women may play a critical role in assisting human reproduction, especially for patients with a thin endometrium or repeated IVF failure in the Asian population.

  14. Vasectomy reversal versus IVF with sperm retrieval: which is better?

    Science.gov (United States)

    Shridharani, Anand; Sandlow, Jay I

    2010-11-01

    This paper will describe why this review is timely and relevant. Over the past two decades, treatment options for couples with reconstructible obstructive azoospermia have improved tremendously. Advances in assisted reproductive technologies (ART), specifically sperm retrieval techniques for intracytoplasmic sperm injection coupled with in-vitro fertilization, as well as refinements in microsurgical reconstruction have led to improved outcomes and cost-effectiveness. Providing the most up-to-date care based on the most recent data allows for better patient outcomes and satisfaction. Microsurgical reconstruction of the vas has remained a cost-effective, reliable and effective means of restoring fertility in the majority of men who have previously undergone vasectomy when the reconstruction is performed by an experienced microsurgeon. However, there are specific instances in which sperm retrieval/IVF/ICSI may be a more appropriate treatment modality as ART techniques continue to improve. Data comparing surgical reconstruction versus sperm retrieval/ICSI/IVF are neither randomized nor homogenous. Therefore, a comprehensive understanding of the factors that can affect outcomes, overall cost, and the morbidity associated with each treatment modality, respective of the institution providing the treatment, is strongly recommended.

  15. 31 CFR 560.416 - Brokering services.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Brokering services. 560.416 Section 560.416 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... provision of goods, services or technology, from whatever source, to or from Iran or the Government of Iran...

  16. 12 CFR 337.6 - Brokered deposits.

    Science.gov (United States)

    2010-01-01

    ... government sponsored minority or women-owned depository institution deposit program. (iii) Notwithstanding... any brokered deposit without restriction by this section. (2)(i) An adequately capitalized insured... restriction on the payment of interest contained in paragraph (b)(2)(ii) of the section. After such 90-day...

  17. Geospatial Brokering - Challenges and Future Directions

    Science.gov (United States)

    White, C. E.

    2012-12-01

    An important feature of many brokers is to facilitate straightforward human access to scientific data while maintaining programmatic access to it for system solutions. Standards-based protocols are critical for this, and there are a number of protocols to choose from. In this discussion, we will present a web application solution that leverages certain protocols - e.g., OGC CSW, REST, and OpenSearch - to provide programmatic as well as human access to geospatial resources. We will also discuss managing resources to reduce duplication yet increase discoverability, federated search solutions, and architectures that combine human-friendly interfaces with powerful underlying data management. The changing requirements witnessed in brokering solutions over time, our recent experience participating in the EarthCube brokering hack-a-thon, and evolving interoperability standards provide insight to future technological and philosophical directions planned for geospatial broker solutions. There has been much change over the past decade, but with the unprecedented data collaboration of recent years, in many ways the challenges and opportunities are just beginning.

  18. Qualities of Knowledge Brokers: Reflections from Practice

    Science.gov (United States)

    Phipps, David; Morton, Sarah

    2013-01-01

    Employing knowledge brokers is one way that universities and research centres have responded to the increasing emphasis on the wider usefulness and uptake of research beyond the academy. While there is an increase in the numbers of such professionals, there has been little focus on their roles, skills and development. In this paper, two knowledge…

  19. ‘Vanishing embryo syndrome’ in IVF/ICSI

    DEFF Research Database (Denmark)

    Hvidtjørn, Dorte; Grove, Jakob; Schendel, Diana

    2005-01-01

    BACKGROUND: In a Danish population-based cohort study assessing the risk of cerebral palsy in children bornafter IVF, we made some interesting observations regarding ‘vanishing co-embryos’. METHODS andRESULTS: All live-born children born in Denmark from 1 January 1995 to 31 December 2000 were...... included inthis analysis. The children conceived by IVF/ICSI (9444) were identified through the IVF Register, the childrenconceived without IVF/ICSI (395 025) were identified through The Danish Medical Birth Register. Main outcomemeasure was the incidence of cerebral palsy. Within the IVF/ICSI children we...... found indications of an increasedrisk of cerebral palsy in those children resulting from pregnancies, where the number of embryos transferred washigher than the number of children born. CONCLUSIONS: The association between vanishing embryo syndromeand incidence of cerebral palsy following IVF requires...

  20. The birth and routinization of IVF in China

    DEFF Research Database (Denmark)

    Wahlberg, Ayo

    2016-01-01

    How can it be that China today is home to some of the world’s largest IVF clinics, carrying out as many as 30,000 cycles annually? In this article, I address how IVF was developed in China during the early 1980s only to be routinized during the exact same period that one of the world’s most...... comprehensive family planning programmes aimed at preventing birth was being rolled out. IVF was not merely imported into China, rather it was experimentally developed within China into a form suitable for its restrictive family planning regulations. As a result, IVF and other assisted reproductive technologies...

  1. 49 CFR 375.409 - May household goods brokers provide estimates?

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false May household goods brokers provide estimates? 375... Estimating Charges § 375.409 May household goods brokers provide estimates? A household goods broker must not... there is a written agreement between the broker and you, the carrier, adopting the broker's estimate as...

  2. Granulocyte colony-stimulating factor in repeated IVF failure, a randomized trial.

    Science.gov (United States)

    Aleyasin, Ashraf; Abediasl, Zhila; Nazari, Atefeh; Sheikh, Mahdi

    2016-06-01

    Recent studies have revealed key roles for granulocyte colony-stimulating factor (GCSF) in embryo implantation process and maintenance of pregnancy, and some studies showed promising results by using local intrauterine infusion of GCSF in patients undergoing in vitro fertilization (IVF). This multicenter, randomized, controlled trial included 112 infertile women with repeated IVF failure to evaluate the efficacy of systemic single-dose subcutaneous GCSF administration on IVF success in these women. In this study, the Long Protocol of ovarian stimulation was used for all participants. Sealed, numbered envelopes assigned 56 patients to receive subcutaneous 300 µg GCSF before implantation and 56 in the control group. The implantation (number of gestational sacs on the total number of transferred embryos), chemical pregnancy (positive serum β-HCG), and clinical pregnancy (gestational sac and fetal heart) rates were compared between the two groups. This trial is registered at www.irct.ir (IRCT201503119568N11). The successful implantation (18% vs 7.2%, P=0.007), chemical pregnancy (44.6% vs 19.6%, P=0.005), and clinical pregnancy (37.5% vs 14.3%, P=0.005) rates were significantly higher in the intervention group than in the control group. After adjustment for participants' age, endometrial thickness, good-quality oocyte counts, number of transferred embryos, and anti-Mullerian hormone levels, GCSF treatment remained significantly associated with successful implantation (OR=2.63, 95% CI=1.09-6.96), having chemical pregnancy (OR= 2.74, 95% CI=1.11-7.38) and clinical pregnancy (OR=2.94, 95% CI=1.23-8.33). In conclusion, administration of single-dose systemic subcutaneous GCSF before implantation significantly increases the IVF success, implantation, and pregnancy rates in infertile women with repeated IVF failure. © 2016 Society for Reproduction and Fertility.

  3. Internal maternal position of women who became pregnant using IVF

    Directory of Open Access Journals (Sweden)

    Vera A. Yakupova

    2015-03-01

    Full Text Available Nowadays in vitro fertilization procedure is widespread. Due to improvements in medical technology parenting has become possible for couples who were doomed to childlessness. Practical request for psychological support couples who have decided to take part in the IVF program has been raised. Shaping the internal position of the IVF parent takes place in special psychological conditions. The IVF procedure is preceded by a period of infertility, the procedure is often the last chance to have a baby alone. Participation in the IVF program involves regular contact with doctors, medical personnel access to the intimate sphere of life couples. The paper analyzes the attitude of women participating in the IVF pregnancy program, the unborn baby and parenting - the elements constituting the parent position. The study which was attended by 224 pregnant women, 62 participants of IVF program and 162 women with physiological pregnancy was carried out on the basis of Kulakov Scientific Centre for Obstetrics, Gynecology and Perinatology. When analyzing the data obtained we were able to identify features of the internal position of women who became pregnant using IVF. In comparison with a group of women with physiological pregnancy, the IVF program participants tend to romanticize the role of parent and child. IVF program participants demonstrate unwillingness to take on the role of parent. The main motivation of mothers in the IVF group concentrated on the very fact of pregnancy and childbirth, proper parenting, while care and support for children is not appealing to women who became pregnant using IVF. Important conditions for becoming a parent are the experience of motherhood and the time of pregnancy expectation.

  4. Agent-Oriented Privacy-Based Information Brokering Architecture for Healthcare Environments

    Directory of Open Access Journals (Sweden)

    Abdulmutalib Masaud-Wahaishi

    2009-01-01

    Full Text Available Healthcare industry is facing a major reform at all levels—locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc. that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

  5. Agent-oriented privacy-based information brokering architecture for healthcare environments.

    Science.gov (United States)

    Masaud-Wahaishi, Abdulmutalib; Ghenniwa, Hamada

    2009-01-01

    Healthcare industry is facing a major reform at all levels-locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc.) that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

  6. Perinatal outcome in singletons after modified natural cycle IVF and standard IVF with ovarian stimulation

    NARCIS (Netherlands)

    Pelinck, Marie-Jose; Keizer, Marjan H.; Hoek, Annemieke; Simons, Arnold H. M.; Schelling, Karin; Middelburg, Karin; Heineman, Maas Jan

    Objective: Singletons born after IVF treatment are at risk for adverse pregnancy outcome, the cause of which is unknown. The aim of the present study was to investigate the influence of ovarian stimulation on perinatal outcome. Study design: In this single-centre retrospective study, perinatal

  7. Perinatal outcome in singletons after modified natural cycle IVF and standard IVF with ovarian stimulation

    NARCIS (Netherlands)

    Pelinck, Marie-José; Keizer, Marjan H.; Hoek, Annemieke; Simons, Arnold H. M.; Schelling, Karin; Middelburg, Karin; Heineman, Maas Jan

    2010-01-01

    Objective: Singletons born after IVF treatment are at risk for adverse pregnancy outcome, the cause of which is unknown. The aim of the present study was to investigate the influence of ovarian stimulation on perinatal outcome. Study design: In this single-centre retrospective study, perinatal

  8. Dehydroepiandrosterone (DHEA) supplementation and IVF outcome in poor responders.

    Science.gov (United States)

    Triantafyllidou, Olga; Sigalos, George; Vlahos, Nikos

    2017-06-01

    Ovarian stimulation of poor ovarian responders still remains a challenging issue. The incidence of poor responders among infertile women is reported in 9-24% IVF cycles and is associated with very low clinical pregnancy rates. Different treatments have been reported in the literature in an attempt to identify the best stimulation protocol for those patients. Administration of dehydroepiandrosterone acetate (DHEA) was suggested as a promising treatment. It is well known that androgens can influence ovarian follicular growth, augment steroidogenesis, promote follicular recruitment and increase the number of primary and pre-antral follicles. The purpose of this review is to evaluate the effect of DHEA supplementation on women with diminished ovarian reserve. Because of the uncertainty of published data, we suggest that well-designed multicentre RCTs are required to provide more insight on the effectiveness of DHEA. The absence of significant side effects should not be considered as an argument to support DHEA treatment.

  9. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice.

    Science.gov (United States)

    La Marca, Antonio; Sunkara, Sesh Kamal

    2014-01-01

    The main objective of individualization of treatment in IVF is to offer every single woman the best treatment tailored to her own unique characteristics, thus maximizing the chances of pregnancy and eliminating the iatrogenic and avoidable risks resulting from ovarian stimulation. Personalization of treatment in IVF should be based on the prediction of ovarian response for every individual. The starting point is to identify if a woman is likely to have a normal, poor or a hyper response and choose the ideal treatment protocol tailored to this prediction. The objective of this review is to summarize the predictive ability of ovarian reserve markers, such as antral follicle count (AFC) and anti-Mullerian hormone (AMH), and the therapeutic strategies that have been proposed in IVF after this prediction. A systematic review of the existing literature was performed by searching Medline, EMBASE, Cochrane library and Web of Science for publications in the English language related to AFC, AMH and their incorporation into controlled ovarian stimulation (COS) protocols in IVF. Literature available to May 2013 was included. The search generated 305 citations of which 41 and 25 studies, respectively, reporting the ability of AMH and AFC to predict response to COS were included in this review. The literature review demonstrated that AFC and AMH, the most sensitive markers of ovarian reserve identified to date, are ideal in planning personalized COS protocols. These sensitive markers permit prediction of the whole spectrum of ovarian response with reliable accuracy and clinicians may use either of the two markers as they can be considered interchangeable. Following the categorization of expected ovarian response to stimulation clinicians can adopt tailored therapeutic strategies for each patient. Current scientific trend suggests the elective use of the GnRH antagonist based regimen for hyper-responders, and probably also poor responders, as likely to be beneficial. The

  10. The stressful (and not so stressful) nature of language brokering: identifying when brokering functions as a cultural stressor for Latino immigrant children in early adolescence.

    Science.gov (United States)

    Kam, Jennifer A; Lazarevic, Vanja

    2014-12-01

    Language brokering remains prevalent among immigrant families, but it is widely assumed that brokering functions as a cultural stressor, resulting in adverse health outcomes for immigrant youth. Few studies, however, have tested this assumption, particularly while using longitudinal data and capturing multiple dimensions of brokering. Thus, this study examined how depressive symptoms and family-based acculturation stress mediated the relationships between various aspects of brokering (i.e., frequency of brokering, positive and negative feelings about brokering, brokering norms, and brokering efficacy) and alcohol, cigarette, and marijuana use and other risky behaviors. Using longitudinal survey data from 234 Latino early adolescents in 6th-8th grades (M age  = 12.4 years; Females = 46.2 %), brokering for parents indirectly affected alcohol and marijuana use through family-based acculturation stress; however, these significant indirect effects became non-significant when taking into account negative brokering feelings and brokering as a burden on one's time. Feeling positively or efficacious about brokering or having pro-brokering norms did not directly predict any adverse mental and behavioral health outcomes. Moderation analyses, however, revealed that brokering for parents did not seem to function as a stressor when Latino early adolescents were high in brokering efficacy (e.g., feeling confident in one's ability to broker) or descriptive brokering norms (e.g., perceiving one's peers as brokering often). By contrast, when Latino early adolescents perceived brokering as a burden, brokering for parents functioned as a stressor, placing Latino early adolescents at risk for family-based acculturation stress, and in turn, alcohol and marijuana use. Such findings point to the complexity of brokering.

  11. Uninformed Decisions? The Online Presentation of Success and Failure of IVF and Related Methods on German IVF Centre Websites.

    Science.gov (United States)

    Kadi, S; Wiesing, U

    2015-12-01

    Background: Patients increasingly use the internet as a source of medical information before initial contact with doctors and during treatment. This applies to reproductive medicine too, where the internet could offer patients the chance to inform themselves in advance about specific procedures and the treatment centres that offer them. In this way it could potentially contribute to informed patient decision-making. This article analyses the web presence of German fertility treatment centres with respect to the provision of information on success rates, risks and side effects of treatment. Methods: Analysis of published success rates and information on the risks and adverse effects of IVF and related methods on German IVF centre websites. Results: Over half of the 129 centres (62.02 %) state a general success rate or their own institution's success rate. Less than a quarter (24.03 %) states their own institution's pregnancy rate and only 7.75 % their own birth rate. The published success rates are mostly pregnancy rates (pregnancy per embryo transfer), which by definition are higher than baby take-home-rates creating unrealistic expectations. Only 61 centres (47.29 %) mention risks and side effects of the procedures offered, and that in varying detail. Only 7 centres (5.43 %) provide information on the risk of psychological stress associated with unsuccessful fertility treatment. Conclusion: There is insufficient opportunity for women and their partners to inform themselves adequately on the internet in advance of treatment about available treatment methods, their success rates and associated risks/side effects; this applies both to specific facilities as well as to the procedures in general. In contrast to other countries, in Germany there is a lack of discussion on content requirements for fertility treatment facility websites.

  12. Congenital malformations in 4224 children conceived after IVF

    NARCIS (Netherlands)

    Anthony, S.; Buitendijk, S. E.; Dorrepaal, C. A.; Lindner, K.; Braat, D. D. M.; den Ouden, A. L.

    2002-01-01

    BACKGROUND: The percentage of children born after IVF will continue to increase due to demographic changes such as increasing maternal age and new developments in assisted reproduction techniques. IVF conceptions may carry an increased risk of congenital malformations. METHODS: We compared overall

  13. Mild strategies for IVF: from theory to practice

    NARCIS (Netherlands)

    Verberg, M.F.G.

    2007-01-01

    Over the last 25 years, ovarian stimulation for IVF treatment has gradually become more complex, time consuming and expensive. Recently, the downsides of ovarian stimulation have attracted increasing attention. Currently, a shift in the focus of IVF is occurring from striving for maximizing instant

  14. Mild ovarian stimulation for IVF: 10 years later

    DEFF Research Database (Denmark)

    Fauser, Bart C J M; Nargund, Geeta; Andersen, Anders Nyboe

    2010-01-01

    Ovarian stimulation to achieve multiple follicle development has been an integral part of IVF treatment. In the context of improved laboratory performance, the need for a large number of oocytes as an integral part of a successful IVF programme may be questioned. The aim of the current debate is ...

  15. Natural cycle in vitro fertilisation (IVF) for subfertile couples

    NARCIS (Netherlands)

    Allersma, Thomas; Farquhar, Cindy; Cantineau, Astrid E. P.

    2013-01-01

    Background Subfertility affects 15% to 20% of couples trying to conceive. In vitro fertilisation (IVF) is one of the assisted reproduction techniques developed to improve chances of achieving pregnancy. In the standard IVF method with controlled ovarian hyperstimulation (COH), growth and development

  16. Consequences of vanishing twins in IVF/ICSI pregnancies

    DEFF Research Database (Denmark)

    Pinborg, Anja Bisgaard; Lidegaard, Ojvind; la Cour Freiesleben, Nina

    2005-01-01

    Spontaneous reductions are a possible cause of the increased morbidity in IVF singletons. The aim of this study was to assess incidence rates of spontaneous reductions in IVF/ICSI twin pregnancies and to compare short- and long-term morbidity in survivors of a vanishing co-twin with singletons...

  17. Achievement test performance in children conceived by IVF.

    Science.gov (United States)

    Mains, L; Zimmerman, M; Blaine, J; Stegmann, B; Sparks, A; Ansley, T; Van Voorhis, B

    2010-10-01

    Long-term follow-up studies of children conceived by IVF are limited. We examine academic performance on standardized tests [Iowa Tests of Basic Skills/Educational Development (ITBS/ITED)] of children conceived by IVF. Parents of children 8-17 years of age at the onset of the study (March 2008) who were conceived by IVF at the University of Iowa Hospitals and Clinics and living in the state of Iowa were contacted by mail. Parents completed questionnaires on their child's health and education and parental education. ITBS/ITED scores from school grades 3-12 were obtained on IVF children and a group of anonymous children matched by grade, year, gender and school district. Scores were analyzed using linear mixed models. Four hundred and ninety-seven couples were contacted. Two hundred and ninety-five couples (463 children) agreed to participate (59.4% of parents), with ITBS/ITED scores available on 423 children (91.4% of participants). IVF children scored higher than the national mean (P divorce and child's BMI. Cryopreservation, length of embryo culture and method of insemination did not affect scores. IVF children scored higher on standardized tests than their matched peers, suggesting that IVF does not have a negative effect on cognitive development. However, long-term follow-up of IVF children is still limited. Further research should be performed on the effect of multiple gestation on academic performance.

  18. Congenital malformations in 4224 children conceived after IVF.

    NARCIS (Netherlands)

    Anthony, S.; Buitendijk, S.E.; Dorrepaal, C.A.; Lindner, K.; Braat, D.D.M.; Ouden, A.L. den

    2002-01-01

    BACKGROUND: The percentage of children born after IVF will continue to increase due to demographic changes such as increasing maternal age and new developments in assisted reproduction techniques. IVF conceptions may carry an increased risk of congenital malformations. METHODS: We compared overall

  19. Congenital malformations in 4224 children conceived after IVF

    NARCIS (Netherlands)

    Anthony, S.; Buitendijk, S.E.; Dorrepaal, C.A.; Lindner, K.; Braat, D.D.M.; Ouden, A.L. den

    2002-01-01

    Background: The percentage of children born after IVF will continue to increase due to demographic changes such as increasing maternal age and new developments in assisted reproduction techniques. IVF conceptions may carry an increased risk of congenital malformations. Methods: We compared overall

  20. The birth and routinization of IVF in China

    DEFF Research Database (Denmark)

    Wahlberg, Ayo

    2016-01-01

    How can it be that China today is home to some of the world’s largest IVF clinics, carrying out as many as 30,000 cycles annually? In this article, I address how IVF was developed in China during the early 1980s only to be routinized during the exact same period that one of the world’s most compr...

  1. Bivariate analysis of basal serum anti-Müllerian hormone measurements and human blastocyst development after IVF

    Directory of Open Access Journals (Sweden)

    Sills E Scott

    2011-12-01

    Full Text Available Abstract Background To report on relationships among baseline serum anti-Müllerian hormone (AMH measurements, blastocyst development and other selected embryology parameters observed in non-donor oocyte IVF cycles. Methods Pre-treatment AMH was measured in patients undergoing IVF (n = 79 and retrospectively correlated to in vitro embryo development noted during culture. Results Mean (+/- SD age for study patients in this study group was 36.3 ± 4.0 (range = 28-45 yrs, and mean (+/- SD terminal serum estradiol during IVF was 5929 +/- 4056 pmol/l. A moderate positive correlation (0.49; 95% CI 0.31 to 0.65 was noted between basal serum AMH and number of MII oocytes retrieved. Similarly, a moderate positive correlation (0.44 was observed between serum AMH and number of early cleavage-stage embryos (95% CI 0.24 to 0.61, suggesting a relationship between serum AMH and embryo development in IVF. Of note, serum AMH levels at baseline were significantly different for patients who did and did not undergo blastocyst transfer (15.6 vs. 10.9 pmol/l; p = 0.029. Conclusions While serum AMH has found increasing application as a predictor of ovarian reserve for patients prior to IVF, its roles to estimate in vitro embryo morphology and potential to advance to blastocyst stage have not been extensively investigated. These data suggest that baseline serum AMH determinations can help forecast blastocyst developmental during IVF. Serum AMH measured before treatment may assist patients, clinicians and embryologists as scheduling of embryo transfer is outlined. Additional studies are needed to confirm these correlations and to better define the role of baseline serum AMH level in the prediction of blastocyst formation.

  2. Staying in the Light: Evaluating Sustainability Models for Brokering Software

    Science.gov (United States)

    Powers, L. A.; Benedict, K. K.; Best, M.; Fyfe, S.; Jacobs, C. A.; Michener, W. K.; Pearlman, J.; Turner, A.; Nativi, S.

    2015-12-01

    The Business Models Team of the Research Data Alliance Brokering Governance Working Group examined several support models proposed to promote the long-term sustainability of brokering middleware. The business model analysis includes examination of funding source, implementation frameworks and obstacles, and policy and legal considerations. The issue of sustainability is not unique to brokering software and these models may be relevant to many applications. Results of this comprehensive analysis highlight advantages and disadvantages of the various models in respect to the specific requirements for brokering services. We offer recommendations based on the outcomes of this analysis while recognizing that all software is part of an evolutionary process and has a lifespan.

  3. Emergency IVF for embryo freezing to preserve female fertility: a French multicentre cohort study.

    Science.gov (United States)

    Courbiere, B; Decanter, C; Bringer-Deutsch, S; Rives, N; Mirallié, S; Pech, J C; De Ziegler, D; Carré-Pigeon, F; May-Panloup, P; Sifer, C; Amice, V; Schweitzer, T; Porcu-Buisson, G; Poirot, C

    2013-09-01

    What are the outcomes of French emergency IVF procedures involving embryo freezing for fertility preservation before gonadotoxic treatment? Pregnancy rates after emergency IVF, cryopreservation of embryos, storage, thawing and embryo transfer (embryo transfer), in the specific context of the preservation of female fertility, seem to be similar to those reported for infertile couples undergoing ART. A French retrospective multicentre cohort study initiated by the GRECOT network-the French Study Group for Ovarian and Testicular Cryopreservation. We sent an e-mail survey to the 97 French centres performing the assisted reproduction technique in 2011, asking whether the centre performed emergency IVF and requesting information about the patients' characteristics, indications, IVF cycles and laboratory and follow-up data. The response rate was 53.6% (52/97). Fourteen French centres reported that they performed emergency IVF (56 cycles in total) before gonadotoxic treatment, between 1999 and July 2011, in 52 patients. The patients had a mean age of 28.9 ± 4.3 years, and a median length of relationship of 3 years (1 month-15 years). Emergency IVF was indicated for haematological cancer (42%), brain tumour (23%), sarcoma (3.8%), mesothelioma (n = 1) and bowel cancer (n = 1). Gynaecological problems accounted for 17% of indications. In 7.7% of cases, emergency IVF was performed for autoimmune diseases. Among the 52 patients concerned, 28% (n = 14) had undergone previous courses of chemotherapy before beginning controlled ovarian stimulation (COS). The initiation of gonadotoxic treatment had to be delayed in 34% of the patients (n = 19). In total, 56 cycles were initiated. The mean duration of stimulation was 11.2 ± 2.5 days, with a mean peak estradiol concentration on the day on which ovulation was triggered of 1640 ± 1028 pg/ml. Three cycles were cancelled due to ovarian hyperstimulation syndrome (n = 1), poor response (n = 1) and treatment error (n = 1). A mean of 8

  4. Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies.

    Science.gov (United States)

    Zheng, Zan; Chen, Letao; Yang, Tubao; Yu, Hong; Wang, Hua; Qin, Jiabi

    2018-04-01

    Studies comparing risk of specific congenital malformations (CM) between multiple pregnancies resulting from IVF/intracytoplasmic sperm injection (ICSI) and those conceived naturally report conflicting results; furthermore, there is a lack of a complete overview. This meta-analysis aimed to address which types of CM are increased in IVF/ICSI multiple pregnancies compared with those conceived naturally. All studies testing the association between IVF/ICSI multiple pregnancies and specific CM identified in various databases were considered. The literature search yielded 856 records, of which 21 cohort studies were included for analysis. Overall, multiple pregnancies achieved with IVF/ICSI experienced a significantly higher risk of chromosomal defects (relative risk [RR] = 1.36; 95% confidence interval [CI]: 1.04-1.77), urogenital (RR = 1.18; 95% CI: 1.03-1.36) and circulatory (RR = 1.22; 95% CI: 1.01-1.47) system malformations. However, the remaining specific CM, such as cleft lip and/or palate, eye, ear, face and neck, respiratory, musculoskeletal, nervous and digestive system malformations, were similar in the two groups. No substantial heterogeneity was observed for most outcomes except for digestive (P = 0.094; I 2 = 38.3%) and circulatory (P = 0.070; I 2 = 35.2%) system malformations. These findings provide additional information on risks of IVF/ICSI for use when counselling patients. Copyright © 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  5. A Brokering Solution for Business Process Execution

    Science.gov (United States)

    Santoro, M.; Bigagli, L.; Roncella, R.; Mazzetti, P.; Nativi, S.

    2012-12-01

    Predicting the climate change impact on biodiversity and ecosystems, advancing our knowledge of environmental phenomena interconnection, assessing the validity of simulations and other key challenges of Earth Sciences require intensive use of environmental modeling. The complexity of Earth system requires the use of more than one model (often from different disciplines) to represent complex processes. The identification of appropriate mechanisms for reuse, chaining and composition of environmental models is considered a key enabler for an effective uptake of a global Earth Observation infrastructure, currently pursued by the international geospatial research community. The Group on Earth Observation (GEO) Model Web initiative aims to increase present accessibility and interoperability of environmental models, allowing their flexible composition into complex Business Processes (BPs). A few, basic principles are at the base of the Model Web concept (Nativi, et al.): 1. Open access 2. Minimal entry-barriers 3. Service-driven approach 4. Scalability In this work we propose an architectural solution aiming to contribute to the Model Web vision. This solution applies the Brokering approach for facilitiating complex multidisciplinary interoperability. The Brokering approach is currently adopted in the new GEOSS Common Infrastructure (GCI) as was presented at the last GEO Plenary meeting in Istanbul, November 2011. According to the Brokering principles, the designed system is flexible enough to support the use of multiple BP design (visual) tools, heterogeneous Web interfaces for model execution (e.g. OGC WPS, WSDL, etc.), and different Workflow engines. We designed and prototyped a component called BP Broker that is able to: (i) read an abstract BP, (ii) "compile" the abstract BP into an executable one (eBP) - in this phase the BP Broker might also provide recommendations for incomplete BPs and parameter mismatch resolution - and (iii) finally execute the eBP using a

  6. Maternal death related to IVF in the Netherlands 1984-2008.

    NARCIS (Netherlands)

    Braat, D.D.M.; Schutte, J.M.; Bernardus, R.E.; Mooij, T.M.; Leeuwen, F.E. van

    2010-01-01

    BACKGROUND: We assessed all deaths in the Netherlands that might have been related to IVF or to an IVF pregnancy in order to investigate this most serious complication. METHODS: All deaths related to IVF, within 1 year after IVF, from 1984 to 2008 were collected by sending a letter to all

  7. Mother-Child Communication Quality during Language Brokering: Validation of Four Measures of Brokering Interaction Goals

    Science.gov (United States)

    Guntzviller, Lisa M.

    2016-01-01

    One hundred dyads of low-income, Spanish-speaking mothers and their bilingual children (age = 12-18; M = 14.12, SD = 1.89) who have language brokered for the mother (i.e., culturally or linguistically mediated between the mother and English speakers) were surveyed. Multiple goals theory posits that mothers and children who do not recognize and…

  8. Are introverts better at partnership brokering? Exploring brokering skills across the introvert-extrovert continuum

    NARCIS (Netherlands)

    Brouwer, J.H.

    2013-01-01

    This article raises the question of whether it matters if a partnership broker is introverted or extroverted[1], [2]. A recent public discussion about Susan Cain’s book ‘Quiet: The power of introverts in a world that can’t stop talking’ has highlighted the importance of recognising one’s temperament

  9. 42 CFR 422.2274 - Broker and agent requirements.

    Science.gov (United States)

    2010-10-01

    ... compensation structure initiated in the year the enrollment occurred. (iv) If the MA organization contracts... Advantage organization markets through independent (i.e., non-employee) brokers or agents, the following requirements must be met: (a) Agents and brokers must be compensated as follows: (1) An MA organization (or...

  10. 78 FR 14848 - Duties of Brokers, Dealers, and Investment Advisers

    Science.gov (United States)

    2013-03-07

    ... of 1940 (``Advisers Act'') is largely principles-based. In contrast, a broker-dealer is not uniformly... interest\\21\\ and disclosure practices of investment advisers and broker-dealers, as well as the economics... Parts III and IV below, we request data and other information relating to the economics and...

  11. 17 CFR 155.2 - Trading standards for floor brokers.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Trading standards for floor brokers. 155.2 Section 155.2 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION TRADING STANDARDS § 155.2 Trading standards for floor brokers. Each contract market shall adopt and submit...

  12. 7 CFR 46.28 - Duties of brokers.

    Science.gov (United States)

    2010-01-01

    ... itemized accounting to the principal promptly on receipt of payment, showing the true gross selling price... broker who agrees to collect funds from the buyer for his principal shall render an itemized accounting... Act. While the broker is not obliged to furnish his principal information regarding the financial...

  13. 78 FR 48457 - Correction of Document Revoking Customs Broker Licenses

    Science.gov (United States)

    2013-08-08

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Correction of Document Revoking Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION: Correction of document revoking certain customs broker licenses. SUMMARY: In a notice published...

  14. 76 FR 71591 - Notice of Revocation of Customs Broker Licenses

    Science.gov (United States)

    2011-11-18

    ... DEPARTMENT OF HOMELAND SECURITY Bureau of Customs and Border Protection Notice of Revocation of Customs Broker Licenses AGENCY: Bureau of Customs and Border Protection, U.S. Department of Homeland Security. ACTION: Customs broker license revocations for the failure to file the 2006 triennial status...

  15. 76 FR 65742 - Revocation of Customs Broker Licenses

    Science.gov (United States)

    2011-10-24

    ... DEPARTMENT OF HOMELAND SECURITY Customs and Border Protection Revocation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security. ACTION: General... U.S. Customs and Border Protection regulations (19 CFR 111.51(b)), the following Customs broker...

  16. 77 FR 74022 - Notice of Cancellation of Customs Broker License

    Science.gov (United States)

    2012-12-12

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker License AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION...) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs broker...

  17. Adolescent Healthcare Brokering: Prevalence, Experience, Impact, and Opportunities

    Science.gov (United States)

    Banas, Jennifer R.; Wallis, Lisa C.; Ball, James W.; Gershon, Sarah

    2016-01-01

    Background: Limited health literacy disproportionately affects those with limited English proficiency (LEP). Parents with LEP might rely on their adolescent children to interpret health information. We call this "adolescent healthcare brokering." This study uncovers the prevalence of brokering, kinds of tasks, emotional and academic…

  18. Establishing the electric pipeline: The role of energy brokers

    International Nuclear Information System (INIS)

    McCullough, R.

    1990-01-01

    This article describes the evolution of energy brokers. As transmission services become more open, the energy broker will arrange transmission paths between supplier and customer, assume inventory risk, solve reliability and/or contract integration problems, balance the financial needs of the buyer and the seller, and know where the supply and the load are to be found

  19. [Health economic consequences of the choice of follicle stimulating hormone alternatives in IVF treatment].

    Science.gov (United States)

    Poulsen, Peter Bo; Højgaard, Astrid; Quartarolo, Jens Piero

    2007-04-02

    There is a choice between two types of hormones for stimulation of the follicles in IVF treatment - recombinant FSH and the urine-derived menotrophin. A literature review by NICE (2004) in the United Kingdom documented that the two types of hormones were equally effective and safe, which is why it was recommended to use the cheaper urine-derived hormone. Based on the EISG study (European and Israeli Study Group), the aim was to analyse the health economic consequences of the choice between the two types of hormone in IVF treatment in Denmark. In a prospective cost-effectiveness analysis (health care sector perspective), menotrophin and recombinant FSH (Gonal-F) were compared. Differences in costs were compared with differences in effects of the two alternatives. The total costs for the average patient are lower when using menotrophin compared with recombinant FSH. Furthermore, the cost per clinical pregnancy was lower with menotrophin compared with recombinant FSH hormone. Menotrophin is therefore less expensive both for the patient as well as for the health care sector. The use of menotrophin instead of recombinant FSH can result in savings of up to DKK 16 million on the drug budget--savings that could finance 1,400 additional IVF cycles. The analysis shows that urine-derived menotrophin is a cost-effective alternative to recombinant FSH with a potential for considerable savings for patients as well as the public drug budget.

  20. Effects of subfertility cause, smoking and body weight on the success rate of IVF

    OpenAIRE

    Lintsen, A.M.; Jong, P.C.M. Pasker-de; Boer, de, E.J.; Burger, C.W.; Jansen, C.A.; Braat, D.D.; Leeuwen, van, F.E.

    2005-01-01

    Background: We investigated the separate and combined effects of smoking and body mass index (BMI) on the success rate of IVF for couples with different causes of subfertility. Methods: The success rate of IVF was examined in 8457 women. Detailed information on reproduction and lifestyle factors was combined with medical record data on IVF treatment. All IVF clinics in The Netherlands participated in this study. The main outcome measures were live birth rate per first cycle of IVF differentia...

  1. Comparison of IVF and ICSI when only few oocytes are available for insemination.

    Science.gov (United States)

    Borini, Andrea; Gambardella, Alessia; Bonu, Maria Antonietta; Dal Prato, Luca; Sciajno, Raffaella; Bianchi, Liana; Cattoli, Monica

    2009-08-01

    The aim of this work was to evaluate the efficiency of IVF and intracytoplasmic sperm injection (ICSI) when few eggs available for insemination. A total of 601 women (group A, mean age 31.2 +/- 2.8 years) who were undergoing a total of 671 assisted reproduction cycles donated their excess oocytes to 694 patients (group B, mean age 41.0 +/- 0.2) for 1606 replacement cycles. Each recipient received three to five eggs. The recipients were divided into two groups depending on the insemination method used (IVF, group B1; or ICSI, group B2); ICSI patients were then subdivided into two further groups based on the semen parameters: B2A adequate for IVF and B2B only suitable for ICSI. The results showed that, when comparing A versus B and B1 versus B2, no significant differences were found in terms of pregnancy (28.0 versus 24.1% and 25.5 versus 21.4%), implantation (15.6 versus 14.9% and 15.9 versus 13.1%) and miscarriage (15.4 versus 20.5% and 17.9 versus 26.3) rates respectively. Comparing subgroups B2A and B2B, no significant differences were found in terms of pregnancy (20.0 versus 21.9%), implantation (14.4 versus 12.7%) and miscarriage rates (18.2 versus 28.6%) respectively. In conclusion, ICSI does not seem to yield better outcomes.

  2. 49 CFR 371.3 - Records to be kept by brokers.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Records to be kept by brokers. 371.3 Section 371.3... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS BROKERS OF PROPERTY § 371.3 Records to be kept by brokers. (a) A broker shall keep a record of each transaction. For purposes of this...

  3. 17 CFR 240.15g-4 - Disclosure of compensation to brokers or dealers.

    Science.gov (United States)

    2010-04-01

    ... brokers or dealers. 240.15g-4 Section 240.15g-4 Commodity and Securities Exchanges SECURITIES AND EXCHANGE... § 240.15g-4 Disclosure of compensation to brokers or dealers. Preliminary Note: Brokers and dealers may..., and dominated and controlled markets. (a) Disclosure requirement. It shall be unlawful for any broker...

  4. 48 CFR 204.7206 - Using CAGE codes to identify agents and brokers.

    Science.gov (United States)

    2010-10-01

    ... identify agents and brokers. 204.7206 Section 204.7206 Federal Acquisition Regulations System DEFENSE... 204.7206 Using CAGE codes to identify agents and brokers. Authorized agents and brokers are entities... code will be assigned to the agent/broker establishment in addition to any codes assigned to the...

  5. 17 CFR 1.57 - Operations and activities of introducing brokers.

    Science.gov (United States)

    2010-04-01

    ... introducing brokers. 1.57 Section 1.57 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION... introducing brokers. (a) Each introducing broker must: (1) Open and carry each customer's and option customer..., That an introducing broker which has entered into a guarantee agreement with a futures commission...

  6. Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI.

    Science.gov (United States)

    van Heesch, M M J; Evers, J L H; van der Hoeven, M A H B M; Dumoulin, J C M; van Beijsterveldt, C E M; Bonsel, G J; Dykgraaf, R H M; van Goudoever, J B; Koopman-Esseboom, C; Nelen, W L D M; Steiner, K; Tamminga, P; Tonch, N; Torrance, H L; Dirksen, C D

    2015-06-01

    Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5? Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable. Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birthweight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life. All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate- or high-risk). To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons. The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to €10 018 and €2093 during the birth admission period (P IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings

  7. Combination of IVF and IVM in naturally cycling women

    DEFF Research Database (Denmark)

    Tang-Pedersen, Mikael; Westergaard, Lars Grabow; Erb, Karin

    2012-01-01

    This study investigated the combination of an unstimulated IVF cycle with in-vitro maturation (IVM) of additional immature cumulus-oocyte-complexes (COC) from the same cycle collected at the same time as the spontaneous preovulatory follicle. This could potentially improve rates of embryo transfer...... and pregnancy/live births compared with conventional unstimulated IVF treatment and at the same time eliminate the risk of ovarian hyperstimulation syndrome. This prospective trial included 77 women with regular menstrual cycles. Age at inclusion was between 20 and 37 years. Results showed a retrieval rate...... between endometrial factors and IVM oocytes together with unknown competence of IVM embryos is suspected. For some time, there has been an increasing interest in mild approaches for fertility treatment, in particular IVF. In-vitro maturation (IVM) of immature eggs outside the ovaries followed by IVF...

  8. Morals, medicine and change: morality brokers, social phobias, and French psychiatry.

    Science.gov (United States)

    Lloyd, Stephanie

    2008-06-01

    This paper will examine how French neurotics are being transformed into 'social phobics' and how the appearance of this group may be tied to new personal and social ideals. There are many people and factors that contribute to this changing definition of mental illness. Amongst these, I will focus on the role of three groups who are most vocally acting as morality brokers in the creation of these new subjects: psychiatrists, patients' groups and pharmaceutical companies.

  9. Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures) in couples with unexplained or mild male factor subfertility.

    Science.gov (United States)

    Pashayan, Nora; Lyratzopoulos, Georgios; Mathur, Raj

    2006-06-23

    In unexplained and mild male factor subfertility, both intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are indicated as first line treatments. Because the success rate of IUI is low, many couples failing IUI subsequently require IVF treatment. In practice, it is therefore important to examine the comparative outcomes (live birth-producing pregnancy), costs, and cost-effectiveness of primary offer of IVF, compared with primary offer of IUI followed by IVF for couples failing IUI. Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable) or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures) to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. Data used in calculations were derived from the published peer-reviewed literature as well as activity data of local infertility units. Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI) + IVF", and "stimulated IUI (S-IUI) + IVF" were 12,600 pounds sterling, 13,100 pound sterling and 15,100 pound sterling per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional 174,200 pounds sterling and 438,000 pounds sterling, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively. For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality) followed by IVF.

  10. Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures in couples with unexplained or mild male factor subfertility

    Directory of Open Access Journals (Sweden)

    Lyratzopoulos Georgios

    2006-06-01

    Full Text Available Abstract Background In unexplained and mild male factor subfertility, both intrauterine insemination (IUI and in-vitro fertilisation (IVF are indicated as first line treatments. Because the success rate of IUI is low, many couples failing IUI subsequently require IVF treatment. In practice, it is therefore important to examine the comparative outcomes (live birth-producing pregnancy, costs, and cost-effectiveness of primary offer of IVF, compared with primary offer of IUI followed by IVF for couples failing IUI. Methods Mathematical modelling was used to estimate comparative clinical and cost effectiveness of either primary offer of one full IVF cycle (including frozen cycles when applicable or "IUI + IVF" (defined as primary IUI followed by IVF for IUI failures to a hypothetical cohort of subfertile couples who are eligible for both treatment strategies. Data used in calculations were derived from the published peer-reviewed literature as well as activity data of local infertility units. Results Cost-effectiveness ratios for IVF, "unstimulated-IUI (U-IUI + IVF", and "stimulated IUI (S-IUI + IVF" were £12,600, £13,100 and £15,100 per live birth-producing pregnancy respectively. For a hypothetical cohort of 100 couples with unexplained or mild male factor subfertility, compared with primary offer of IVF, 6 cycles of "U-IUI + IVF" or of "S-IUI + IVF" would cost an additional £174,200 and £438,000, representing an opportunity cost of 54 and 136 additional IVF cycles and 14 to 35 live birth-producing pregnancies respectively. Conclusion For couples with unexplained and mild male factor subfertility, primary offer of a full IVF cycle is less costly and more cost-effective than providing IUI (of any modality followed by IVF.

  11. Estimating the net effect of progesterone elevation on the day of hCG on live birth rates after IVF: a cohort analysis of 3296 IVF cycles.

    Science.gov (United States)

    Venetis, Christos A; Kolibianakis, Efstratios M; Bosdou, Julia K; Lainas, George T; Sfontouris, Ioannis A; Tarlatzis, Basil C; Lainas, Tryfon G

    2015-03-01

    What is the proper way of assessing the effect of progesterone elevation (PE) on the day of hCG on live birth in women undergoing fresh embryo transfer after in vitro fertilization (IVF) using GnRH analogues and gonadotrophins? This study indicates that a multivariable approach, where the effect of the most important confounders is controlled for, can lead to markedly different results regarding the association between PE on the day of hCG and live birth rates after IVF when compared with the bivariate analysis that has been typically used in the relevant literature up to date. PE on the day of hCG is associated with decreased pregnancy rates in fresh IVF cycles. Evidence for this comes from observational studies that mostly failed to control for potential confounders. This is a retrospective analysis of a cohort of fresh IVF/intracytoplasmic sperm injection cycles (n = 3296) performed in a single IVF centre during the period 2001-2013. Patients in whom ovarian stimulation was performed with gonadotrophins and GnRH analogues. Natural cycles and cycles where stimulation involved the administration of clomiphene were excluded. In order to reflect routine clinical practice, no other exclusion criteria were imposed on this dataset. The primary outcome measure for this study was live birth defined as the delivery of a live infant after 24 weeks of gestation. We compared the association between PE on the day of hCG (defined as P > 1.5 ng/ml) and live birth rates calculated by simple bivariate analyses with that derived from multivariable logistic regression. The multivariable analysis controlled for female age, number of oocytes retrieved, number of embryos transferred, developmental stage of embryos at transfer (cleavage versus blastocyst), whether at least one good-quality embryo was transferred, the woman's body mass index, the total dose of FSH administered during ovarian stimulation and the type of GnRH analogues used (agonists versus antagonists) during ovarian

  12. Risk communication and informed consent in the medical tourism industry: a thematic content analysis of Canadian broker websites.

    Science.gov (United States)

    Penney, Kali; Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory

    2011-09-26

    Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally

  13. Risk communication and informed consent in the medical tourism industry: A thematic content analysis of canadian broker websites

    Science.gov (United States)

    2011-01-01

    Background Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. Methods An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Results Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across

  14. Risk communication and informed consent in the medical tourism industry: A thematic content analysis of canadian broker websites

    Directory of Open Access Journals (Sweden)

    Crooks Valorie A

    2011-09-01

    Full Text Available Abstract Background Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. Methods An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Results Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was

  15. Neonatal and maternal outcomes comparing women undergoing two in vitro fertilization (IVF) singleton pregnancies and women undergoing one IVF twin pregnancy.

    Science.gov (United States)

    Sazonova, Antonina; Källen, Karin; Thurin-Kjellberg, Ann; Wennerholm, Ulla-Britt; Bergh, Christina

    2013-03-01

    To compare outcomes for women undergoing two in vitro fertilization (IVF) pregnancies with singletons and women undergoing one IVF twin pregnancy. The concept of single-embryo transfer in IVF has reduced the risks of both maternal and neonatal complications, but there is still a discussion of whether or not twins are a desired outcome of IVF. Registry study. Not applicable. All reported twins after IVF with double-embryo transfer (n = 1,982) and their mothers (n = 991) and all mothers (n = 921) who gave birth to two IVF singletons (n = 1,842). None. Maternal and neonatal outcomes including severe neonatal morbidity. Preterm birth, very preterm birth, low birth weight, very low birth weight, and small for gestational age were dramatically increased for IVF twins compared with two IVF singletons with the same mother, with adjusted odds ratios from 4 to 16. Significantly higher rates of respiratory complications, sepsis, and jaundice were detected among the IVF twins. Significantly higher rates of preeclampsia, preterm premature rupture of the membranes, and cesarean section were observed for IVF twin pregnancies. The neonatal and maternal outcomes were dramatically better for women undergoing two IVF singleton pregnancies compared with one IVF twin pregnancy after double-embryo transfer. These results support single-embryo transfer to minimize the risks associated with twin pregnancies. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. BCube: A Broker Framework for Next Generation Geoscience

    Science.gov (United States)

    Khalsa, S. S.; Pearlman, J.; Nativi, S.

    2013-12-01

    EarthCube is an NSF initiative that aims to transform the conduct of research through the creation of community-guided cyberinfrastructure enabling the integration information and data across the geosciences. Following an initial phase of concept and community development activities, NSF has made awards for the development of cyberinfrastructure 'building blocks.' In this talk we describe the goals and methods for one of these projects - BCube, for Brokering Building Blocks. BCube addresses the need for effective and efficient multi-disciplinary collaboration and interoperability through the introduction of brokering technologies. Brokers, as information systems middleware, have existed for many years and are found in diverse domains and industries such as financial systems, business-to-business interfaces, medicine and the automotive industry, to name a few. However, the emergence of brokers in science is relatively new and is now being piloted with great promise in cyberinfrastructure and science communities in the U.S., Europe, and elsewhere. Brokers act as intermediaries between information systems that implement well-defined interfaces, providing a bridge between communities using different specifications. The BCube project is helping to build a truly cross-disciplinary, global platform for data providers, cyberinfrastructure developers, and data users to make data more available and interoperable through a brokering framework. Building on the GEOSS Discover and Access Broker (DAB), BCube will develop new modules and services including * Expanded semantic brokering * Business Model support for work flows * Automated metadata generation * Automated linking to services discovered via web crawling * Plug and play for most community service buses * Credential passing for seamless access to data * Ranking of search results from brokered catalogs Because facilitating cross-discipline research involves cultural and well as technical challenges, BCube is also

  17. A qualitative study of women's decision-making at the end of IVF treatment.

    Science.gov (United States)

    Peddie, V L; van Teijlingen, E; Bhattacharya, S

    2005-07-01

    The decision not to pursue further in vitro fertilization (IVF) after one or more unsuccessful attempts is an important and often difficult one for couples. Relatively little is known about the woman's perception of this decision-making process. The aim of this study was to examine patients' perspectives of decision-making, including circumstances influencing it and satisfaction with the decision-making process. Semi-structured interviews were conducted with a purposive sample of 25 women who had decided to end treatment after unsuccessful IVF treatment. Interviews were tape-recorded and transcribed by means of thematic analysis using the open coding technique. Women experienced difficulty in accepting that their infertility would remain unresolved. Many felt that they had started with unrealistic expectations of treatment success and felt vulnerable to the pressures of both the media and society. Although the decision to end treatment was difficult, it offered many women a way out of the emotional distress caused by IVF; however, the process of decision-making created a sense of 'confrontation' for the women in which they had to address issues they had previously avoided. Adoptive parents perceived less societal pressure than those who remained childless. Efforts to improve the psychological preparation of couples who decide to end IVF treatment should be directed towards examination of the existing system of consultation, which has certain limitations in terms of the quality of communication and the provision of post-treatment support. Further efforts to develop strategies, which facilitate the decision-making process, should be considered.

  18. The psychological impact of IVF failure after two or more cycles of IVF with a mild versus standard treatment strategy

    OpenAIRE

    Klerk, Cora; Macklon, Nick; Heijnen, E.M.; Eijkemans, René; Fauser, Bart; Passchier, Jan; Hunfeld, Joke

    2007-01-01

    textabstractBackground: Failure of IVF treatment after a number of cycles can be devastating for couples. Although mild IVF strategies reduce the psychological burden of treatment, failure may cause feelings of regret that a more aggressive approach, including the transfer of two embryos, was not employed. In this study, the impact of treatment failure after two or more cycles on stress was studied, following treatment with a mild versus a standard treatment strategy. Methods: Randomized cont...

  19. Single embryo transfer: the role of natural cycle/minimal stimulation IVF in the future.

    Science.gov (United States)

    Nygren, Karl-Gösta

    2007-05-01

    There are several good reasons to assume that single embryo transfer (SET) eventually will become the norm internationally in IVF treatments. A tendency is clearly visible, as demonstrated in the latest IVF World Report. The Nordic countries and Belgium have been leading the way. Sweden at present has 70% SET, with 5% twins and a pregnancy rate per transfer remaining constant at about 30%. As a consequence, recent data show a drastic reduction of the risk of prematurity and therefore of child morbidity and perinatal mortality. It is now time to discuss alternatives to the current clinical policy of quite an aggressive ovarian stimulation in settings where SET is the norm. When and at what proportion could natural cycle/soft stimulation be used? What group of patients would benefit? What will the consequences be in terms of efficacy, safety, cost, time and quality of life? Selection of the most beneficial, rather than the most aggressive, ovarian stimulation protocol by clinicians and by the couples themselves in the future may well include a much wider use of natural cycle/soft stimulation in IVF.

  20. Embryo quality and implantation rate in two different culture media: ISM1 versus Universal IVF Medium.

    Science.gov (United States)

    Xella, Susanna; Marsella, Tiziana; Tagliasacchi, Daniela; Giulini, Simone; La Marca, Antonio; Tirelli, Alessandra; Volpe, Annibale

    2010-04-01

    To compare the outcome of two different culture media marketed by the MediCult AS Company (Jyllinge, Denmark)-Universal IVF Medium and ISM1 Medium culture-which, in addition to glucose, pyruvate, and energy-providing components, also contain amino acids, nucleotides, vitamins, and cholesterol. Laboratory and retrospective clinical study. University teaching hospital. A total of 726 patients, undergoing IVF-intracytoplasmic sperm injection procedure, comparable in mean age range, oocyte retrieval, and infertility indication, were included in the study. Laboratory quality and standard procedures were maintained unaffected. Oocyte retrieval, different embryo culture media. Embryo quality, ongoing pregnancy, and implantation rate. The frequency of good-quality embryos (79% vs. 74%) and the percentages of ongoing pregnancy (27.5% vs. 18%) and implantation rate (15% vs. 10%) were significantly higher in the group treated with ISM1 Medium rather than Universal IVF Medium. ISM1 Medium culture seems to improve the performance of embryonic growth and development, as well as increasing the percentage of pregnancy. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  1. Gonadotrophin releasing hormone antagonist in IVF/ICSI

    Directory of Open Access Journals (Sweden)

    M S Kamath

    2008-01-01

    Full Text Available Objective : To study the efficacy of gonadotrophin releasing hormone (GnRH antagonist in In-vitro-fertilization/Intracytoplasmic sperm injection (IVF/ICSI cycles. Type of Study : Observational study. Setting: Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu. Materials and Methods: GnRH antagonists were introduced into our practice in November 2005. Fifty-two women undergoing the antagonist protocol were studied and information gathered regarding patient profile, treatment parameters (total gonadotrophin dosage, duration of treatment, and oocyte yield, and outcomes in terms of embryological parameters (cleavage rates, implantation rates and clinical pregnancy. These parameters were compared with 121 women undergoing the standard long protocol. The costs between the two groups were also compared. Main Outcome : Clinical pregnancy rate. Results : The clinical pregnancy rate per embryo transfer in the antagonist group was 31.7% which was comparable to the clinical pregnancy rate in women undergoing the standard long protocol (30.63%. The costs between the two groups were comparable. Conclusions : GnRH antagonist protocol was found to be effective and comparable to the standard long protocol regimen. In addition it was simple, convenient, and patient friendly.

  2. Knowledge brokers in a knowledge network: the case of Seniors Health Research Transfer Network knowledge brokers.

    Science.gov (United States)

    Conklin, James; Lusk, Elizabeth; Harris, Megan; Stolee, Paul

    2013-01-09

    The purpose of this paper is to describe and reflect on the role of knowledge brokers (KBs) in the Seniors Health Research Transfer Network (SHRTN). The paper reviews the relevant literature on knowledge brokering, and then describes the evolving role of knowledge brokering in this knowledge network. The description of knowledge brokering provided here is based on a developmental evaluation program and on the experiences of the authors. Data were gathered through qualitative and quantitative methods, analyzed by the evaluators, and interpreted by network members who participated in sensemaking forums. The results were fed back to the network each year in the form of formal written reports that were widely distributed to network members, as well as through presentations to the network's members. The SHRTN evaluation and our experiences as evaluators and KBs suggest that a SHRTN KB facilitates processes of learning whereby people are connected with tacit or explicit knowledge sources that will help them to resolve work-related challenges. To make this happen, KBs engage in a set of relational, technical, and analytical activities that help communities of practice (CoPs) to develop and operate, facilitate exchanges among people with similar concerns and interests, and help groups and individuals to create, explore, and apply knowledge in their practice. We also suggest that the role is difficult to define, emergent, abstract, episodic, and not fully understood. The KB role within this knowledge network has developed and matured over time. The KB adapts to the social and technical affordances of each situation, and fashions a unique and relevant process to create relationships and promote learning and change. The ability to work with teams and to develop relevant models and feasible approaches are critical KB skills. The KB is a leader who wields influence rather than power, and who is prepared to adopt whatever roles and approaches are needed to bring about a valuable

  3. IVF outcome is optimized when embryos are replaced between 5 and 15 mm from the fundal endometrial surface: a prospective analysis on 1184 IVF cycles

    Science.gov (United States)

    2013-01-01

    Background Some data suggest that the results of human in vitro fertilization (IVF) may be affected by the site of the uterine cavity where embryos are released. It is not yet clear if there is an optimal range of embryo-fundus distance (EFD) within which embryos should be transferred to optimize IVF outcome. Methods The present study included 1184 patients undergoing a blind, clinical-touch ET of 1–2 fresh embryos loaded in a soft catheter with a low amount of culture medium. We measured the EFD using transvaginal US performed immediately after ET, with the aim to assess (a) if EFD affects pregnancy and implantation rates, and (b) if an optimal EFD range can be identified. Results Despite comparable patients’ clinical characteristics, embryo morphological quality, and endometrial thickness, an EFD between 5 and 15 mm allowed to obtain significantly higher pregnancy and implantation rates than an EFD above 15 mm. The abortion rate was much higher (although not significantly) when EFD was below 5 mm than when it was between 5 and 15 mm. Combined together, these results produced an overall higher ongoing pregnancy rate in the group of patients whose embryos were released between 5 and 15 mm from the fundal endometrial surface. Conclusions The site at which embryos are released affects IVF outcome and an optimal EFD range exists; this observations suggest that US-guided ET could be advantageous vs. clinical-touch ET, as it allows to be more accurate in releasing embryos within the optimal EFD range. PMID:24341917

  4. Natural cycle in vitro fertilisation (IVF) for subfertile couples.

    Science.gov (United States)

    Allersma, Thomas; Farquhar, Cindy; Cantineau, Astrid E P

    2013-08-30

    Subfertility affects 15% to 20% of couples trying to conceive. In vitro fertilisation (IVF) is one of the assisted reproduction techniques developed to improve chances of achieving pregnancy. In the standard IVF method with controlled ovarian hyperstimulation (COH), growth and development of multiple follicles are stimulated by using gonadotrophins, often combined with a gonadotrophin-releasing hormone (GnRH) agonist or antagonist. Although it is an established method of conception for subfertile couples, the treatment is expensive and has a high risk of adverse effects. Studies have shown that IVF in a natural cycle (NC) or a modified natural cycle (MNC) might be a promising low risk and low cost alternative to the standard stimulated IVF treatment since the available dominant follicle of each cycle is used. In this review, we included available randomised controlled studies comparing natural cycle IVF (NC and MNC) with standard IVF. To compare the efficacy and safety of natural cycle IVF (including both NC-IVF and MNC-IVF) with controlled ovarian hyperstimulation IVF (COH-IVF) in subfertile couples. An extended search including of the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ClinicalTrials.gov, conference abstracts in the Web of Knowledge, the World Health Organization International Trials Registry Platform search portal, LILACS database, PubMed and the OpenSIGLE database was conducted according to Cochrane guidelines. The last search was on 31st July 2013. All randomised controlled trials (RCTs) comparing either natural cycle IVF or modified natural cycle IVF versus standard IVF in subfertile couples were included. Data selection and extraction and risk of bias assessment were carried out independently by two authors (TA and AC). The primary outcome measures were live birth rate and ovarian hyperstimulation syndrome (OHSS) rate per randomised woman. We

  5. Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success.

    Science.gov (United States)

    Garrido, Nicolás; Bellver, José; Remohí, José; Simón, Carlos; Pellicer, Antonio

    2011-07-01

    To report the use of cumulative live-birth rates (CLBRs) per ovarian stimulation cycle to measure the success of IVF is proving to be the most accurate method for advising couples who failed to conceive, although the accuracy yielded is relatively low, and cycle outcome is highly dependent on the number of embryos replaced. Our aim with this work is to report the CLBRs of IVF as a function of the number of embryos required to reach a live birth (EmbR), considering age, day of ET, and infertility etiology. Survival curves and Kaplan-Meier methods to analyze CLBR in a retrospective cohort with respect to the number of EmbR. University-affiliated infertility center. Infertile couples undergoing IVF using own oocytes. None. CLBR per embryo transferred. CLBRs increase rapidly between 1 and 5 EmbR, moderately between 5 and 15, and slowly thereafter. Live-birth rates rise more slowly when embryos are transferred on days 2-3 rather than on days 5-6, with comparable long-term results. Women's age is a negative factor from 35 to 37 years old, with a dramatic decrease in live-birth rates beyond age 40 years. In addition, there are significant worse results in endometriosis patients. The relationship between CLBR and number of EmbR provides realistic and precise information regarding IVF success and can be used to guide couples and practitioners. Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. The INeS study: prevention of multiple pregnancies: a randomised controlled trial comparing IUI COH versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility.

    Science.gov (United States)

    Bensdorp, Alexandra J; Slappendel, Els; Koks, Carolien; Oosterhuis, Jur; Hoek, Annemieke; Hompes, Peter; Broekmans, Frank; Verhoeve, Harold; de Bruin, Jan Peter; van Weert, Janne Meije; Traas, Maaike; Maas, Jacques; Beckers, Nicole; Repping, Sjoerd; Mol, Ben W; van der Veen, Fulco; van Wely, Madelon

    2009-12-18

    Multiple pregnancies are high risk pregnancies with higher chances of maternal and neonatal mortality and morbidity. In the past decades the number of multiple pregnancies has increased. This trend is partly due to the fact that women start family planning at an increased age, but also due to the increased use of ART.Couples with unexplained or mild male subfertility generally receive intrauterine insemination IUI with controlled hormonal stimulation (IUI COH). The cumulative pregnancy rate is 40%, with a 10% multiple pregnancy rate.This study aims to reveal whether alternative treatments such as IVF elective Single Embryo Transfer (IVF e SET) or Modified Natural Cycle IVF (MNC IVF) can reduce the number of multiple pregnancy rates, but uphold similar pregnancy rates as IUI COH in couples with mild male or unexplained subfertility. Secondly, the aim is to perform a cost effective analyses and assess treatment preference of these couples. We plan a multicentre randomised controlled clinical trial in the Netherlands comparing six cycles of intra-uterine insemination with controlled ovarian hyperstimulation or six cycles of Modified Natural Cycle (MNC) IVF or three cycles with IVF-elective Single Embryo Transfer (eSET) plus cryo-cycles within a time frame of 12 months.Couples with unexplained subfertility or mild male subfertility and a poor prognosis for treatment independent pregnancy will be included. Women with anovulatory cycles, severe endometriosis, double sided tubal pathology or serious endocrine illness will be excluded.Our primary outcome is the birth of a healthy singleton. Secondary outcomes are multiple pregnancy, treatment costs, and patient experiences in each treatment arm. The analysis will be performed according tot the intention to treat principle. We will test for non-inferiority of the three arms with respect to live birth. As we accept a 12.5% loss in pregnancy rate in one of the two IVF arms to prevent multiple pregnancies, we need 200 couples

  7. The INeS study: prevention of multiple pregnancies: a randomised controlled trial comparing IUI COH versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility

    Directory of Open Access Journals (Sweden)

    Beckers Nicole

    2009-12-01

    Full Text Available Abstract Background Multiple pregnancies are high risk pregnancies with higher chances of maternal and neonatal mortality and morbidity. In the past decades the number of multiple pregnancies has increased. This trend is partly due to the fact that women start family planning at an increased age, but also due to the increased use of ART. Couples with unexplained or mild male subfertility generally receive intrauterine insemination IUI with controlled hormonal stimulation (IUI COH. The cumulative pregnancy rate is 40%, with a 10% multiple pregnancy rate. This study aims to reveal whether alternative treatments such as IVF elective Single Embryo Transfer (IVF e SET or Modified Natural Cycle IVF (MNC IVF can reduce the number of multiple pregnancy rates, but uphold similar pregnancy rates as IUI COH in couples with mild male or unexplained subfertility. Secondly, the aim is to perform a cost effective analyses and assess treatment preference of these couples. Methods/Design We plan a multicentre randomised controlled clinical trial in the Netherlands comparing six cycles of intra-uterine insemination with controlled ovarian hyperstimulation or six cycles of Modified Natural Cycle (MNC IVF or three cycles with IVF-elective Single Embryo Transfer (eSET plus cryo-cycles within a time frame of 12 months. Couples with unexplained subfertility or mild male subfertility and a poor prognosis for treatment independent pregnancy will be included. Women with anovulatory cycles, severe endometriosis, double sided tubal pathology or serious endocrine illness will be excluded. Our primary outcome is the birth of a healthy singleton. Secondary outcomes are multiple pregnancy, treatment costs, and patient experiences in each treatment arm. The analysis will be performed according tot the intention to treat principle. We will test for non-inferiority of the three arms with respect to live birth. As we accept a 12.5% loss in pregnancy rate in one of the two IVF arms

  8. Brokers in participatory urban governance: Assembling formal and informal politics

    NARCIS (Netherlands)

    Koster, M.

    2016-01-01

    Participatory urban governance, with its focus on citizen representation and the equitable distribution of resources, has been implemented globally to deepen democracy. Some individuals position themselves as voluntary representatives, or brokers, between the state and their fellow citizens. In this

  9. African Logistics Agents and Middlemen as Cultural Brokers in Guangzhou

    Directory of Open Access Journals (Sweden)

    Gordon Mathews

    2015-01-01

    Full Text Available This article begins by asking how African traders learn to adjust to the foreign world of Guangzhou, China, and suggests that African logistics agents and middlemen serve as cultural brokers for these traders. After defining “cultural broker” and discussing why these brokers are not usually Chinese, it explores this role as played by ten logistics agents/middlemen from Kenya, Nigeria, Ghana and the Democratic Republic of the Congo. As logistics agents, these people help their customers in practically adjusting to Chinese life, and as middlemen they serve to grease the wheels of commerce between African customers and Chinese suppliers. This is despite their own ambivalent views of China as a place to live. They play an essential role in enabling harmonious relations between Africans and Chinese in Guangzhou, even though they see themselves not as cultural brokers but simply as businessmen.

  10. 77 FR 16249 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2012-03-20

    ... Dependable International Services 12574 New Orleans. and Transport, Inc.. Professional Customs Brokers, Inc.... Horizon Logistics, LLC 28432 Dallas. Sandra L. Smith 15266 Dallas. Barry E. Booth 09627 San Francisco...

  11. Knowledge brokering in public health: a tale of two studies.

    Science.gov (United States)

    Traynor, R; DeCorby, K; Dobbins, M

    2014-06-01

    A Knowledge Broker is one approach for facilitating the integration of evidence-informed decision making in public health practice. In this paper, the findings from two studies investigating a Knowledge Broker intervention as a means of enhancing capacity for evidence-informed decision making are presented. Contextual factors that facilitate this strategy are also identified. This paper describes work done through a single mixed-methods study (randomized controlled trial with a qualitative component) and a case study. The Health Evidence team conducted two studies examining Knowledge Broker impact in Canadian public health departments. The effectiveness of knowledge translation strategies of varying intensities for promoting the use of research evidence in decisions related to child obesity prevention were explored via a randomized controlled trial with a fundamental descriptive component (2003-2007). In a case study (2010-2013), the authors partnered with three health departments to develop and implement tailored strategies targeted at the organization. Knowledge Brokers worked with designated staff in these studies via one-on-one consultations, small group meetings, and/or workshops and presentations. The Knowledge Broker role was assessed by analysing data from close-ended surveys, interviews, organizational documents, and reflective journals. In this paper, the authors focus on findings from the qualitative analysis of implementing the Knowledge Broker role in both studies and explore several contextual factors that impacted study outcomes. Knowledge Brokers were shown to enhance individual capacity by improving knowledge and skill in searching for, critically appraising, and applying research evidence to practice-based issues. Organizational capacity was also enhanced with strong management support and policies. Effective Knowledge Broker attributes included both expertise in research methodology and public health, as well as intangible traits such as

  12. Association of gene polymorphisms of interleukin-10 (IL-10 with recurrent miscarriage (RM after fertilization in vitro (IVF

    Directory of Open Access Journals (Sweden)

    K. P. Golovatyuk

    2017-02-01

    Full Text Available The objective: to study genotype frequencies and allelic variants of gene IL-10-1082G>A (rs1800896, depending on the reproductive status and evaluation association with RM after IVF among the residents of Odessa region of Ukraine. Under supervision there were 240 patients of the main group with the RM after IVF and 100 apparently healthy fertile women in the control group K with a history of at least one term delivery and lack of spontaneous abortion episodes. SNPs typing of the genes for immune response in was used the polymerase chain reaction with the melting reaction products in the presence of "adjacent" oligonucleotides. It has been established that the carriers of AA genotype of the gene IL-10-1082G>A, which have been women-residents of Odessa region of Ukraine, had a high probability of occurrence of  RM during pregnancy after IVF (OR 2,56; 95% CI 1,51 - 4,35. Typing of SNPs of the immune response gene IL-10 (rs1800896 can be used as a method of early diagnosis and pregravid prediction of reproductive losses in women with RM after IVF.

  13. HP-HMG versus rFSH in treatments combining fresh and frozen IVF cycles: success rates and economic evaluation.

    Science.gov (United States)

    Wex-Wechowski, Jaro; Abou-Setta, Ahmed M; Kildegaard Nielsen, Sandy; Kennedy, Richard

    2010-08-01

    The economic implications of the choice of gonadotrophin influence decision making but their cost-effectiveness in frozen-embryo transfer cycles has not been adequately studied. An economic evaluation was performed comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) using individual patient data (n=986) from two large randomized controlled trials using a long agonist IVF protocol. The simulation model incorporated live birth data and published UK costs of IVF-related medical resources. After treatment for up-to-three cycles (one fresh and up to two subsequent fresh or frozen cycles conditional on availability of cryopreserved embryos), the cumulative live birth rate was 53.7% (95% CI 49.3-58.1%) for HP-HMG and 44.6% (40.2-49.0%) for rFSH (OR 1.44, 95% CI 1.12-1.85; Pcosts per IVF treatment for HP-HMG and rFSH were pound5393 ( pound5341-5449) and pound6269 ( pound6210-6324), respectively (number needed to treat to fund one additional treatment was seven; Pcosts applied, the median cost per IVF baby delivered with HP-HMG was pound11,157 ( pound11,089-11,129) and pound14,227 ( pound14,183-14,222) with rFSH (Pcost saving using HP-HMG remained after varying model parameters in a probabilistic sensitivity analysis. 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  14. Innovation and Virtual Environments: Towards Virtual Knowledge Brokers

    OpenAIRE

    VERONA G; PRANDELLI E.; SAWHNEY M.

    2006-01-01

    The authors examine the implications of virtual customer environments for supporting the innovation process. By building on the literature of knowledge brokers, they introduce the concept of virtual knowledge brokers — actors who leverage the internet to support third parties’ innovation activities. These actors enable firms to extend their reach in engaging with customers and they also allow firms to have a richer dialogue with customers because of their perceived neutrality. Consequently...

  15. The ‘dark side’ of knowledge brokering

    Science.gov (United States)

    Wilson, Paul; Boaden, Ruth

    2016-01-01

    Deploying knowledge brokers to bridge the ‘gap’ between researchers and practitioners continues to be seen as an unquestionable enabler of evidence-based practice and is often endorsed uncritically. We explore the ‘dark side’ of knowledge brokering, reflecting on its inherent challenges which we categorize as: (1) tensions between different aspects of brokering; (2) tensions between different types and sources of knowledge; and (3) tensions resulting from the ‘in-between’ position of brokers. As a result of these tensions, individual brokers may struggle to maintain their fragile and ambiguous intermediary position, and some of the knowledge may be lost in the ‘in-between world’, whereby research evidence is transferred to research users without being mobilized in their day-to-day practice. To be effective, brokering requires an amalgamation of several types of knowledge and a multidimensional skill set that needs to be sustained over time. If we want to maximize the impact of research on policy and practice, we should move from deploying individual ‘brokers’ to embracing the collective process of ‘brokering’ supported at the organizational and policy levels. PMID:28429974

  16. Logistics of large scale commercial IVF embryo production.

    Science.gov (United States)

    Blondin, P

    2016-01-01

    The use of IVF in agriculture is growing worldwide. This can be explained by the development of better IVF media and techniques, development of sexed semen and the recent introduction of bovine genomics on farms. Being able to perform IVF on a large scale, with multiple on-farm experts to perform ovum pick-up and IVF laboratories capable of handling large volumes in a consistent and sustainable way, remains a huge challenge. To be successful, there has to be a partnership between veterinarians on farms, embryologists in the laboratory and animal owners. Farmers must understand the limits of what IVF can or cannot do under different conditions; veterinarians must manage expectations of farmers once strategies have been developed regarding potential donors; and embryologists must maintain fluent communication with both groups to make sure that objectives are met within predetermined budgets. The logistics of such operations can be very overwhelming, but the return can be considerable if done right. The present mini review describes how such operations can become a reality, with an emphasis on the different aspects that must be considered by all parties.

  17. Why do couples discontinue unlimited free IVF treatments?

    Science.gov (United States)

    Lande, Yechezkel; Seidman, Daniel S; Maman, Ettie; Baum, Micha; Hourvitz, Ariel

    2015-03-01

    Worldwide, IVF is often discontinued before a live birth is achieved due to high costs. Even when partial financial coverage is provided, often medical providers advise treatment discontinuation. In Israel, unlimited IVF is offered free of charge for a couples' first two children. Our objective was to assess the reasons couples discontinue IVF treatments before achieving two children in a completely unlimited cost-free environment. This cohort study included all primary infertile women, reason they ceased treatments. Of the 134 couples included, only 46 ceased IVF treatments without achieving two children, after performing an average of 6.2 IVF cycles to achieve their first birth. The reasons given were: lost hope of success (13), psychological burden (18), divorce (6), medical staff recommendation (5), bureaucratic difficulties (3) and general medical condition (1). The main reasons for "drop out" in our cost-free environment were as follows: psychological burden and lost hope of success. Due to high availability of treatments, medical staff recommendation was a less significant factor in our study.

  18. How should we assess the safety of IVF technologies?

    Science.gov (United States)

    Brison, Daniel R; Roberts, Stephen A; Kimber, Susan J

    2013-12-01

    Clinical IVF treatment was established over 30 years ago through pioneering work by Edwards and Steptoe and other teams around the world and is now considered routine treatment. However, the pace of scientific and technological advances means that IVF practitioners can now access an increasing array of new and invasive technologies. The examples are many but include: extended embryo culture, development of media to include growth factors, developments in genetic screening, use of time-lapse technology and the advent of vitrification of embryos and oocytes. In parallel, wider scientific and medical advances are raising our awareness of the potential impact of assisted reproduction technology on areas such as embryonic development, gene expression and genomic imprinting and the developmental origins of health and disease. A recently suggested paradigm for assessing new technologies in IVF includes development in animal models such as rodents and large animals, preclinical research with human gametes and embryos donated to research, prospective clinical trials in IVF and, finally, follow-up studies of IVF children. In this paper, we describe efforts to address key areas of this pathway, namely preclinical research using human gametes/embryos and long-term, follow-up studies of the health of assisted reproduction children. Copyright © 2013 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  19. Experience with the bonanno catheter in the management of OHSS from IVF-ET Cycles.

    Science.gov (United States)

    Okohue, J E; Oriji, V K; Ikimalo, J I

    2017-07-01

    To document our experience with the use of the Bonanno catheter as a closed abdominal drain for OHSS Methods: A retrospective study of all IVF embryo transfer (ET) treatment cycles carried out between May 2006 and April 2009 at a dedicated IVF centre. Case notes of patients with OHSS were retrieved and the outcome of the continuous closed abdominal drain with Bonanno catheter documented. Within the period under review, 234 patients had controlled ovarian stimulation with ultrasound guided egg retrieval. Two hundred and twenty eight (228) got to the stage of embryo transfer with 72 clinical pregnancies. The clinical pregnancy rate was 31.58%. Fourteen (6%) of those who were stimulated developed OHSS and had a closed abdominal drain of the ascitic fluid using the Bonanno catheter. The average number of days of the abdominal drainage was 7.5days and the average volume of ascitic fluid drained from a patient per day was 2454.9 + 748mls. Eight (8) patients who had OHSS achieved clinical pregnancy (six intrauterine, one ectopic and one heterotopic pregnancies), giving a clinical pregnancy rate of 57.14% in patients with OHSS. Four patients had blocked Bonanno catheters and three of them had the catheter changed while the fourth had the catheter successfully flushed. Four patients had the insertion site dressing changed due to soaking with ascitic fluid. There was no incidence of injury to intra abdominal organs or broken catheter. Bonanno Catheter is both effective and safe in draining ascitic fluid following OHSS.

  20. Association between serum estradiol level on the hCG administration day and IVF-ICSI outcome

    Directory of Open Access Journals (Sweden)

    Tayfun Kutlu

    2012-01-01

    Full Text Available Background: Estradiol (E2 is required for follicular development and play an important role in embryo implantation. Objective: The aim of this study was to assess the impact of serum E2 levels on the day of hCG administration in IVF-ICSI patients who are performed controlled ovarian hyperstimulation (COH.Materials and Methods: A total of 203 women who were undergone one time IVF cyclus were evaluated in this cross sectional study. All the patients were treated either with long protocol or with microdose flare protocol. The patients were categorized into five groups according to the serum E2 levels on the day of hCG administration.Results: The mean number of the retrieved oocytes was (NRO 10.6±6.7, mean fertilization rate was 55.7±24.8, and implantation rate was 9.0±19.2. Of 203 patients, 43 (21% patients were pregnant. When the overall results are examined, the number of the retrieved oocytes and the number of transferred embryos were better in patients with serum E2 levels >4000 pg/ml and these values were statistically significant. There were no statistical difference in patients 37 years or older. In women ≤36 years old, the IVF-ICSI outcomes were better in patients with serum E2 levels >4000 pg/ml.Conclusion: In spite of the lack of high quality evidence to support a positive association between serum E2 levels and IVF-ICSI outcomes, this study shows that high E2 levels during COH might be associated with an increased potential of pregnancy depending on better ovarian response. When the overall results are examined, the best scores were in patients with serum E2 levels >4000 pg/ml.

  1. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial.

    Science.gov (United States)

    Einarsson, Snorri; Bergh, Christina; Friberg, Britt; Pinborg, Anja; Klajnbard, Anna; Karlström, Per-Olof; Kluge, Linda; Larsson, Ingrid; Loft, Anne; Mikkelsen-Englund, Anne-Lis; Stenlöf, Kaj; Wistrand, Anna; Thurin-Kjellberg, Ann

    2017-08-01

    Does an intensive weight reduction programme prior to IVF increase live birth rates for infertile obese women? An intensive weight reduction programme resulted in a large weight loss but did not substantially affect live birth rates in obese women scheduled for IVF. Among obese women, fertility and obstetric outcomes are influenced negatively with increased risk of miscarriage and a higher risk of maternal and neonatal complications. A recent large randomized controlled trial found no effect of lifestyle intervention on live birth in infertile obese women. A prospective, multicentre, randomized controlled trial was performed between 2010 and 2016 in the Nordic countries. In total, 962 women were assessed for eligibility and 317 women were randomized. Computerized randomization with concealed allocation was performed in the proportions 1:1 to one of two groups: weight reduction intervention followed by IVF-treatment or IVF-treatment only. One cycle per patient was included. Nine infertility clinics in Sweden, Denmark and Iceland participated. Women under 38 years of age planning IVF, and having a BMI ≥30 and non-financial support from Impolin AB, during the conduct of the study, and personal fees from Merck outside the submitted work. Dr Friberg reports personal fees from Ferring, Merck, MSD, Finox and personal fees from Studentlitteratur, outside the submitted work. Dr Englund reports personal fees from Ferring, and non-financial support from Merck, outside the submitted work. Dr Bergh reports and has been reimbursed for: writing a newsletter twice a year (Ferring), lectures (Ferring, MSD, Merck), and Nordic working group meetings (Finox). Dr Karlström reports lectures (Ferring, Finox, Merck, MSD) and Nordic working group meetings (Ferring). Ms Kluge, Dr Einarsson, Dr Pinborg, Dr Klajnbard, Dr Stenlöf, Dr Larsson, Dr Loft and Dr Wistrand have nothing to disclose. ClinicalTrials.gov number, NCT01566929. 23-03-2012. 05-10-2010. © The Author 2017. Published by

  2. Association between ambient air pollution and pregnancy rate in women who underwent IVF.

    Science.gov (United States)

    Choe, S A; Jun, Y B; Lee, W S; Yoon, T K; Kim, S Y

    2018-04-05

    Are the concentrations of five criteria air pollutants associated with probabilities of biochemical pregnancy loss and intrauterine pregnancy in women? Increased concentrations of ambient particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) during controlled ovarian stimulation (COS) and after embryo transfer were associated with a decreased probability of intrauterine pregnancy. Exposure to high ambient air pollution was suggested to be associated with low fertility and high early pregnancy loss in women. Using a retrospective cohort study design, we analysed 6621 cycles of 4581 patients who underwent one or more fresh IVF cycles at a fertility centre from January 2006 to December 2014, and lived in Seoul at the time of IVF treatment. To estimate patients' individual exposure to air pollution, we computed averages of hourly concentrations of five air pollutants including PM10, NO2, CO, sulphur dioxide (SO2) and ozone (O3) measured at 40 regulatory monitoring sites in Seoul for each of the four exposure periods: period 1 (start of COS to oocyte retrieval), period 2 (oocyte retrieval to embryo transfer), period 3 (embryo transfer to hCG test), and period 4 (start of COS to hCG test). Hazard ratios (HRs) from the time-varying Cox-proportional hazards model were used to estimate probabilities of biochemical pregnancy loss and intrauterine pregnancy for an interquartile range (IQR) increase in each air pollutant concentration during each period, after adjusting for individual characteristics. We tested the robustness of the result using generalised linear mixed model, accounting for within-woman correlation. Mean age of the women was 35 years. Average BMI was 20.9 kg/m2 and the study population underwent 1.4 IVF cycles on average. Cumulative pregnancy rate in multiple IVF cycles was 51.3% per person. Survival analysis showed that air pollution during periods 1 and 3 was generally associated with IVF outcomes. Increased NO2 (adjusted HR = 0.93, 95% CI

  3. Single embryo transfer and IVF/ICSI outcome: a balanced appraisal.

    Science.gov (United States)

    Gerris, Jan M R

    2005-01-01

    This review considers the value of single embryo transfer (SET) to prevent multiple pregnancies (MP) after IVF/ICSI. The incidence of MP (twins and higher order pregnancies) after IVF/ICSI is much higher (approximately 30%) than after natural conception (approximately 1%). Approximately half of all the neonates are multiples. The obstetric, neonatal and long-term consequences for the health of these children are enormous and costs incurred extremely high. Judicious SET is the only method to decrease this epidemic of iatrogenic multiple gestations. Clinical trials have shown that programmes with >50% of SET maintain high overall ongoing pregnancy rates ( approximately 30% per started cycle) while reducing the MP rate to select patients suitable for SET and embryos with a high putative implantation potential. The typical patient suitable for SET is young (aged Embryo selection is performed using one or a combination of embryo characteristics. Available evidence suggests that, for the overall population, day 3 and day 5 selection yield similar results but better than zygote selection results. Prospective studies correlating embryo characteristics with documented implantation potential, utilizing databases of individual embryos, are needed. The application of SET should be supported by other measures: reimbursement of IVF/ICSI (earned back by reducing costs), optimized cryopreservation to augment cumulative pregnancy rates per oocyte harvest and a standardized format for reporting results. To make SET the standard of care in the appropriate target group, there is a need for more clinical studies, for intensive counselling of patients, and for an increased sense of responsibility in patients, health care providers and health insurers.

  4. Association of high fetuin-B concentrations in serum with fertilization rate in IVF: a cross-sectional pilot study.

    Science.gov (United States)

    Floehr, Julia; Dietzel, Eileen; Neulen, Josef; Rösing, Benjamin; Weissenborn, Ute; Jahnen-Dechent, Willi

    2016-03-01

    Is serum fetuin-B associated with the fertilization rate in in vitro fertilization (IVF)? Serum fetuin-B increased during IVF cycles when oocytes could be fertilized while remained unchanged in fertilization failure. Fetuin-B deficiency in mice causes premature zona pellucida hardening mediated by the zona protease ovastacin. Thus fetuin-B deficiency renders females infertile. We determined the human serum fetuin-B reference range, studying longitudinally, over the course of one month, five male and seven female volunteers without hormone treatment and four female volunteers on varying hormonal contraception. We sampled blood and determined serum fetuin-B, luteinizing hormone (LH), estradiol (E2) and progesterone (P4). In addition, we determined serum fetuin-B and estradiol in eight women undergoing intracytoplasmatic sperm injection (ICSI, nine ICSI cycles) and 19 women undergoing IVF (21 IVF cycles) after ovarian stimulation with recombinant human follicular stimulating hormone (rFSH) and/or a combined medication of FSH and LH. At least three blood samples were analyzed in each cycle. We compared serum fetuin-B and follicular fluid fetuin-B in nine patients by measuring follicular fetuin-B in pooled follicular fluid, and in fluid obtained from individual follicles. Samples were drawn from January 2012 to March 2014. All volunteers and patients gave informed consent. Fetuin-B was measured employing a commercial sandwich enzyme-linked immunosorbent assay. Serum fetuin-B was determined as duplicates in 5 male (34 ± 14.6 years) and 11 female volunteers (29.4 ± 4.1 years) as well as in female volunteers on hormonal contraception (30.0 ± 6.5 years). The duplicate standard deviation was 4.0 ± 2.3%. The contraceptive drugs were mono or combined preparations containing 0-0.03 mg ethinyl estradiol, and 0.15-3.0 mg of various progestins. In addition, serum fetuin-B was determined as triplicates in 27 female patients undergoing conventional IVF (19) or ICSI (8). The

  5. Weight reduction intervention for obese infertile women prior to IVF

    DEFF Research Database (Denmark)

    Einarsson, Snorri; Bergh, Christina; Friberg, Britt

    2017-01-01

    in the weight reduction group reaching BMI ≤ 25 kg/m2 or reaching a weight loss of at least five BMI units to the IVF only group. No statistical differences in live birth rates between the groups in either subgroup analysis were found. LIMITATIONS, REASON FOR CAUTION: The study was not powered to detect a small......STUDY QUESTION: Does an intensive weight reduction programme prior to IVF increase live birth rates for infertile obese women? SUMMARY ANSWER: An intensive weight reduction programme resulted in a large weight loss but did not substantially affect live birth rates in obese women scheduled for IVF...... in infertile obese women. STUDY DESIGN, SIZE, DURATION: A prospective, multicentre, randomized controlled trial was performed between 2010 and 2016 in the Nordic countries. In total, 962 women were assessed for eligibility and 317 women were randomized. Computerized randomization with concealed allocation...

  6. Perceived barriers to elective single embryo transfer among IVF professionals: a national survey.

    NARCIS (Netherlands)

    Peperstraten, A.M. van; Hermens, R.P.M.G.; Nelen, W.L.D.M.; Stalmeier, P.F.M.; Scheffer, G.J.; Grol, R.P.T.M.; Kremer, J.A.M.

    2008-01-01

    BACKGROUND: After initial years of improvement, the multiple pregnancy rate after in vitro fertilization (IVF) in Europe now remains stable at 23% with single embryo transfer (SET) constituting 19% of all IVF cycles. Although elective SET prevents multiple pregnancies after IVF, couples and

  7. What Do We Know about Knowledge Brokers in Paediatric Rehabilitation? A Systematic Search and Narrative Summary.

    Science.gov (United States)

    Schleifer Taylor, Jacqueline; Verrier, Molly C; Landry, Michel D

    2014-01-01

    To conduct a systematic review of the literature related to the use of knowledge brokers within paediatric rehabilitation, and specifically to determine (1) how knowledge brokers are defined and used in paediatric rehabilitation and (2) whether knowledge brokers in paediatric rehabilitation have demonstrably improved the performance of health care providers or organizations. The MEDLINE, CINAHL, EMBASE, and AMED databases were systematically searched to identify studies relating to knowledge brokers or knowledge brokering within paediatric rehabilitation, with no restriction on the study design or primary aim. Following review of titles and abstracts, those studies identified as potentially relevant were assessed based on the inclusion criteria that they: (1) examined some aspect of knowledge brokers/brokering in paediatric rehabilitation; (2) included sufficient descriptive detail on how knowledge brokers/brokering were used; and(3) were peer-reviewed and published in English. Of 1513 articles retrieved, 4 met the inclusion criteria, 3 of which referenced the same knowledge broker initiative. Two papers used mixed methods, one qualitative methodology, and one case presentation. Because of the different methods used in the included studies, the findings are presented in a narrative summary. This study provides an overview of the limited understanding of knowledge brokers within paediatric rehabilitation. Knowledge broker initiatives introduced within paediatric rehabilitation have been anchored in different theoretical frameworks, and no conclusions can be drawn as to the optimum combination of knowledge brokering activities and methods, nor about optimal duration, for sustained results.

  8. Accurate and noninvasive embryos screening during in vitro fertilization (IVF) assisted by Raman analysis of embryos culture medium Accurate and noninvasive embryos screening during IVF

    Science.gov (United States)

    Shen, A. G.; Peng, J.; Zhao, Q. H.; Su, L.; Wang, X. H.; Hu, J. M.; Yang, J.

    2012-04-01

    In combination with morphological evaluation tests, we employ Raman spectroscopy to select higher potential reproductive embryos during in vitro fertilization (IVF) based on chemical composition of embryos culture medium. In this study, 57 Raman spectra are acquired from both higher and lower quality embryos culture medium (ECM) from 10 patients which have been preliminarily confirmed by clinical assay. Data are fit by using a linear combination model of least squares method in which 12 basis spectra represent the chemical features of ECM. The final fitting coefficients provide insight into the chemical compositions of culture medium samples and are subsequently used as criterion to evaluate the quality of embryos. The relative fitting coefficients ratios of sodium pyruvate/albumin and phenylalanine/albumin seem act as key roles in the embryo screening, attaining 85.7% accuracy in comparison with clinical pregnancy. The good results demonstrate that Raman spectroscopy therefore is an important candidate for an accurate and noninvasive screening of higher quality embryos, which potentially decrease the time-consuming clinical trials during IVF.

  9. The broker function of the IAEA

    International Nuclear Information System (INIS)

    1973-01-01

    The market for enriched uranium has recently begun to look like that foreseen when the Agency was established: few but big suppliers of enriched uranium and many competing purchasers. This development is the result of two strong forces that in recent years have influenced the market for nuclear power plants. The first is the continued advances in nuclear power technology which have made nuclear power plants a practical and commercially acceptable source of electric energy. Allied to this is the fact that nuclear power plants using slightly enriched uranium have increased in number over those using natural uranium; in the latter case there would have been a far wider range of suppliers. The second is the steep rise in recent years in oil prices followed by upward movement in other fossil fuel prices, not to mention the present energy crises. This development in the market for enriched uranium has renewed the interest of Member States in the Agency's function as a broker or intermediary between its Member States, because this function applies particularly to the supply of enriched uranium, Plutonium and reactors. It was a function of serious concern to the founders of the Agency

  10. Kształcenie brokerów informacji w Polsce / Education information brokers in Poland

    Directory of Open Access Journals (Sweden)

    Karolina Kustra

    2013-07-01

    Full Text Available We współczesnym świecie, w dobie Internetu, to informacja jest najważniejsza, ale żeby ocenić czy jest wiarygodna potrzebni są specjaliści – brokerzy informacji. W Polsce ten zawód jest jeszcze młody, a jego przedstawiciele nie mając własnego stowarzyszenia, stosują się do zasad kodeksu etyki infobrokerskiej stworzonego przez Association of Independent Information Professionals. Oferta kształcenia infobrokerów w Polsce jest coraz szersza i przyszli brokerzy informacji mogą się przygotowywać do zawodu na studiach I i II stopnia, studiach podyplomowych oraz na szkoleniach i kursach. English abstractIn the modern world, the age of the Internet, the information is important, but to assess whether there is credible experts are needed – information brokers. In Poland, the profession is still young, and it’s representatives don’t have their own associations, follow the rules of the Code of Ethical Business Practiced created by the Association of Independent Information Professionals. Offer infobrokerów education in Poland is getting wider and future information brokers can prepare for the profession at the undergraduate and secondary education, post-graduate studies and training courses.

  11. Cost--effectiveness analysis of salpingectomy prior to IVF, based on a randomized controlled trial.

    Science.gov (United States)

    Strandell, Annika; Lindhard, Anette; Eckerlund, Ingemar

    2005-12-01

    In patients with ultrasound-visible hydrosalpinges, salpingectomy prior to IVF increases the chance of a live birth. This study compared the cost-effectiveness of this strategy (intervention) with that of optional salpingectomy after a failed cycle (control). Data from a Scandinavian randomized controlled trial were used to calculate the individual number of treatments and their outcomes. Only patients with ultrasound-visible hydrosalpinges were considered in the main analysis, and a maximum of three fresh cycles were included. The costs for surgical procedures, IVF treatment, medication, complications, management of pregnancy and delivery as well as of early pregnancy losses were calculated from standardized hospital charges. Among the 51 patients in the intervention group, the live birth rate was 60.8% compared with 40.9% in 44 controls. The average cost per patient was 13,943 euro and 12,091 euro, respectively. Thus, the average cost per live birth was 22,823 euro in the intervention group and 29,517 euro in the control group. The incremental cost-effectiveness ratio for adopting the intervention strategy was estimated at 9306 euro. The incremental cost to achieve the higher birth rate of the intervention strategy seems reasonable.

  12. Analysis of the Relationship between CGB5 155G/C Polymorphism and in vitro Fertilization-embryo Transfer Outcome (IVF-ET in the Iranian Population

    Directory of Open Access Journals (Sweden)

    Bahareh Babaei Houlari

    2018-01-01

    Full Text Available Abstract Background: Successful pregnancy depends on the ability of the embryo to achieve appropriate extent of trophoblastic proliferation and invasion into maternal endometrium as well as, once implanted, to induce its own blood supply. Beta Human chorionic gonadotropin (β-hCG, enhances blastocyst implantation, uterine vascularization, and angiogenesis, as well as regulates maintenance of uterine quiescence and immunological adaptation during pregnancy. The β-subunit of hCG is encoded by CGB3, CGB6, CGB5, CGB7 and CGB8 genes. The aim of this study was to evaluate the association of CGB5-G/C polymorphism and the clinical outcomes in women who underwent IVF-ET procedures. Materials and Methods: A total of 200 patients undergoing IVF-ET (100 patients with positive and 100 patients with negative IVF-ET outcome were included in this study. Genotyping of CGB5 at -155G/C polymorphic site was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP. Statistical analysis was performed using the MedCalc software. Results: Our findings show that the CC genotype of the CGB5 -155G/C polymorphism is associated with decreased risk of IVF-ET failure (OR=0.29; 95%CI=0.1-0.85; p=0.02. However, the allelic distribution of the CGB5 -155G/C is not significantly different between two groups (χ2=1.46; p=0.22. Conclusion: The results of this study suggested that CGB5 (-155G/C CC genotype has a protective effect on IVF-ET outcome. More studies with larger sample sizes on different populations are necessary to elucidate the underlying mechanisms which can explain the associations found between the GGB5 gene polymorphisms and IVF-ET outcome.

  13. Presence of bile acids in human follicular fluid and their relation with embryo development in modified natural cycle IVF.

    Science.gov (United States)

    Nagy, R A; van Montfoort, A P A; Dikkers, A; van Echten-Arends, J; Homminga, I; Land, J A; Hoek, A; Tietge, U J F

    2015-05-01

    Are bile acids (BA) and their respective subspecies present in human follicular fluid (FF) and do they relate to embryo quality in modified natural cycle IVF (MNC-IVF)? BA concentrations are 2-fold higher in follicular fluid than in serum and ursodeoxycholic acid (UDCA) derivatives were associated with development of top quality embryos on Day 3 after fertilization. Granulosa cells are capable of synthesizing BA, but a potential correlation with oocyte and embryo quality as well as information on the presence and role of BA subspecies in follicular fluid have yet to be investigated. Between January 2001 and June 2004, follicular fluid and serum samples were collected from 303 patients treated in a single academic centre that was involved in a multicentre cohort study on the effectiveness of MNC-IVF. Material from patients who underwent a first cycle of MNC-IVF was used. Serum was not stored from all patients, and the available material comprised 156 follicular fluid and 116 matching serum samples. Total BA and BA subspecies were measured in follicular fluid and in matching serum by enzymatic fluorimetric assay and liquid chromatography-mass spectrometry, respectively. The association of BA in follicular fluid with oocyte and embryo quality parameters, such as fertilization rate and cell number, presence of multinucleated blastomeres and percentage of fragmentation on Day 3, was analysed. Embryos with eight cells on Day 3 after oocyte retrieval were more likely to originate from follicles with a higher level of UDCA derivatives than those with fewer than eight cells (P IVF were used, which resulted in 14 samples only from women with an ongoing pregnancy, therefore further prospective studies are required to confirm the association of UDCA with IVF pregnancy outcomes. The inter-cycle variability of BA levels in follicular fluid within individuals has yet to be investigated. We checked for macroscopic signs of contamination of follicular fluid by blood but the

  14. IVF, same-sex couples and the value of biological ties

    DEFF Research Database (Denmark)

    Di Nucci, Ezio

    2016-01-01

    Ought parents, in general, to value being biologically tied to their children? Is it important, in particular, that both parents be biologically tied to their children? I will address these fundamental questions by looking at a fairly new practice within IVF treatments, so-called IVF......-with-ROPA (Reception of Oocytes from Partner), which allows lesbian couples to 'share motherhood', with one partner providing the eggs while the other becomes pregnant. I believe that IVF-with-ROPA is, just like other IVF treatments, morally permissible, but here I argue that the increased biological ties which IVF...

  15. The ISMAAR proposal on terminology for ovarian stimulation for IVF

    NARCIS (Netherlands)

    Nargund, G.; Fauser, B. C. J. M.; Macklon, N. S.; Ombelet, W.; Nygren, K.; Frydman, R.

    IVF is performed with oocytes collected in natural and stimulated cycles. Different approaches to ovarian stimulation have been employed worldwide. Following the introduction of GnRH antagonists and strategies to reduce multiple births such as single embryo transfer, there is a genuine scientific

  16. The Effect of Endometrial Thickness on In vitro Fertilization (IVF ...

    African Journals Online (AJOL)

    The value of measuring the endometrial thickness and studying the endometrial receptivity in the context of assisted conception remains a contentious issue. A prospective analysis was carried out to determine the effect of endometrial thickness on IVF - embryo transfer / ICSI outcome in dedicated Assisted Reproductive ...

  17. Why doesn't conventional IVF work in the horse?

    NARCIS (Netherlands)

    Leemans, Bart; Gadella, Bart M; Stout, Tom Arjun Edgar; De Schauwer, Catharina; Nelis, Hilde Maria; Hoogewijs, Maarten; Van Soom, Ann

    2016-01-01

    In contrast to man and many other mammalian species, conventional in vitro fertilization (IVF) with horse gametes is not reliably successful. The apparent inability of stallion spermatozoa to penetrate the zona pellucida in vitro is most likely due to incomplete activation of spermatozoa

  18. The ISMAAR proposal on terminology for ovarian stimulation for IVF

    NARCIS (Netherlands)

    Nargund, G.; Fauser, B. C. J. M.; Macklon, N. S.; Ombelet, W.; Nygren, K.; Frydman, R.

    2007-01-01

    IVF is performed with oocytes collected in natural and stimulated cycles. Different approaches to ovarian stimulation have been employed worldwide. Following the introduction of GnRH antagonists and strategies to reduce multiple births such as single embryo transfer, there is a genuine scientific

  19. CONTENT AND PROGNOSTIC VALUE OF SOME CYTOKINES IN BLOOD SERUM AND FOLLICULAR FLUID IN WOMEN WITH POLYCYSTIC OVARY SYNDROME PARTICIPATING IN THE IVF PROGRAM

    Directory of Open Access Journals (Sweden)

    Виктория Васильевна Лихачева

    2017-10-01

    Conclusions. The level of IL-8 below 100 pg/ml in the follicular fluid of the infertile patients with PCOS, as well as the increase in serum IL-6 of more than 2.5 pg/ml in the women with tubal infertility can be recommended as predictors of the negative outcome of the IVF programs . When obtaining such results during the IVF program, it is advisable to resolve the issue of delayed transfer of embryos for the purpose of conducting an additional course of immunomodulatory therapy in the framework of preimplantation preparation.

  20. Pregnancy outcome in women with endometriosis achieving pregnancy with IVF.

    Science.gov (United States)

    Benaglia, Laura; Candotti, Giorgio; Papaleo, Enrico; Pagliardini, Luca; Leonardi, Marta; Reschini, Marco; Quaranta, Lavinia; Munaretto, Maria; Viganò, Paola; Candiani, Massimo; Vercellini, Paolo; Somigliana, Edgardo

    2016-12-01

    Are women with endometriosis who conceive with IVF at increased risk of preterm birth? Women with endometriosis who conceive with IVF do not face an increased risk of preterm birth. The eutopic endometrium of women with endometriosis has been repeatedly shown to present molecular and cellular alterations. On this basis, it has been hypothesized that pregnancy outcome may be altered in affected women. However, to date, available evidence from epidemiological studies is scanty and conflicting. Data tended to be partly consistent only for an increased risk of preterm birth and placenta previa. Retrospective matched case-control study of women achieving an IVF singleton pregnancy progressing beyond 12 weeks' gestation. Women achieving IVF singleton pregnancies that progressed beyond 12 weeks' gestation at two infertility units were reviewed. Cases were women with a history of surgery for endometriosis and/or with a sonographic diagnosis of the disease at the time of the IVF cycle. Controls were women without current or past evidence of endometriosis who were matched to cases by age (± 6 months), type of cycle (fresh or frozen cycle) and study period. Male factor and unexplained infertility were the most common diagnoses in the control group. Two hundred and thirty-nine women with endometriosis and 239 controls were selected. The main outcome of the study was the rate of preterm birth (birth IVF pregnancies only, and specific data from properly designed studies are required to support any inference for natural pregnancies. The results of our study suggest that women with endometriosis conceiving with IVF can be reassured regarding the risk of preterm birth. The observed association with placenta previa requires further investigation and may open a new avenue of research. No external funding was used for this study. None of the authors have any conflict of interest to declare. © The Author 2016. Published by Oxford University Press on behalf of the European Society

  1. To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

    OpenAIRE

    Carneiro, M?rcia Mendon?a; Costa, Luciana Maria Pyramo; de ?vila, Ivete

    2017-01-01

    Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain. There is little evidence of a clear connection between DIE and infertility, and the absolute benefits of surgery for DIE have not been established. This paper aimed to review the current literature on the effect of surgery for DIE on fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women...

  2. 17 CFR 270.10b-1 - Definition of regular broker or dealer.

    Science.gov (United States)

    2010-04-01

    ... COMMISSION (CONTINUED) RULES AND REGULATIONS, INVESTMENT COMPANY ACT OF 1940 § 270.10b-1 Definition of regular broker or dealer. The term regular broker or dealer of an investment company shall mean: (a) One... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Definition of regular broker...

  3. 76 FR 163 - Agency Information Collection Activities: CBP Regulations Pertaining to Customs Brokers

    Science.gov (United States)

    2011-01-03

    ... broker exam would complete CBP Form 3124E, ``Application for Customs Broker License Exam''; or to apply... U.S.C. 1641. CBP Forms 3124 and 3124E may be found at http://www.cbp.gov/xp/cgov/toolbox/forms/ . Further information about the customs broker exam and how to apply for it may be found at http://www.cbp...

  4. 77 FR 17367 - Permissible Sharing of Client Records by Customs Brokers

    Science.gov (United States)

    2012-03-26

    ...-0038] RIN 1651-AA80 Permissible Sharing of Client Records by Customs Brokers AGENCY: U.S. Customs and... would allow brokers, upon the client's consent in a written authorization, to share client information... services to the broker's clients. Although the proposed rule was prepared in response to a request from a...

  5. 75 FR 66050 - Permissible Sharing of Client Records by Customs Brokers

    Science.gov (United States)

    2010-10-27

    .... USCBP-2010-0038] RIN 1651-AA80 Permissible Sharing of Client Records by Customs Brokers AGENCIES... the Code of Federal Regulations (CFR) pertaining to the obligations of customs brokers to keep clients' information confidential. The proposed amendment would allow brokers, upon the client's consent in a written...

  6. 77 FR 74546 - Posting of Pamphlet Provided for in the International Marriage Broker Regulation Act

    Science.gov (United States)

    2012-12-14

    ... Marriage Broker Regulation Act ACTION: Notice of posting of pamphlet provided for in section 833(a) of the International Marriage Broker Regulation Act, Title D of Public Law 109-162. SUMMARY: Section 833(a) of the International Marriage Broker Regulation Act, Title D of Public Law 109-162, provided that the Secretary of...

  7. 29 CFR 453.21 - Interests held in agents, brokers, and surety companies.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 2 2010-07-01 2010-07-01 false Interests held in agents, brokers, and surety companies... LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Qualified Agents, Brokers, and Surety Companies for the Placing of Bonds § 453.21 Interests held in agents, brokers, and surety companies. (a) Section...

  8. 17 CFR 250.4 - Exemption of certain brokers, dealers and underwriters.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Exemption of certain brokers... and General Exemptions § 250.4 Exemption of certain brokers, dealers and underwriters. (a) General exemption. Subject to the provision of § 250.6, any broker, dealer or underwriter, as defined in paragraph...

  9. 17 CFR 240.15b2-2 - Inspection of newly registered brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... brokers and dealers. 240.15b2-2 Section 240.15b2-2 Commodity and Securities Exchanges SECURITIES AND... Regulations Under the Securities Exchange Act of 1934 Registration of Brokers and Dealers § 240.15b2-2 Inspection of newly registered brokers and dealers. (a) Definition. For the purpose of this section the term...

  10. 17 CFR 405.3 - Notification provisions for certain registered government securities brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... certain registered government securities brokers and dealers. 405.3 Section 405.3 Commodity and Securities... REPORTS AND AUDIT § 405.3 Notification provisions for certain registered government securities brokers and dealers. (a) Every registered government securities broker or dealer, other than a government securities...

  11. 75 FR 67094 - Agency Information Collection Activities: CBP Regulations Pertaining to Customs Brokers

    Science.gov (United States)

    2010-11-01

    ... Activities: CBP Regulations Pertaining to Customs Brokers AGENCY: U.S. Customs and Border Protection... collection requirement concerning the: CBP Regulations Pertaining to Customs Brokers (19 CFR Part 111). This... Pertaining to Customs Brokers (19 CFR Part 111). OMB Number: 1651-0034. Form Numbers: CBP Forms 3124 and...

  12. 17 CFR 300.304 - Retained rights of brokers or dealers.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Retained rights of brokers or... Completion of Open Contractual Commitments § 300.304 Retained rights of brokers or dealers. (a) Nothing stated in these rules shall be construed to prejudice the right of a broker or dealer to any claim...

  13. 12 CFR 220.101 - Transactions of customers who are brokers or dealers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Transactions of customers who are brokers or... OF THE FEDERAL RESERVE SYSTEM CREDIT BY BROKERS AND DEALERS (REGULATION T) Interpretations § 220.101 Transactions of customers who are brokers or dealers. The Board has recently considered certain questions...

  14. 17 CFR 240.17h-2T - Risk assessment reporting requirements for brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... requirements for brokers and dealers. 240.17h-2T Section 240.17h-2T Commodity and Securities Exchanges... Organizations § 240.17h-2T Risk assessment reporting requirements for brokers and dealers. (a) Reporting requirements of risk assessment information required to be maintained by section 240.17h-1T. (1) Every broker...

  15. 29 CFR 2580.412-22 - Interests held in agents, brokers and surety companies.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Interests held in agents, brokers and surety companies... SECURITY ACT OF 1974 TEMPORARY BONDING RULES Qualified Agents, Brokers and Surety Companies for the Placing of Bonds § 2580.412-22 Interests held in agents, brokers and surety companies. Section 13(c...

  16. 17 CFR 230.139a - Publications by brokers or dealers distributing asset-backed securities.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Publications by brokers or... Publications by brokers or dealers distributing asset-backed securities. The publication or distribution by a broker or dealer of information, an opinion or a recommendation with respect to asset-backed securities...

  17. 17 CFR 240.17a-7 - Records of non-resident brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... brokers and dealers. 240.17a-7 Section 240.17a-7 Commodity and Securities Exchanges SECURITIES AND... Stabilizing Activities § 240.17a-7 Records of non-resident brokers and dealers. (a)(1) Except as provided in paragraphs (b) and (c) of this section, each non-resident broker or dealer registered or applying for...

  18. 17 CFR 403.1 - Application of part to registered brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... registered brokers and dealers. 403.1 Section 403.1 Commodity and Securities Exchanges DEPARTMENT OF THE... SECURITIES AND BALANCES § 403.1 Application of part to registered brokers and dealers. With respect to their activities in government securities, compliance by registered brokers or dealers with § 240.8c-1 of this...

  19. 7 CFR 3565.108 - Responsibility for actions of agents and mortgage brokers.

    Science.gov (United States)

    2010-01-01

    ... brokers. 3565.108 Section 3565.108 Agriculture Regulations of the Department of Agriculture (Continued... Requirements § 3565.108 Responsibility for actions of agents and mortgage brokers. An approved lender is responsible for the actions of its agents and mortgage brokers. ...

  20. 17 CFR 404.5 - Securities counts by registered government securities brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... registered government securities brokers and dealers. 404.5 Section 404.5 Commodity and Securities Exchanges... AND PRESERVATION OF RECORDS § 404.5 Securities counts by registered government securities brokers and dealers. (a) Securities counts. Every registered government securities broker or dealer shall comply with...

  1. 13 CFR 120.956 - Suspension or revocation of brokers and dealers.

    Science.gov (United States)

    2010-01-01

    ... brokers and dealers. 120.956 Section 120.956 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION... Suspension or revocation of brokers and dealers. The appropriate Office of Capital Access official in accordance with Delegations of Authority may suspend or revoke the privilege of any broker or dealer to...

  2. 29 CFR 2580.412-35 - Disqualification of agents, brokers and sureties.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Disqualification of agents, brokers and sureties. 2580.412...-35 Disqualification of agents, brokers and sureties. Since 13(c) is to be construed as disqualifying any agent, broker, surety or other company from having a bond placed through or with it, if the plan...

  3. 17 CFR 404.1 - Application of part to registered brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... registered brokers and dealers. 404.1 Section 404.1 Commodity and Securities Exchanges DEPARTMENT OF THE... PRESERVATION OF RECORDS § 404.1 Application of part to registered brokers and dealers. Compliance by a registered broker or dealer with § 240.17a-3 of this title (pertaining to records to be made), § 240.17a-4 of...

  4. 75 FR 3666 - Basis Reporting by Securities Brokers and Basis Determination for Stock; Correction

    Science.gov (United States)

    2010-01-22

    ... Basis Reporting by Securities Brokers and Basis Determination for Stock; Correction AGENCY: Internal... on Thursday, December 17, 2009, relating to reporting sales of securities by brokers and determining... 3, in the preamble, under paragraph heading ``a. Form and Manner of New Broker Reporting...

  5. 17 CFR 240.17a-11 - Notification provisions for brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... brokers and dealers. 240.17a-11 Section 240.17a-11 Commodity and Securities Exchanges SECURITIES AND... Stabilizing Activities § 240.17a-11 Notification provisions for brokers and dealers. (a) This section shall apply to every broker or dealer registered with the Commission pursuant to section 15 of the Act. (b)(1...

  6. 12 CFR 221.5 - Special purpose loans to brokers and dealers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Special purpose loans to brokers and dealers... FEDERAL RESERVE SYSTEM CREDIT BY BANKS AND PERSONS OTHER THAN BROKERS OR DEALERS FOR THE PURPOSE OF PURCHASING OR CARRYING MARGIN STOCK (REGULATION U) § 221.5 Special purpose loans to brokers and dealers. (a...

  7. 31 CFR 103.19 - Reports by brokers or dealers in securities of suspicious transactions.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Reports by brokers or dealers in... Reports Required To Be Made § 103.19 Reports by brokers or dealers in securities of suspicious transactions. (a) General. (1) Every broker or dealer in securities within the United States (for purposes of...

  8. 27 CFR 31.63 - Agents, auctioneers, brokers, etc., acting on behalf of others.

    Science.gov (United States)

    2010-04-01

    ..., brokers, etc., acting on behalf of others. 31.63 Section 31.63 Alcohol, Tobacco Products and Firearms... Exemptions and Exceptions Persons Who Are Not Dealers in Liquors Or Beer § 31.63 Agents, auctioneers, brokers... auction on behalf of others; (b) Agents or brokers who solicit orders for liquors in the name of a...

  9. 17 CFR 240.15b1-1 - Application for registration of brokers or dealers.

    Science.gov (United States)

    2010-04-01

    ... of brokers or dealers. 240.15b1-1 Section 240.15b1-1 Commodity and Securities Exchanges SECURITIES... Rules and Regulations Under the Securities Exchange Act of 1934 Registration of Brokers and Dealers § 240.15b1-1 Application for registration of brokers or dealers. (a) An application for registration of...

  10. Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data.

    Science.gov (United States)

    Carpinello, Olivia J; Casson, Peter R; Kuo, Chia-Ling; Raj, Renju S; Sills, E Scott; Jones, Christopher A

    2016-06-01

    In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes. To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth. Medical records of patients who conceived with IVF (n = 116) and delivered at >20 weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated. The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3 % (SET), 9.1 % (DET) and 10.0 % for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7 % (SET), 36.6 % (DET), and 47.1 % for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1 %, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively. Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.

  11. Does supplementation of in-vitro culture medium with melatonin improve IVF outcome in PCOS?

    Science.gov (United States)

    Kim, Mi Kyoung; Park, Eun A; Kim, Hyung Joon; Choi, Won Yun; Cho, Jung Hyun; Lee, Woo Sik; Cha, Kwang Yul; Kim, You Shin; Lee, Dong Ryul; Yoon, Tae Ki

    2013-01-01

    Human pre-ovulatory follicular fluid (FF) contains a higher concentration of melatonin than serum. The aim of this study was to evaluate the effect of melatonin supplementation of culture medium on the clinical outcomes of an in-vitro maturation (IVM) IVF-embryo transfer programme for patients with polycystic ovarian syndrome (PCOS). Melatonin concentrations in the culture media of granulosa cells (GC) or cumulus-oocyte-complexes (COC) were measured and the clinical outcomes after using IVM media with or without melatonin were analysed. In the culture media of GC or COC, melatonin concentrations gradually increased. When human chorionic gonadotrophin priming protocols were used, implantation rates in the melatonin-supplemented group were higher than those of the non-supplemented control group (PPregnancy rates were also higher, although not significantly. The findings suggest that the addition of melatonin to IVM media may improve the cytoplasmic maturation of human immature oocytes and subsequent clinical outcomes. It is speculated that follicular melatonin may be released from luteinizing GC during late folliculogenesis and that melatonin supplementation may be used to improve the clinical outcomes of IVM IVF-embryo transfer. Melatonin is primarily produced by the pineal gland and regulates a variety of important central and peripheral actions related to circadian rhythms and reproduction. Interestingly, human pre-ovulatory follicular fluid contains a higher concentration of melatonin than serum. However, in contrast to animal studies, the direct role of melatonin on oocyte maturation in the human system has not yet been investigated. So, the aim of the study was to evaluate the effect of melatonin supplementation of culture medium on the clinical outcome of an in-vitro maturation (IVM) IVF-embryo transfer programme for PCOS patients. The melatonin concentrations in culture medium of granulosa cells (GC) or cumulus-oocyte-complexes (COC) were measured and the

  12. Interconnecting Multidiscilinary Data Infrastructures: From Federation to Brokering Framework

    Science.gov (United States)

    Nativi, S.

    2014-12-01

    Standardization and federation activities have been played an essential role to push interoperability at the disciplinary and cross-disciplinary level. However, they demonstrated not to be sufficient to resolve important interoperability challenges, including: disciplinary heterogeneity, cross-organizations diversities, cultural differences. Significant international initiatives like GEOSS, IODE, and CEOS demonstrated that a federation system dealing with global and multi-disciplinary domain turns out to be rater complex, raising more the already high entry level barriers for both Providers and Users. In particular, GEOSS demonstrated that standardization and federation actions must be accompanied and complemented by a brokering approach. Brokering architecture and its implementing technologies are able to implement an effective interoperability level among multi-disciplinary systems, lowering the entry level barriers for both data providers and users. This presentation will discuss the brokering philosophy as a complementary approach for standardization and federation to interconnect existing and heterogeneous infrastructures and systems. The GEOSS experience will be analyzed, specially.

  13. Cardiovascular health of 9-year-old IVF offspring is not associated with IVF but with parental subfertility

    NARCIS (Netherlands)

    Kuiper, D.; Hoek, A.; La Bastide-Van Gemert, S.; Seggers, J.; Heineman, M.J.; Hadders-Algra, M.

    Study question: Does the in vitro procedure, ovarian hyperstimulation or subfertility affect blood pressure (BP) of 9-year-old IVF children born to subfertile couples? Summary answer: Our study demonstrates that the higher BP in 9-year-old children born to subfertile couples is not due to

  14. Social workers as transition brokers: facilitating the transition from pediatric to adult medical care.

    Science.gov (United States)

    Shanske, Susan; Arnold, Janis; Carvalho, Maria; Rein, Jennifer

    2012-01-01

    Transition from pediatric to adult medical care and the significant psychosocial considerations impacting this developmental process are a primary focus in health care today. Social workers are often the informal brokers of this complex and nuanced process and are uniquely trained to complete biopsychosocial assessments to understand the needs of patients and families and address psychosocial factors. Their extensive knowledge of resources and systems, along with their sophisticated understanding of the relationship issues, family dynamics, cultural implications, and basic person-in-context approach allow for unique collaboration with the health care team, family, and community supports to develop successful transition plans and programs.

  15. The Association Between LH Serum Levels at the time of hCG Injection and Clinical Pregnancy during IVF

    Directory of Open Access Journals (Sweden)

    Budi Wiweko

    2015-12-01

    Full Text Available Some studies showed that recombinant follicle stimulating hormone (r-FSH administration without LH supplementation has a good success rate on in vitro fertilization (IVF. However, LH role in IVF has been controversial. This study was conducted to evaluate the association between serum LH levels at the time of hCG injection and clinical pregnancy during IVF. This retrospective study included 136 patients underwent long protocol IVF from January 2005 to December 2009 in Yasmin Clinic, Cipto Mangunkusumo Hospital, Jakarta. The controlled ovarian hyper-stimulation protocol used in this study was gonadotropin-releasing hormone (GnRH agonist and r-FSH.  Serum LH level was measured on the day of hCG administration and the outcome evaluated was the clinical pregnancy following IVF cycles. There were 32 IVF cycles resulted in pregnancy out of 136 cycles (23.5%. There was significant difference between serum LH levels on the day of hCG administration and clinical pregnancy outcome (p=0.036. LH serum level cut-off value of ≥1.050 IU/l was the best value to predict pregnancy outcome with 62.5% sensitivity, 59.4% specificity, 83.3% positive predictive value, and 32.76% negative predictive value. It was concluded that there was an association between serum LH levels at the time of hCG injection and clinical pregnancy during IVF. Keywords: IVF cycles, LH levels serum, hCG administration   Hubungan Kadar LH saat Penyuntikan hCG dengan Kejadian Kehamilan pada Fertilisasi In vitro Abstrak Pemberian follicles stimulating hormone rekombinan (r-FSH tanpa suplementasi LH memiliki tingkat keberhasilan fertilisasi in vitro (FIV yang baik namun, peran LH pada FIV masih kontroversial. Tujuan penelitian ini adalah untuk mengevaluasi hubungan antara kadar serum LH pada hari penyuntikan hCG dengan kehamilan klinis selama FIV. Penelitian retrospektif ini melibatkan 136 perempuan yang menjalani FIV siklus pertama dengan protokol panjang mulai bulan Januari 2005 sampai

  16. Data analysis in an Object Request Broker environment

    International Nuclear Information System (INIS)

    Malon, D.M.; May, E.N.; Grossman, R.L.; Day, C.T.; Quarrie, D.R.

    1995-01-01

    Computing for the Next Millenium will require software interoperability in heterogeneous, increasingly object-oriented environments. The Common Object Request Broker Architecture (CORBA) is a software industry effort, under the aegis of the Object Management Group (OMG), to standardize mechanisms for software interaction among disparate applications written in a variety of languages and running on a variety of distributed platforms. In this paper, we describe some of the design and performance implications for software that must function in such a brokered environment in a standards-compliant way. We illustrate these implications with a physics data analysis example as a case study

  17. Data analysis in an object request broker environment

    International Nuclear Information System (INIS)

    Malon, David M.; May, Edward N.; Grossman, Robert L.; Day, Christopher T.; Quarrie, David R.

    1996-01-01

    Computing for the Next Millennium will require software interoperability in heterogeneous, increasingly object-oriented environments. The Common Request Broker Architecture (CORBA) is a software industry effort, under the aegis of the Object Management Group (OMG), to standardize mechanism for software interaction among disparate applications written in a variety of languages and running on a variety of distributed platforms. In this paper, we describe some of the design and performance implications for software that must function is such a brokered environment in a standards-compliant way. We illustrate these implications with a physics data analysis example as a case study. (author)

  18. Follicular fluid lipid fingerprinting from women with PCOS and hyper response during IVF treatment.

    Science.gov (United States)

    Cordeiro, Fernanda Bertuccez; Cataldi, Thaís Regiani; do Vale Teixeira da Costa, Lívia; de Lima, Camila Bruna; Stevanato, Juliana; Zylbersztejn, Daniel Suslik; Ferreira, Christina Ramires; Eberlin, Marcos Nogueira; Cedenho, Agnaldo Pereira; Turco, Edson Guimarães Lo

    2015-01-01

    Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder that leads to lower natural reproductive potential and presents a challenge for assisted reproductive medicine because patients may exhibit immature oocyte retrieval and a higher risk of ovarian hyper stimulation syndrome during in vitro fertilization (IVF) treatment. This study aimed to identify potential lipid biomarkers for women with PCOS and a hyper response to controlled ovarian stimulation. Follicular fluid samples were collected from patients who underwent IVF, including normal responder women who became pregnant (control group, n = 11), women with PCOS and a hyper response to gonadotropins (PCOS group, n = 7) and women with only hyper response to gonadotropins (HR group, n = 7). A lipidomic analysis was performed by electrospray ionization mass spectrometry, and candidate biomarkers were analyzed by tandem mass spectrometry experiment. The lipid profiles indicated particularities related to differences in phosphatidylcholine (PCOS and HR), phosphatidylserine, phosphatydilinositol and phosphatidylglycerol (control), sphingolipids (PCOS) and phosphatidylethanolamine (control and HR). These findings contribute to the understanding of the molecular mechanisms associated with lipid metabolism in the PCOS-related hyper response, and strongly suggest that these lipids may be useful as biomarkers, leading to the development of more individualized treatment for pregnancy outcome.

  19. Individualization of the FSH starting dose in IVF/ICSI cycles using the antral follicle count

    Directory of Open Access Journals (Sweden)

    La Marca Antonio

    2013-02-01

    Full Text Available Abstract Background The FSH starting dose is usually chosen according to women’s age, anamnesis, clinical criteria and markers of ovarian reserve. Currently used markers include antral follicle count (AFC, which is considered to have a very high performance in predicting ovarian response to FSH. The objective of the present study to elaborate a nomogram based on AFC for the calculation of the appropriate FSH starting dose in IVF cycles. Methods This is a retrospective study performed at the Mother-Infant Department of Modena University Hospital. IVF patients (n=505 were subjected to blood sampling and transvaginal ultrasound for measurement of serum day3 FSH, estradiol and AFC. The variables predictive of the number of retrieved oocytes were assessed by backwards stepwise multiple regression. The variables reaching the statistical significance were then used in the calculation for the final predictive model. Results A model based on age, AFC and FSH was able to accurately predict the ovarian sensitivity and accounted for 30% of the variability of ovarian response to FSH. An FSH dosage nomogram was constructed and overall it predicts a starting dose lower than 225 IU in 50.2% and 18.1% of patients younger and older than 35 years, respectively. Conclusions The daily FSH dose may be calculated on the basis of age and two markers of ovarian reserve, namely AFC and FSH, with the last two variables being the most significant predictors. The nomogram seems easily applicable during the daily clinical practice.

  20. Random-start IVF treatment: An emergent fertility preservation technique between cytotoxic treatment courses and stem-cell transplantation in acute myelocytic leukemia

    Directory of Open Access Journals (Sweden)

    Ghada Hussein

    2015-12-01

    Conclusions: Although it is still experimental, emergency IVF treatment considered as a novel approach for fertility preservation in cancer patients not only before the start of chemotherapy but even between the treatment courses if the patient’s physical and psychological conditions are stable and acceptable.

  1. 17 CFR 240.17a-23 - Recordkeeping and reporting requirements relating to broker-dealer trading systems.

    Science.gov (United States)

    2010-04-01

    ... requirements relating to broker-dealer trading systems. 240.17a-23 Section 240.17a-23 Commodity and Securities... relating to broker-dealer trading systems. (a) Scope of section. This section shall apply to any registered broker or dealer that acts as the sponsor of a broker-dealer trading system. (b) Definitions. For...

  2. 17 CFR 201.520 - Suspension of registration of brokers, dealers, or other Exchange Act-registered entities...

    Science.gov (United States)

    2010-04-01

    ... brokers, dealers, or other Exchange Act-registered entities: Application. 201.520 Section 201.520... Rules Relating to Temporary Orders and Suspensions § 201.520 Suspension of registration of brokers... of a registered broker, dealer, municipal securities dealer, government securities broker, government...

  3. 17 CFR 240.15a-10 - Exemption of certain brokers or dealers with respect to security futures products.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Exemption of certain brokers... Brokers and Dealers § 240.15a-10 Exemption of certain brokers or dealers with respect to security futures products. (a) A broker or dealer that is registered by notice with the Commission pursuant to section 15(b...

  4. 7 CFR 4290.1630 - Regulation of Brokers and Dealers and disclosure to purchasers of Leverage or Trust Certificates.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Regulation of Brokers and Dealers and disclosure to... Brokers and Dealers and disclosure to purchasers of Leverage or Trust Certificates. (a) Brokers and Dealers. Each broker, dealer, and Pool or Trust assembler approved by the Secretary pursuant to these...

  5. Addition of low dose hCG to rFSh benefits older women during ovarian stimulation for IVF

    Directory of Open Access Journals (Sweden)

    Gomaa Hala

    2012-08-01

    Full Text Available Abstract Background To compare the outcome of IVF cycles in women receiving controlled ovarian stimulation with recFSH or recFSH plus low dose hCG. Methods A retrospective case control study, performed at a private practice affiliated with an academic institute. Patients were infertile women who were treated with IVF/ICSI and controlled ovarian stimulation in a long GnRH agonist protocol using either low dose hCG in addition to recFSH [N = 88] or recFSH alone [N = 99]. Primary outcomes were mean FSH dose, number of mature eggs, number of fertilized eggs, and serum levels of estradiol. Secondary outcomes were endometrial thickness, cycle cancellations and pregnancy rates. Results A significant increase in number of mature and fertilized eggs was observed in women over 40 years of age using low dose hCG in addition to recFSH. The estradiol level was significantly higher on the day of hCG administration and the serum level of FSH on cycle day 7 and on the day of hCG administration were lower. Conclusion Addition of low dose hCG to recFSH compared with recFSH alone significantly modified cycle characteristics in patients >/= 40 years and could be of potential benefit for IVF cycles in older infertile women.

  6. From Kisiizi to Baltimore: cultivating knowledge brokers to support global innovation for community engagement in healthcare.

    Science.gov (United States)

    Ibe, Chidinma A; Basu, Lopa; Gooden, Rachel; Syed, Shamsuzzoha B; Dadwal, Viva; Bone, Lee R; Ephraim, Patti L; Weston, Christine M; Wu, Albert W

    2018-02-09

    Reverse Innovation has been endorsed as a vehicle for promoting bidirectional learning and information flow between low- and middle-income countries and high-income countries, with the aim of tackling common unmet needs. One such need, which traverses international boundaries, is the development of strategies to initiate and sustain community engagement in health care delivery systems. In this commentary, we discuss the Baltimore "Community-based Organizations Neighborhood Network: Enhancing Capacity Together" Study. This randomized controlled trial evaluated whether or not a community engagement strategy, developed to address patient safety in low- and middle-income countries throughout sub-Saharan Africa, could be successfully applied to create and implement strategies that would link community-based organizations to a local health care system in Baltimore, a city in the United States. Specifically, we explore the trial's activation of community knowledge brokers as the conduit through which community engagement, and innovation production, was achieved. Cultivating community knowledge brokers holds promise as a vehicle for advancing global innovation in the context of health care delivery systems. As such, further efforts to discern the ways in which they may promote the development and dissemination of innovations in health care systems is warranted. Trial Registration Number: NCT02222909 . Trial Register Name: Reverse Innovation and Patient Engagement to Improve Quality of Care and Patient Outcomes (CONNECT). Date of Trial's Registration: August 22, 2014.

  7. School Business Community Partnership Brokers. Program Guidelines, 2010-2013

    Science.gov (United States)

    Australian Government Department of Education, Employment and Workplace Relations, 2009

    2009-01-01

    These guidelines for 2010-2013 relate specifically to the Partnership Brokers program. This program is part of the Australian Government's contribution to the Youth Attainment and Transitions National Partnership and will commence on 1 January 2010. These Guidelines set out the requirements for the provision of services by organisations contracted…

  8. Designing a Robot for Cultural Brokering in Education

    Science.gov (United States)

    Kim, Yanghee

    2016-01-01

    The increasing number of English language learning children in U.S. classrooms and the need for effective programs that support these children present a great challenge to the current educational paradigm. The challenge may be met, at least in part, by an innovative humanoid robot serving as a cultural broker that mediates collaborative…

  9. As Endowment Values Plummet, Some Institutions Consider Suing Brokers

    Science.gov (United States)

    Masterson, Kathryn

    2008-01-01

    This article reports that as many as five colleges or charitable foundations whose endowments have suffered significant investment losses or were unable to access money in their accounts in recent months are considering legal action against their brokers or investment managers, alleging misrepresentation of risk or mismanagement. Jacob H.…

  10. Between Indian and White Worlds: The Cultural Broker.

    Science.gov (United States)

    Szasz, Margaret Connell, Ed.

    During the five centuries of contact between Native and non-Native peoples of the Americas, thousands of intermediaries have moved across the continents' cultural frontiers. These cultural brokers have included traders, missionaries, persons of mixed race, diplomats, Indian schoolchildren attending missionary or government boarding schools, White…

  11. An Education Broker Toolset for Web Course Customization.

    Science.gov (United States)

    Langenbach, Christian; Bodendorf, Freimut

    Within an electronic education market, an electronic education mall is defined as a virtual service center to support various transaction processes by providing a technological platform with appropriate value-added services and interfaces for suppliers and customers. In this context, an education broker service is of central importance, because…

  12. 12 CFR 703.8 - Broker-dealers.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Broker-dealers. 703.8 Section 703.8 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION REGULATIONS AFFECTING CREDIT UNIONS INVESTMENT AND DEPOSIT... commitments, as evidenced by capital strength, liquidity, and operating results. The Federal credit union...

  13. Knowledge Sharing in Construction Partnering - Redundancy, Boundary Objects and Brokers

    DEFF Research Database (Denmark)

    Koch, Christian; Thuesen, Christian Langhoff

    2013-01-01

    common assignment of meaning, brokers (e.g. design managers), boundary objects (e.g. drawings) and arenas (e.g. meetings). The paper presents an ethnographic case study of a project partnership between engineers, architects and contractors in construction using the partnering concept. The focus is on two...

  14. Evaluating Sustainability Models for Interoperability through Brokering Software

    Science.gov (United States)

    Pearlman, Jay; Benedict, Karl; Best, Mairi; Fyfe, Sue; Jacobs, Cliff; Michener, William; Nativi, Stefano; Powers, Lindsay; Turner, Andrew

    2016-04-01

    Sustainability of software and research support systems is an element of innovation that is not often discussed. Yet, sustainment is essential if we expect research communities to make the time investment to learn and adopt new technologies. As the Research Data Alliance (RDA) is developing new approaches to interoperability, the question of uptake and sustainability is important. Brokering software sustainability is one of the areas that is being addressed in RDA. The Business Models Team of the Research Data Alliance Brokering Governance Working Group examined several support models proposed to promote the long-term sustainability of brokering middleware. The business model analysis includes examination of funding source, implementation frameworks and challenges, and policy and legal considerations. Results of this comprehensive analysis highlight advantages and disadvantages of the various models with respect to the specific requirements for brokering services. We offer recommendations based on the outcomes of this analysis that suggest that hybrid funding models present the most likely avenue to long term sustainability.

  15. 12 CFR 303.243 - Brokered deposit waivers.

    Science.gov (United States)

    2010-01-01

    ... and use of brokered deposits; (7) A recent consolidated financial statement with balance sheet and income statements; and (8) The reasons the institution believes its acceptance, renewal or rollover of...) The time period for which the waiver is requested; (2) A statement of the policy governing the use of...

  16. 75 FR 11898 - Notice of Cancellation of Customs Broker License

    Science.gov (United States)

    2010-03-12

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker License AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security... 1641), and the U.S. Customs and Border Protection regulations (19 CFR 111.51(b)), the following Customs...

  17. 76 FR 22912 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2011-04-25

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, DHS. ACTION: General Notice. SUMMARY: Pursuant to section 641 of the Tariff Act of 1930, as amended (19 U.S.C. 1641), and the U.S. Customs and...

  18. 77 FR 5819 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2012-02-06

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs...

  19. 75 FR 5618 - Notice of Cancellation of Customs Broker License

    Science.gov (United States)

    2010-02-03

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker License AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51(b)), the following Customs...

  20. 76 FR 22912 - Notice of Revocation of Customs Broker License

    Science.gov (United States)

    2011-04-25

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs And Border Protection Notice of Revocation of Customs Broker License AGENCY: U.S. Customs and Border Protection, DHS. ACTION: General Notice. SUMMARY: Pursuant to section 641 of the Tariff Act of 1930, as amended, (19 U.S.C. 1641) and the U.S. Customs and...

  1. 76 FR 7873 - Notice of Cancellation of Customs Broker License

    Science.gov (United States)

    2011-02-11

    ... DEPARTMENT OF HOMELAND SECURITY Customs and Border Protection Notice of Cancellation of Customs Broker License AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security. ACTION...), and the U.S. Customs and Border Protection regulations (19 CFR 111.51(b)), the following Customs...

  2. 77 FR 43609 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2012-07-25

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.53), the following Customs...

  3. 76 FR 44032 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2011-07-22

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs...

  4. 75 FR 52456 - Customs Broker License Examination Individual Eligibility Requirements

    Science.gov (United States)

    2010-08-26

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection 19 CFR Part 111 [USCBP-2008-0059; CBP Dec. 10-28] RIN 1651-AA74 Customs Broker License Examination Individual Eligibility Requirements AGENCY: Customs and Border Protection, Department of Homeland Security. ACTION: Final rule...

  5. 75 FR 47825 - Notice of Cancellation of Customs Broker License

    Science.gov (United States)

    2010-08-09

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker License AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51(b)), the following Customs...

  6. 75 FR 76998 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2010-12-10

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs...

  7. 76 FR 2918 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2011-01-18

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs...

  8. 75 FR 11899 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2010-03-12

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs...

  9. 76 FR 13205 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2011-03-10

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.45), the following Customs...

  10. 75 FR 75691 - Notice of Cancellation of Customs Broker License

    Science.gov (United States)

    2010-12-06

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker License AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security.... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.45), the following Customs...

  11. 75 FR 47825 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2010-08-09

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Cancellation of Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security... 1641) and the U.S. Customs and Border Protection regulations (19 CFR 111.51), the following Customs...

  12. Information Brokers/Free-Lance Librarians: An Alternative Reference Service.

    Science.gov (United States)

    Hogan, Matthew

    This paper examines the profession of information brokerage through a look at types of services provided, and through a discussion of major issues, including that of fee for service. The types of information broker and free-lance librarian services are identified: (1) non-profit reference and research services administered by public libraries and…

  13. Microbial brokers of insect-plant interactions revisited.

    Science.gov (United States)

    Douglas, Angela E

    2013-07-01

    Recent advances in sequencing methods have transformed the field of microbial ecology, making it possible to determine the composition and functional capabilities of uncultured microorganisms. These technologies have been instrumental in the recognition that resident microorganisms can have profound effects on the phenotype and fitness of their animal hosts by modulating the animal signaling networks that regulate growth, development, behavior, etc. Against this backdrop, this review assesses the impact of microorganisms on insect-plant interactions, in the context of the hypothesis that microorganisms are biochemical brokers of plant utilization by insects. There is now overwhelming evidence for a microbial role in insect utilization of certain plant diets with an extremely low or unbalanced nutrient content. Specifically, microorganisms enable insect utilization of plant sap by synthesizing essential amino acids. They also can broker insect utilization of plant products of extremely high lignocellulose content, by enzymatic breakdown of complex plant polysaccharides, nitrogen fixation, and sterol synthesis. However, the experimental evidence for microbial-mediated detoxification of plant allelochemicals is limited. The significance of microorganisms as brokers of plant utilization by insects is predicted to vary, possibly widely, as a result of potentially complex interactions between the composition of the microbiota and the diet and insect developmental age or genotype. For every insect species feeding on plant material, the role of resident microbiota as biochemical brokers of plant utilization is a testable hypothesis.

  14. 77 FR 45647 - Notice of Cancellation of Customs Broker Licenses

    Science.gov (United States)

    2012-08-01

    ... Ferrara International Logistics 11930 New York. J.B. Fong & Co., Inc 06461 San Francisco. Air 7 Seas Transport Logistics, Inc 23081 San Francisco. Liberty Port Broker, Inc 20911 New York. Sky Sea Forwarding Corp 13261 New York. Contact Customs Clearance, Inc 13467 New York. Legacy Worldwide Logistics, Inc...

  15. Information broker: a useless overhead or a necessity

    Science.gov (United States)

    Maitan, Jacek

    1996-01-01

    The richness and diversity of information available over the Internet, its size, convenience of access, and its dynamic growth will create new ways to offer better education opportunities in medicine. The Internet will especially benefit medical training process that is expensive and requires continuous updating. The use of the Internet will lower the delivery cost and make medical information available to all potential users. On the other hand, since medical information must be trusted and new policies must be developed to support these capabilities, technologies alone are not enough. In general, we must deal with issues of liability, remuneration for educational and professional services, and general issues of ethics associated with patient-physician relationship in a complicated environment created by a mix of managed and private care combined with modern information technology. In this paper we will focus only on the need to create, to manage and to operate open system over the Internet, or similar low-cost and easy access networks, for the purpose of medical education process. Finally, using business analysis, we argue why the medical education infrastructure needs an information broker, a third party organization that will help the users to access the information and the publishers to display their titles. The first section outlines recent trends in medical education. In the second section, we discuss transfusion medicine requirements. In the third section we provide a summary of the American Red Cross (ARC) transfusion audit system; we discuss the relevance of the assumptions used in this system to other areas of medicine. In the fourth section we describe the overall system architecture and discuss key components. The fifth section covers business issues associated with medical education systems and with the potential role of ARC in particular. The last section provides a summary of findings.

  16. Hysteroscopic proximal tubal occlusion versus laparoscopic salpingectomy as a treatment for hydrosalpinges prior to IVF or ICSI: an RCT.

    Science.gov (United States)

    Dreyer, K; Lier, M C I; Emanuel, M H; Twisk, J W R; Mol, B W J; Schats, R; Hompes, P G A; Mijatovic, V

    2016-09-01

    Does hysteroscopic proximal tubal occlusion by intratubal devices as a treatment for hydrosalpinges result in comparable ongoing pregnancy rates following IVF/ICSI when compared with laparoscopic salpingectomy? Hysteroscopic proximal tubal occlusion by intratubal devices is inferior to laparoscopic salpingectomy in the treatment of hydrosalpinges in women undergoing IVF/ICSI with respect to ongoing pregnancy rates. It is known that women with hydrosalpinges undergoing IVF have poorer pregnancy outcomes compared with women with other forms of tubal infertility. In these women, both laparoscopic salpingectomy and laparoscopic proximal tubal ligation are known to improve IVF outcomes. At present, it is unclear whether a less-invasive hysteroscopic treatment with intratubal devices leads to similar ongoing pregnancy rates following IVF when compared with laparoscopic salpingectomy. A two-centre, randomized, controlled, non-inferiority trial. Between October 2009 and December 2014 a total of 85 women were included in this study; of whom, 42 were randomized to hysteroscopic proximal occlusion by intratubal device placement and 43 were randomized to laparoscopic salpingectomy. Randomization was based on a computer-generated randomization list. The study was unblinded. The primary outcome was ongoing pregnancy rate, defined as a fetal heartbeat on ultrasound beyond 10-week gestation following one IVF/ICSI treatment (fresh and frozen-thawed embryo transfers). We studied women aged 18-41 years, with uni- or bilateral ultrasound visible hydrosalpinges who were scheduled for an IVF/ICSI treatment. The ongoing pregnancy rates per patient according to the intention-to-treat principle were 11/42 (26.2%) after hysteroscopic proximal occlusion by intratubal devices (intervention group) versus 24/43 (55.8%) after laparoscopic salpingectomy (control group) (P = 0.008) [absolute difference: 26.1%; 95% confidence interval (CI): 0.5-51.7, relative risk (RR): 0.56; 95% CI: 0.31-1.03, P

  17. Semantic Web-based Vocabulary Broker for Open Science

    Science.gov (United States)

    Ritschel, B.; Neher, G.; Iyemori, T.; Murayama, Y.; Kondo, Y.; Koyama, Y.; King, T. A.; Galkin, I. A.; Fung, S. F.; Wharton, S.; Cecconi, B.

    2016-12-01

    Keyword vocabularies are used to tag and to identify data of science data repositories. Such vocabularies consist of controlled terms and the appropriate concepts, such as GCMD1 keywords or the ESPAS2 keyword ontology. The Semantic Web-based mash-up of domain-specific, cross- or even trans-domain vocabularies provides unique capabilities in the network of appropriate data resources. Based on a collaboration between GFZ3, the FHP4, the WDC for Geomagnetism5 and the NICT6 we developed the concept of a vocabulary broker for inter- and trans-disciplinary data detection and integration. Our prototype of the Semantic Web-based vocabulary broker uses OSF7 for the mash-up of geo and space research vocabularies, such as GCMD keywords, ESPAS keyword ontology and SPASE8 keyword vocabulary. The vocabulary broker starts the search with "free" keywords or terms of a specific vocabulary scheme. The vocabulary broker almost automatically connects the different science data repositories which are tagged by terms of the aforementioned vocabularies. Therefore the mash-up of the SKOS9 based vocabularies with appropriate metadata from different domains can be realized by addressing LOD10 resources or virtual SPARQL11 endpoints which maps relational structures into the RDF format12. In order to demonstrate such a mash-up approach in real life, we installed and use a D2RQ13 server for the integration of IUGONET14 data which are managed by a relational database. The OSF based vocabulary broker and the D2RQ platform are installed at virtual LINUX machines at the Kyoto University. The vocabulary broker meets the standard of a main component of the WDS15 knowledge network. The Web address of the vocabulary broker is http://wdcosf.kugi.kyoto-u.ac.jp 1 Global Change Master Directory2 Near earth space data infrastructure for e-science3 German Research Centre for Geosciences4 University of Applied Sciences Potsdam5 World Data Center for Geomagnetism Kyoto6 National Institute of Information and

  18. Live birth rates in the first complete IVF cycle among 20 687 women using a freeze-all strategy.

    Science.gov (United States)

    Zhu, Qianqian; Chen, Qiuju; Wang, Li; Lu, Xuefeng; Lyu, Qifeng; Wang, Yun; Kuang, Yanping

    2018-05-01

    What is the chance of having a child following one complete IVF cycle for patients using a freeze-all strategy? The chance of having a child after the first complete IVF cycle was 50.74% with the freeze-all strategy. Several studies have reported on live birth rates (LBRs) based on only the fresh embryo transfer cycle or fresh and frozen-thawed embryo transfer cycles. However, the LBR using a freeze-all strategy in IVF is unknown. This retrospective cohort study included 20 687 women who started their first IVF cycles using a freeze-all strategy during the period from 1 January 2007, through 31 March 2016, in China. Data on 20 687 women undergoing their first complete cycles using a freeze-all strategy from 2007 to 2016 were analyzed to estimate LBRs. The LBR in a complete cycle was defined as the chance of a live birth from an ovarian stimulation cycle including all subsequent frozen embryo transfers from this stimulation. The relationship between LBR and number of oocyte was explored. The LBR for the first complete cycle was 50.74% for patients using a freeze-all strategy. By age group, the LBR declined from 63.81% for women under 31 years old to 4.71% for women over 40 years old after the first complete cycle. The LBRs improved as the number of oocytes retrieved increased up to 25 in the freeze-all strategy. This was a retrospective study without a control group. Data on BMI and smoking status were not collected in this database. Our results showed that 50.74% of patients could achieve a live birth after the first complete cycle via a freeze-all strategy. In addition, the LBRs were positively correlated with the number of oocytes retrieved via the freeze-all strategy. These findings are critical for patients and clinicians in making an informed decision to embark on IVF treatment. This work was supported by grants from the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.) and the Shanghai Ninth People's Hospital Foundation of China (JYLJ030

  19. Predicting the chance of live birth for women undergoing IVF: a novel pretreatment counselling tool.

    Science.gov (United States)

    Dhillon, R K; McLernon, D J; Smith, P P; Fishel, S; Dowell, K; Deeks, J J; Bhattacharya, S; Coomarasamy, A

    2016-01-01

    Which pretreatment patient variables have an effect on live birth rates following assisted conception? The predictors in the final multivariate logistic regression model found to be significantly associated with reduced chances of IVF/ICSI success were increasing age (particularly above 36 years), tubal factor infertility, unexplained infertility and Asian or Black ethnicity. The two most widely recognized prediction models for live birth following IVF were developed on data from 1991 to 2007; pre-dating significant changes in clinical practice. These existing IVF outcome prediction models do not incorporate key pretreatment predictors, such as BMI, ethnicity and ovarian reserve, which are readily available now. In this cohort study a model to predict live birth was derived using data collected from 9915 women who underwent IVF/ICSI treatment at any CARE (Centres for Assisted Reproduction) clinic from 2008 to 2012. Model validation was performed on data collected from 2723 women who underwent treatment in 2013. The primary outcome for the model was live birth, which was defined as any birth event in which at least one baby was born alive and survived for more than 1 month. Data were collected from 12 fertility clinics within the CARE consortium in the UK. Multivariable logistic regression was used to develop the model. Discriminatory ability was assessed using the area under receiver operating characteristic (AUROC) curve, and calibration was assessed using calibration-in-the-large and the calibration slope test. The predictors in the final model were female age, BMI, ethnicity, antral follicle count (AFC), previous live birth, previous miscarriage, cause and duration of infertility. Upon assessing predictive ability, the AUROC curve for the final model and validation cohort was (0.62; 95% confidence interval (CI) 0.61-0.63) and (0.62; 95% CI 0.60-0.64) respectively. Calibration-in-the-large showed a systematic over-estimation of the predicted probability of live

  20. Comprehensive protocol of traceability during IVF: the result of a multicentre failure mode and effect analysis.

    Science.gov (United States)

    Rienzi, L; Bariani, F; Dalla Zorza, M; Albani, E; Benini, F; Chamayou, S; Minasi, M G; Parmegiani, L; Restelli, L; Vizziello, G; Costa, A Nanni

    2017-08-01

    Can traceability of gametes and embryos be ensured during IVF? The use of a simple and comprehensive traceability system that includes the most susceptible phases during the IVF process minimizes the risk of mismatches. Mismatches in IVF are very rare but unfortunately possible with dramatic consequences for both patients and health care professionals. Traceability is thus a fundamental aspect of the treatment. A clear process of patient and cell identification involving witnessing protocols has to be in place in every unit. To identify potential failures in the traceability process and to develop strategies to mitigate the risk of mismatches, previously failure mode and effects analysis (FMEA) has been used effectively. The FMEA approach is however a subjective analysis, strictly related to specific protocols and thus the results are not always widely applicable. To reduce subjectivity and to obtain a widespread comprehensive protocol of traceability, a multicentre centrally coordinated FMEA was performed. Seven representative Italian centres (three public and four private) were selected. The study had a duration of 21 months (from April 2015 to December 2016) and was centrally coordinated by a team of experts: a risk analysis specialist, an expert embryologist and a specialist in human factor. Principal investigators of each centre were first instructed about proactive risk assessment and FMEA methodology. A multidisciplinary team to perform the FMEA analysis was then formed in each centre. After mapping the traceability process, each team identified the possible causes of mistakes in their protocol. A risk priority number (RPN) for each identified potential failure mode was calculated. The results of the FMEA analyses were centrally investigated and consistent corrective measures suggested. The teams performed new FMEA analyses after the recommended implementations. In each centre, this study involved: the laboratory director, the Quality Control & Quality

  1. Defining poor and optimum performance in an IVF programme.

    Science.gov (United States)

    Castilla, Jose A; Hernandez, Juana; Cabello, Yolanda; Lafuente, Alejandro; Pajuelo, Nuria; Marqueta, Javier; Coroleu, Buenaventura

    2008-01-01

    At present there is considerable interest in healthcare administration, among professionals and among the general public concerning the quality of programmes of assisted reproduction. There exist various methods for comparing and analysing the results of clinical activity, with graphical methods being the most commonly used for this purpose. As yet, there is no general consensus as to how the poor performance (PP) or optimum performance (OP) of assisted reproductive technologies should be defined. Data from the IVF/ICSI register of the Spanish Fertility Society were used to compare and analyse different definitions of PP or OP. The primary variable best reflecting the quality of an IVF/ICSI programme was taken to be the percentage of singleton births per IVF/ICSI cycle initiated. Of the 75 infertility clinics that took part in the SEF-2003 survey, data on births were provided by 58. A total of 25 462 cycles were analysed. The following graphical classification methods were used: ranking of the proportion of singleton births per cycles started in each centre (league table), Shewhart control charts, funnel plots, best and worst-case scenarios and state of the art methods. The clinics classified as producing PP or OP varied considerably depending on the classification method used. Only three were rated as providing 'PP' or 'OP' by all methods, unanimously. Another four clinics were classified as 'poor' or 'optimum' by all the methods except one. On interpreting the results derived from IVF/ICSI centres, it is essential to take into account the characteristics of the method used for this purpose.

  2. The Role of Knowledge Brokers in International Ocean Policy

    Science.gov (United States)

    Mannix, H.

    2013-12-01

    The concept of the 'boundary' between science and policy has been used as a tool to separate and protect the credibility of both parties - the scientist and the policy maker. While this separation is important, it also results in frustration by both sides, a reduction in efficiency and ultimately establishes policy that has the potential to be more effective. Many now agree that the process of knowledge generation and transmission to decision makers, and eventually into effective policy, should not be a one-way, linear push of information, but a multi-party dialogue in which decision makers, scientists and intermediaries work together to increase the effectiveness of the scientific information for the policy process. These intermediaries, or knowledge brokers, are described as persons or organizations that actively facilitate the creation, sharing, and use of knowledge. This work discusses the reasons for the boundary between science and policy and the inherent challenges in bridging the boundary. It examines the role and activities of knowledge brokers and illuminates the process by which scientific and technical knowledge is translated from knowledge generators (i.e. scientists) to knowledge users (i.e. policy makers) in international environmental governance. The study then considers the role of knowledge brokers in practice, through a case study of the ongoing effort to establish marine protected areas in the high seas. Specifically, this study examines who the knowledge brokers are working on this topic, their activities, and what lessons their experiences hold for the effective translation of scientific information to policy makers in other international issues. The study concludes that 1) knowledge brokers and boundary organizations are an essential part of the effective translation of scientific knowledge to policy makers in international environmental governance and 2) both knowledge generators and knowledge users would benefit by recognizing the role of

  3. Does 45,X/46,XX mosaicism with 6-28% of aneuploidy affect the outcomes of IVF or ICSI?

    Science.gov (United States)

    Homer, L; Morel, F; Gallon, F; Le Martelot, M-T; Amice, V; Kerlan, V; De Braekeleer, M

    2012-07-01

    Several studies have shown an increased frequency of chromosomal aberrations in female partners of couples examined prior to intracytoplasmic sperm injection (ICSI). A retrospective cohort study was performed to determine whether 45,X/46,XX mosaicism affects the outcomes of in vitro fertilization (IVF) or ICSI. Forty-six women with a 45,X/46,XX karyotype with 6-28% of aneuploidy were compared with 59 control women (46,XX), matched for age, from the female population who underwent IVF or ICSI between 1 January 1996 and 31 December 2006 at the Reproductive Medicine Unit at Brest University Hospital. The outcomes of 254 treatment cycles were compared according to patient karyotype. No difference was found in the number of retrieved oocytes (8.9 ± 5.5 vs 8.5 ± 4.7; p=0.56) or the number of mature oocytes (7.4 ± 4.7 vs 6.9 ± 4.2; p=0.49) between the 45,X/46,XX group and the 46,XX group, respectively. Fertilization rates did not differ between the groups for either IVF or ICSI. In addition, no difference was found in the pregnancy rate by cycle (17.4% vs 18.7%, respectively; p=0.87). The percentage of first-trimester miscarriages was similar in both groups (13.6% vs 12.5%, respectively; p=0.51). 45,X/46,XX mosaicism with 6-28% of aneuploidy has no adverse effect on the outcomes of IVF or ICSI among women referred to assisted reproductive technologies. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  4. Effect of granulocyte colony stimulating factor (G-CSF on IVF outcomes in infertile women: An RCT

    Directory of Open Access Journals (Sweden)

    Maryam Eftekhar

    2016-05-01

    Full Text Available Background: Despite major advances in assisted reproductive techniques, the implantation rates remain relatively low. Some studies have demonstrated that intrauterine infusion of granulocyte colony stimulating factor (G-CSF improves implantation in infertile women. Objective: To assess the G-CSF effects on IVF outcomes in women with normal endometrial thickness. Materials and methods: In this randomized controlled clinical trial, 100 infertile women with normal endometrial thickness who were candidate for IVF were evaluated in two groups. Exclusion criteria were positive history of repeated implantation failure (RIF, endocrine disorders, severe endometriosis, congenital or acquired uterine anomaly and contraindication for G-CSF (renal disease, sickle cell disease, or malignancy. In G-CSF group (n=50, 300 μg trans cervical intrauterine of G-CSF was administered at the oocyte retrieval day. Controls (n=50 were treated with standard protocol. Chemical, clinical and ongoing pregnancy rates, implantation rate, and miscarriage rate were compared between groups. Results: Number of total and mature oocytes (MII, two pronuclei (2PN, total embryos, transferred embryos, quality of transferred embryos, and fertilization rate did not differ significantly between two groups. So there were no significant differences between groups in chemical, clinical and ongoing pregnancy rate, implantation rate, and miscarriage rate Conclusion: our result showed in normal IVF patients with normal endometrial thickness, the intrauterine infusion of G-CSF did not improve pregnancy outcomes.

  5. Coenzyme Q10 Supplementation and Oocyte Aneuploidy in Women Undergoing IVF-ICSI Treatment

    Directory of Open Access Journals (Sweden)

    Yaakov Bentov

    2014-01-01

    Full Text Available Background The age-related reduction in live-birth rate is attributed to a high rate of aneuploidy and follicle depletion. We showed in an animal model that treatment with Coenzyme Q10 (CoQ10 markedly improved reproductive outcome. The aim of this study was to compare the post-meiotic oocyte aneuploidy rate in in vitro fertilization (IVF and intra cytoplasmic sperm injection (ICSI patients treated with CoQ10 or placebo. Methods We conducted a double blind placebo controlled randomized trial that included IVF-ICSI patients 35-43 years of age. The patients were treated with either 600 mg of CoQ10 or an equivalent number of placebo caps. We compared the post-meiotic aneuploidy rate using polar body biopsy (PBBX and comparative genomic hybridization (CGH. According to the power calculation, 27 patients were needed for each arm. Results Owing to safety concerns regarding the effects of polar body biopsy on embryo quality and implantation, the study was terminated before reaching the target number of participants. A total of 39 patients were evaluated and randomized (17 CoQ10, 22 placebo, 27 were given the study medication (12 CoQ10, 15 placebo, and 24 completed an IVF-ICSI cycle including PBBX and embryo transfer (10 CoQ10, 14 placebo. Average age, base line follicle stimulating hormone (FSH, peak estradiol and progesterone serum level, as well as the total number of human menopausal gonadotropin (hMG units–-did not differ between the groups. The rate of aneuploidy was 46.5% in the CoQ10 group compared to 62.8% in the control. Clinical pregnancy rate was 33% for the CoQ10 group and 26.7% for the control group. Conclusion No significant differences in outcome were detected between the CoQ10 and placebo groups. However, the final study was underpowered to detect a difference in the rate of aneuploidy.

  6. The costs to the NHS of multiple births after IVF treatment in the UK.

    Science.gov (United States)

    Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

    2006-01-01

    To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

  7. New Reproductive Assemblages: Understanding, Managing and ‘Using’ Human In Vitro Fertilization (IVF)

    OpenAIRE

    Just, E.M.

    2009-01-01

    This dissertation is a contribution to the ongoing discussion about the body and in vitro fertilization (IVF), also known as assisted reproduction or technologically enhanced reproduction. With help of empirical research on Dutch and Polish IVF-couples, Edyta Just puts into question the meaning of IVF and discusses the best way of managing the phenomenon and to use it to transform existing ideologies, norms, convictions en discussions on matters such as reproduction, (in)fertility, female/mal...

  8. Stressful life events are associated with a poor in vitro fertilization (IVF) - outcome: a prospective study

    DEFF Research Database (Denmark)

    Ebbesen, Signe Maria Schneevoigt; Zachariae, Robert; Mehlsen, Mimi Yung

    2009-01-01

    -fertility-related, naturally occurring stressors may influence IVF pregnancy chances. Our aim was to explore the association between IVF-outcome and negative, i.e. stressful, life-events during the previous 12 months. METHODS: Prior to IVF, 809 women (mean age: 31.2 years) completed the List of Recent Events (LRE...... number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end...

  9. Factors associated with a poor prognosis for the IVF-ICSI live birth rate in women with rAFS stage III and IV endometriosis.

    Science.gov (United States)

    Roux, Pauline; Perrin, Jeanne; Mancini, Julien; Agostini, Aubert; Boubli, Léon; Courbiere, Blandine

    2017-07-01

    To assess the factors associated with a poor prognosis for a cumulative IVF live birth rate (LBR) in women with stage III and IV endometriosis according to the revised classification of the American Fertility Society (rAFS). A retrospective cohort study was conducted between January 1, 2010, and December 31, 2014, in our Reproductive Medicine Center. We analyzed different factors associated with a poor prognosis for a cumulative IVF LBR in women with rAFS stage III and IV endometriosis. A total of 101 patients were included, representing 232 IVF-ICSI cycles and 212 embryo transfers. The primary endpoint was the cumulative LBR per cycle and per patient. The cumulative LBR per cycle was 14.7% (n = 34) and that per patient was 31.7% (n = 32). The cumulative LBR was significantly decreased by active smoking [ adj OR = 3.4, 95% CI (1.12-10.60), p = 0.031], poor ovarian response (POR) according to the Bologna criteria [ adj OR = 11.5, 95% CI (1.37-96.83), p = 0.024], and rAFS stage IV [ adj OR = 3.2, 95% CI (1.13-8.95), p = 0.024]. The cumulative LBR per women was 59.4% without factors associated with a poor prognosis and 25.6% in the case of one factor, and it decreased to 7.7% in the case of two or three factors (p endometriosis had a negative impact on the IVF-ICSI cumulative LBR for women with rAFS stage III and IV endometriosis. Because smoking dramatically decreases the LBR with endometriosis, stopping smoking before IVF-ICSI should be strongly advised.

  10. The inSIGHT study: costs and effects of routine hysteroscopy prior to a first IVF treatment cycle. A randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Smit Janine G

    2012-08-01

    Full Text Available Abstract Background In in vitro fertilization (IVF and intracytoplasmatic sperm injection (ICSI treatment a large drop is present between embryo transfer and occurrence of pregnancy. The implantation rate per embryo transferred is only 30%. Studies have shown that minor intrauterine abnormalities can be found in 11–45% of infertile women with a normal transvaginal sonography or hysterosalpingography. Two randomised controlled trials have indicated that detection and treatment of these abnormalities by office hysteroscopy after two failed IVF cycles leads to a 9–13% increase in pregnancy rate. Therefore, screening of all infertile women for intracavitary pathology prior to the start of IVF/ICSI is increasingly advocated. In absence of a scientific basis for such a policy, this study will assess the effects and costs of screening for and treatment of unsuspected intrauterine abnormalities by routine office hysteroscopy, with or without saline infusion sonography (SIS, prior to a first IVF/ICSI cycle. Methods/design Multicenter randomised controlled trial in asymptomatic subfertile women, indicated for a first IVF/ICSI treatment cycle, with normal findings at transvaginal sonography. Women with recurrent miscarriages, prior hysteroscopy treatment and intermenstrual blood loss will not be included. Participants will be randomised for a routine fertility work-up with additional (SIS and hysteroscopy with on-the-spot-treatment of predefined intrauterine abnormalities versus the regular fertility work-up without additional diagnostic tests. The primary study outcome is the cumulative ongoing pregnancy rate resulting in live birth achieved within 18 months of IVF/ICSI treatment after randomisation. Secondary study outcome parameters are the cumulative implantation rate; cumulative miscarriage rate; patient preference and patient tolerance of a SIS and hysteroscopy procedure. All data will be analysed according to the intention-to-treat principle

  11. The inSIGHT study: costs and effects of routine hysteroscopy prior to a first IVF treatment cycle. A randomised controlled trial.

    Science.gov (United States)

    Smit, Janine G; Kasius, Jenneke C; Eijkemans, Marinus J C; Koks, Carolien A M; Van Golde, Ron; Oosterhuis, Jurjen G E; Nap, Annemiek W; Scheffer, Gabrielle J; Manger, Petra A P; Hoek, Annemiek; Kaplan, Mesrure; Schoot, Dick B C; van Heusden, Arne M; Kuchenbecker, Walter K H; Perquin, Denise A M; Fleischer, Kathrin; Kaaijk, Eugenie M; Sluijmer, Alexander; Friederich, Jaap; Laven, Joop S E; van Hooff, Marcel; Louwe, Leonie A; Kwee, Janet; Boomgaard, Jantien J; de Koning, Corry H; Janssen, Ineke C A H; Mol, Femke; Mol, Ben W J; Torrance, Helen L; Broekmans, Frank J M

    2012-08-08

    In in vitro fertilization (IVF) and intracytoplasmatic sperm injection (ICSI) treatment a large drop is present between embryo transfer and occurrence of pregnancy. The implantation rate per embryo transferred is only 30%. Studies have shown that minor intrauterine abnormalities can be found in 11-45% of infertile women with a normal transvaginal sonography or hysterosalpingography. Two randomised controlled trials have indicated that detection and treatment of these abnormalities by office hysteroscopy after two failed IVF cycles leads to a 9-13% increase in pregnancy rate. Therefore, screening of all infertile women for intracavitary pathology prior to the start of IVF/ICSI is increasingly advocated. In absence of a scientific basis for such a policy, this study will assess the effects and costs of screening for and treatment of unsuspected intrauterine abnormalities by routine office hysteroscopy, with or without saline infusion sonography (SIS), prior to a first IVF/ICSI cycle. Multicenter randomised controlled trial in asymptomatic subfertile women, indicated for a first IVF/ICSI treatment cycle, with normal findings at transvaginal sonography. Women with recurrent miscarriages, prior hysteroscopy treatment and intermenstrual blood loss will not be included. Participants will be randomised for a routine fertility work-up with additional (SIS and) hysteroscopy with on-the-spot-treatment of predefined intrauterine abnormalities versus the regular fertility work-up without additional diagnostic tests. The primary study outcome is the cumulative ongoing pregnancy rate resulting in live birth achieved within 18 months of IVF/ICSI treatment after randomisation. Secondary study outcome parameters are the cumulative implantation rate; cumulative miscarriage rate; patient preference and patient tolerance of a SIS and hysteroscopy procedure. All data will be analysed according to the intention-to-treat principle, using univariate and multivariate logistic regression and

  12. Extending the GI Brokering Suite to Support New Interoperability Specifications

    Science.gov (United States)

    Boldrini, E.; Papeschi, F.; Santoro, M.; Nativi, S.

    2014-12-01

    The GI brokering suite provides the discovery, access, and semantic Brokers (i.e. GI-cat, GI-axe, GI-sem) that empower a Brokering framework for multi-disciplinary and multi-organizational interoperability. GI suite has been successfully deployed in the framework of several programmes and initiatives, such as European Union funded projects, NSF BCube, and the intergovernmental coordinated effort Global Earth Observation System of Systems (GEOSS). Each GI suite Broker facilitates interoperability for a particular functionality (i.e. discovery, access, semantic extension) among a set of brokered resources published by autonomous providers (e.g. data repositories, web services, semantic assets) and a set of heterogeneous consumers (e.g. client applications, portals, apps). A wide set of data models, encoding formats, and service protocols are already supported by the GI suite, such as the ones defined by international standardizing organizations like OGC and ISO (e.g. WxS, CSW, SWE, GML, netCDF) and by Community specifications (e.g. THREDDS, OpenSearch, OPeNDAP, ESRI APIs). Using GI suite, resources published by a particular Community or organization through their specific technology (e.g. OPeNDAP/netCDF) can be transparently discovered, accessed, and used by different Communities utilizing their preferred tools (e.g. a GIS visualizing WMS layers). Since Information Technology is a moving target, new standards and technologies continuously emerge and are adopted in the Earth Science context too. Therefore, GI Brokering suite was conceived to be flexible and accommodate new interoperability protocols and data models. For example, GI suite has recently added support to well-used specifications, introduced to implement Linked data, Semantic Web and precise community needs. Amongst the others, they included: DCAT: a RDF vocabulary designed to facilitate interoperability between Web data catalogs. CKAN: a data management system for data distribution, particularly used by

  13. Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies.

    Science.gov (United States)

    Sunkara, Sesh Kamal; Khalaf, Yacoub; Maheshwari, Abha; Seed, Paul; Coomarasamy, Arri

    2014-06-01

    Is there a relationship between ovarian reserve, quantified as ovarian response to stimulation, and miscarriage rate following IVF treatment? There is a strong association between the number of oocytes retrieved and miscarriage rate following IVF treatment, with the miscarriage rate decreasing with an increasing number of oocytes and then levelling off: poor responders have a higher miscarriage rate across all age groups. Poor ovarian response is a manifestation of a decline in the quantity of the primordial follicle pool. Whether poor ovarian response is associated with a decline in oocyte quality contributing to miscarriage is however debated. Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA), the statutory regulator of assisted reproduction treatment (ART) in the UK. The HFEA has collected data on all ART performed in the UK since 1991. Data from 1991 to June 2008 involving 402 185 stimulated fresh IVF cycles and 124 351 pregnancy outcomes were analysed. Data on all women undergoing a stimulated fresh IVF treatment cycle with at least one oocyte retrieved during the period from 1991 to June 2008 were analysed for their early pregnancy outcomes. There was a strong association between the number of oocytes retrieved and the clinical miscarriage rate. The miscarriage rate fell from 20 to 13% with an increasing number of oocytes before levelling off. Stepwise logistic regression identified three cut-off points (4, 10 and 15 oocytes) at or beyond which the probability of clinical miscarriage fell. There was no increase in miscarriage rate with very high oocyte numbers (>20 oocytes). The lowest risk of miscarriage (9.9%) was for women under 38 years of age, with primary infertility without a female cause and producing more than three oocytes. Although the analysis was performed only on stimulated IVF cycles (excluding unstimulated cycles), the data had the limitation that there was no information on the total gonadotrophin

  14. Using an Acculturation-Stress-Resilience Framework to Explore Latent Profiles of Latina/o Language Brokers.

    Science.gov (United States)

    Kam, Jennifer A; Marcoulides, Katerina M; Merolla, Andy J

    2017-12-01

    With survey data from 243 Latina/o early adolescent language brokers, latent profile analyses were conducted to identify different types (i.e., profiles) of brokers. Profiles were based on how often Latina/o early adolescents brokered for family members, as well as their levels of family-based acculturation stress, negative brokering beliefs, parentification, and positive brokering beliefs. Three brokering profiles emerged: (1) infrequent-ambivalents, (2) occasional-moderates, and (3) parentified-endorsers. Profile membership was significantly predicted by ethnic identification and brokering in a medical context. Respect, brokering at school, and brokering at home did not significantly predict profile membership. In addition, parentified-endorsers had more frequent perceived ethnic/racial discrimination and depressive symptoms than other profiles. In contrast, infrequent-ambivalents engaged in risky behaviors less frequently than other profiles. © 2017 The Authors. Journal of Research on Adolescence © 2017 Society for Research on Adolescence.

  15. The Effect of Body Mass Index on the Outcome of IVF/ICSI Cycles in Non Polycystic Ovary Syndrome Women

    Directory of Open Access Journals (Sweden)

    Ashraf Moini

    2008-01-01

    Full Text Available Background: The aim of this study was to investigate the effect of body mass index (BMI onthe outcome of in vitro fertilization (IVF/ intracytoplasmic sperm injection (ICSI cycles in nonpolycystic ovary syndrome (PCOs women.Materials and Methods: In this cross sectional study, 287 infertile non PCOs women referred toRoyan institute, Tehran, Iran between 2002 and 2003 were enrolled. Patients with age≥40 years oldor BMI <20 Kg/m2 were excluded. All of patients underwent IVF or ICSI cycles. The outcome ofassisted reproductive technology (ART were compared between three groups: patients with 20≤BMI≤25 (normal weight group; patients with 25< BMI≤30 (over weight and patients with BMImore than 30 Kg/m2 (obese group. ANOVA, T test, Chi-square and logistic regression were used foranalysis.P value less than 0.05 was considered as significant level.Results: One hundred thirty three (46.3% subjects had normal BMI, 117 women (40.8% wereoverweight and 37 women (12.9% were obese. Obese group had lower pregnancy rate (13.5%in comparision to normal (29.3% and overweight (21.4% groups although this difference wasnot statistically significant (p=0.09. Chi square analysis showed that normal weight women hadsignificantly higher regular mensturation (p=0.02. The logestic regression analysis showed that BMIsignificantly affects on pregnancy rate of ART cycles in non PCOs women (p=0.038.Conclusion: The finding of this study suggested that in non PCOs women, BMI had independentadverse effect on the pregnancy rate of IVF/ICSI cycles.

  16. Supporting people with disabilities in managing individual budgets: the role of support brokers.

    Science.gov (United States)

    Quach, Emma D; O'Connor, Darlene Dee; McGaffigan, Erin

    2010-01-01

    Nationwide people with disabilities are self-directing their long-term care supports through individual budgets. Because these individuals may rely on a "support broker" to assist them in making and executing decisions regarding their budgets, the interactions between the participant and the support broker can influence participant autonomy. Massachusetts piloted a program for 14 participants to receive individual budgets for home and community-based services. Central to this pilot were the participant-designated support brokers, including home care case managers and peer advocates. Analysis of data on participants and support brokers indicated that the support brokers struggled with when, how, and how much to assist participants to self-direct. Case managers or other providers assuming the support broker's role will need proper training if they are to respond skillfully to challenging situations self-direction may bring.

  17. A Review on Broker Based Cloud Service Model

    Directory of Open Access Journals (Sweden)

    Nagarajan Rajganesh

    2016-09-01

    Full Text Available Cloud computing emerged as a utility oriented computing that facilitates resource sharing under pay-as-you-go model. Nowadays, cloud offerings are not limited to range of services and anything can be shared as a service through the Internet. In this work, a detailed literature survey with respect to cloud service discovery and composition has been accounted. A proposed architecture with the inclusion of cloud broker is presented in our work. It focuses the importance of suitable service selection and its ranking towards fulfilling the customer’s service requirements. The proposed cloud broker advocates techniques such as reasoning and decision making capabilities for the improved cloud service selection and composition.

  18. Developing brokered community transportation for seniors and people with disabilities.

    Science.gov (United States)

    Marx, Jerry; Davis, Christie; Miftari, Caitlin; Salamone, Anne; Weise, Wendy

    2010-01-01

    Communities are exploring ways to increase transportation coordination to improve access for seniors. One such effort is a brokered transportation system in which one agency serves as the central point of contact for ride information or actually arranging transportation for clients of multiple programs by use of a combination of transportation services. A team of social work faculty and students from the University of New Hampshire (UNH) Social Work Outreach Center, a center that provides service learning opportunities to students, collaborated with a local coalition to investigate the specific transportation needs of the region's senior citizens. A total of 641 people participated in the survey. Results indicate that the study population experiences problems reliably meeting daily living needs due to inconsistent or unavailable private and public transportation options. Study findings also indicate the promising potential of brokered transportation systems, particularly for isolated seniors in rural and suburban areas with relatively limited public and private transportation options.

  19. Towards a Brokering Framework for Business Process Execution

    Science.gov (United States)

    Santoro, Mattia; Bigagli, Lorenzo; Roncella, Roberto; Mazzetti, Paolo; Nativi, Stefano

    2013-04-01

    Advancing our knowledge of environmental phenomena and their interconnections requires an intensive use of environmental models. Due to the complexity of Earth system, the representation of complex environmental processes often requires the use of more than one model (often from different disciplines). The Group on Earth Observation (GEO) launched the Model Web initiative to increase present accessibility and interoperability of environmental models, allowing their flexible composition into complex Business Processes (BPs). A few, basic principles are at the base of the Model Web concept (Nativi, et al.): (i) Open access, (ii) Minimal entry-barriers, (iii) Service-driven approach, and (iv) Scalability. This work proposes an architectural solution, based on the Brokering approach for multidisciplinary interoperability, aiming to contribute to the Model Web vision. The Brokering approach is currently adopted in the new GEOSS Common Infrastructure (GCI) as was presented at the last GEO Plenary meeting in Istanbul, November 2011. We designed and prototyped a component called BP Broker. The high-level functionalities provided by the BP Broker are: • Discover the needed model implementations in an open, distributed and heterogeneous environment; • Check I/O consistency of BPs and provide suggestions for mismatches resolving: • Publish the EBP as a standard model resource for re-use. • Submit the compiled BP (EBP) to a WF-engine for execution. A BP Broker has the following features: • Support multiple abstract BP specifications; • Support encoding in multiple WF-engine languages. According to the Brokering principles, the designed system is flexible enough to support the use of multiple BP design (visual) tools, heterogeneous Web interfaces for model execution (e.g. OGC WPS, WSDL, etc.), and different Workflow engines. The present implementation makes use of BPMN 2.0 notation for BP design and jBPM workflow engine for eBP execution; however, the strong

  20. Nurses as Antibiotic Brokers: Institutionalized Praxis in the Hospital.

    Science.gov (United States)

    Broom, Alex; Broom, Jennifer; Kirby, Emma; Scambler, Graham

    2017-11-01

    We are likely moving rapidly toward a post-antibiotic era, as a result of escalating antimicrobial resistance, rapidly declining antibiotic production and profligate overuse. Hitherto research has almost exclusively focused on doctors' prescribing, with nurses' roles in antibiotic use remaining virtually invisible. Drawing on interviews with 30 nurses, we focus on nurses as brokers of doctors' antibiotic decisions, nursing capacity to challenge doctors' decisions, and, "back stage" strategies for circumnavigating organizational constraints. We argue that nurses occupy an essential and conscious position as brokers within the hospital; a subject position that is not neutral, facilitates (short-term) cohesion, and involves the pursuit of particular (preferred) nursing outcomes. Illustrating how authority can be diffuse, mediated by institutionalized praxis, and how professionals evade attempts to govern their practice, we challenge the reification of physician prescribing power, arguing that it may work against the utilization of nurses as important stakeholders in the future of antibiotics.

  1. Absence from work and emotional stress in women undergoing IVF or ICSI: an analysis of IVF-related absence from work in women and the contribution of general and emotional factors.

    Science.gov (United States)

    Bouwmans, Clazien A M; Lintsen, Bea A M E; Al, Maiwen; Verhaak, Chris M; Eijkemans, René J C; Habbema, J Dik F; Braat, Didi D M; Hakkaart-Van Roijen, Leona

    2008-01-01

    To assess productivity losses due to absence from work during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment and to describe the pattern of IVF-related absence from work. Additionally, the influence of general and psychological variables on IVF-related absence from work was analyzed. Prospective cohort study. Eight IVF hospitals participated in the study. Women undergoing their first treatment with IVF/ICSI. The Health and Labour Questionnaire (HLQ) was used to estimate the costs of IVF-related absence from work (n=384). Diaries were used to collect background information and reasons for IVF-related absence. Psychological data were derived using the Spielberger State and Trait Anxiety Inventory (STAI), the Beck Depression Inventory for Primary Care (BDI-PC) and the Inventory Social Relations and the Illness Cognition Questionnaire. Regression analyses were performed using two models, one without and one with psychological data, to assess the impact of the different variables on IVF-related absence from work. IVF-related absence from work and the costs of productivity losses due to IVF/ICSI per treatment. Overall absence from work during IVF/ICSI treatment was on average 33 hours, of which 23 hours were attributed to IVF/ICSI. Costs of productivity losses due to IVF/ICSI were euro596 per woman. Significant predictors of IVF-related absence from work were the number of hours of paid work, age and self-reported physical and/or emotional problems due to IFV treatment. Women experiencing emotional complaints and women with physical complaints due to IVF/ICSI reported significantly more IVF-related absence from work.

  2. Strengthening regional innovation through network-based innovation brokering

    OpenAIRE

    Svare, Helge; Gausdal, Anne Haugen

    2015-01-01

    The primary objective of this paper is to demonstrate how regional innovation system theory may be translated into manageable micro-level methods with the potential for strengthening the productive dynamics of a regional innovation system. The paper meets this objective by presenting network-based innovation brokering (NBIB), a practical method designed using insights from regional innovation system theory and trust theory. Five cases from two Norwegian regional innovation networks show that ...

  3. Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

    NARCIS (Netherlands)

    Tjon-Kon-Fat, R. I.; Bensdorp, A. J.; Bossuyt, P. M. M.; Koks, C.; Oosterhuis, G. J. E.; Hoek, A.; Hompes, P.; Broekmans, F. J.; Verhoeve, H. R.; de Bruin, J. P.; van Golde, R.; Repping, S.; Cohlen, B. J.; Lambers, M. D. A.; van Bommel, P. F.; Slappendel, E.; Perquin, D.; Smeenk, J.; Pelinck, M. J.; Gianotten, J.; Hoozemans, D. A.; Maas, J. W. M.; Groen, H.; Eijkemans, M. J. C.; van der Veen, F.; Mol, B. W. J.; van Wely, M.

    2015-01-01

    STUDY QUESTION: What is the cost-effectiveness of in vitro fertilization(IVF) with conventional ovarian stimulation, single embryotransfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation

  4. Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

    NARCIS (Netherlands)

    Tjon-Kon-Fat, R. I.; Bensdorp, A. J.; Bossuyt, P. M M; Koks, C.; Oosterhuis, G. J E; Hoek, A.; Hompes, P.; Broekmans, F. J.; Verhoeve, H. R.; De Bruin, J. P.; Van Golde, R.; Repping, S.; Cohlen, B. J.; Lambers, M. D A; Van Bommel, P. F.; Slappendel, E.; Perquin, D.; Smeenk, J.; Pelinck, M. J.; Gianotten, J.; Hoozemans, D. A.; Maas, J. W M; Groen, H.; Eijkemans, M. J C; Van Der Veen, F.; Mol, B. W J; Van Wely, M.

    2015-01-01

    STUDY QUESTION What is the cost-effectiveness of in vitro fertilization (IVF) with conventional ovarian stimulation, single embryo transfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation

  5. Oocytes with a dark zona pellucida demonstrate lower fertilization, implantation and clinical pregnancy rates in IVF/ICSI cycles.

    Directory of Open Access Journals (Sweden)

    Wei Shi

    Full Text Available The morphological assessment of oocytes is important for embryologists to identify and select MII oocytes in IVF/ICSI cycles. Dysmorphism of oocytes decreases viability and the developmental potential of oocytes as well as the clinical pregnancy rate. Several reports have suggested that oocytes with a dark zona pellucida (DZP correlate with the outcome of IVF treatment. However, the effect of DZP on oocyte quality, fertilization, implantation, and pregnancy outcome were not investigated in detail. In this study, a retrospective analysis was performed in 268 infertile patients with fallopian tube obstruction and/or male factor infertility. In 204 of these patients, all oocytes were surrounded by a normal zona pellucida (NZP, control group, whereas 46 patients were found to have part of their retrieved oocytes enclosed by NZP and the other by DZP (Group A. In addition, all oocytes enclosed by DZP were retrieved from 18 patients (Group B. No differences were detected between the control and group A. Compared to the control group, the rates of fertilization, good quality embryos, implantation and clinical pregnancy were significantly decreased in group B. Furthermore, mitochondria in oocytes with a DZP in both of the two study groups (A and B were severely damaged with several ultrastructural alterations, which were associated with an increased density of the zona pellucida and vacuolization. Briefly, oocytes with a DZP affected the clinical outcome in IVF/ICSI cycles and appeared to contain more ultrastructural alterations. Thus, DZP could be used as a potential selective marker for embryologists during daily laboratory work.

  6. Absence from work and emotional stress in women undergoing IVF or ICSI: an analysis of IVF-related absence from work in women and the contribution of general and emotional factors.

    NARCIS (Netherlands)

    Bouwmans, C.A.; Lintsen, A.M.E.; Al, M.; Verhaak, C.M.; Eijkemans, R.J.; Habbema, J.D.F.; Braat, D.D.M.; Hakkaart-van Roijen, L.

    2008-01-01

    OBJECTIVE: To assess productivity losses due to absence from work during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment and to describe the pattern of IVF-related absence from work. Additionally, the influence of general and psychological variables on IVF-related

  7. A longitudinal study investigating the role of decisional conflicts and regret and short-term psychological adjustment after IVF treatment failure.

    Science.gov (United States)

    Chan, Celia Hoi Yan; Lau, Hi Po Bobo; Tam, Michelle Yi Jun; Ng, Ernest Hung Yu

    2016-12-01

    What is the relationship between decisional conflict, decisional regret and psychological well-being in women following unsuccessful IVF cycles? The mediating effect of decisional regret on the relationship between decisional conflict and fertility-related quality of life (FRQOL) has been found to be moderated by the availability (versus absence) of frozen embryos after an unsuccessful IVF cycle. Infertility treatment is marked by its open-ended nature. Stresses in treatment decision-making could be aggravated by a culture which honours families through procreation. While studies have investigated treatment-related decision-making among infertile women, little is known about the mental health consequences of decisional conflict and decisional regret following an unsuccessful IVF cycle. A study was conducted over a 3-month period with infertile women who had recently experienced a failed IVF cycle (T 0 ). Decisional conflict when they decided on terminating or continuing treatment (T 1 ) and decisional regret 3 months later (T 2 ) were measured. Participants reported their levels of depression, anxiety and FRQOL at three time points. A total of 151 participants completed all time points (attrition rate: 39%). The average age of participants was 37.2 years, and they had had 1.1 cycles (range: 0-8) on average at the time of study intake. The duration of the study was 2 years. Participants were infertile women who were not pregnant following an IVF cycle recruited from a university-affiliated assisted reproduction centre. Following the notification of a negative pregnancy result, patients were invited to complete measures of FRQOL, depression and anxiety across three time points and decisional conflict and decisional regret at T 1 and T 2 respectively. Decisional regret partially mediated the effect of decisional conflict on overall and treatment-specific FRQOL (P IVF cycle (P IVF cycle. Healthcare professionals should be aware of the psychological ramifications of

  8. Determinants and consequences of child culture brokering in families from the former Soviet Union.

    Science.gov (United States)

    Jones, Curtis J; Trickett, Edison J; Birman, Dina

    2012-09-01

    Child culture brokering occurs when immigrant children help their families navigate the new culture and language. The present study develops a model of the child culture broker role that situates it within the family and community economic and acculturative contexts of 328 families from the former Soviet Union. Path analysis was utilized to explore the relationships of community and family economic and cultural contexts with child culture brokering, child emotional distress, and family disagreements. All children reported some culture brokering for their parents. Less English proficient parents with lower status jobs, and living in areas with more Russian speaking families tended to utilize their children as brokers more often. Further, community economic conditions also predicted brokering indirectly, mediated by parent job social status. Brokering was related to child emotional distress and family disagreements. Further, culture brokering was a mediator of the impact of parent job social status on both child emotional distress and family disagreements. These results add to our understanding of the culture broker role and emphasize the utility of approaching research on it from an ecological perspective.

  9. Taikongs and Calos: the role of middlemen and brokers in Javanese international migration.

    Science.gov (United States)

    Spaan, E

    1994-01-01

    "This article discusses international migration from Java in the past and present and the role brokers have played in stimulating this movement. It describes legal and clandestine labor migration to Singapore, Malaysia, and Saudi Arabia, the influence of employment brokers on the process, and the organization of the recruitment networks. The involvement of brokers is crucial but not always beneficial for the migrants. Migrants are dependent on the brokers and risk exploitation. In the case of movement to Saudi Arabia, there is a linkage with religious institutions and the Islamic pilgrimage." excerpt

  10. Vanishing twins: a predictor of small-for-gestational age in IVF singletons

    DEFF Research Database (Denmark)

    Pinborg, Anja; Lidegaard, Ojvind; Freiesleben, Nina la Cour

    2007-01-01

    The purpose of this study was to assess the effect of a vanishing twin on the risk of being small-for-gestational age (SGA) in in vitro fertilization (IVF) singletons.......The purpose of this study was to assess the effect of a vanishing twin on the risk of being small-for-gestational age (SGA) in in vitro fertilization (IVF) singletons....

  11. Effects of subfertility cause, smoking and body weight on the success rate of IVF

    NARCIS (Netherlands)

    Lintsen, A.M.E.; Pasker-Jong, P.C.M. de; Boer, E.J. de; Burger, C.W.; Jansen, C.A.M.; Braat, D.D.M.; Leeuwen, F.E. van; Kortman, M.; Velde, E.R. te; Macklon, N.; Jansen, C.A.M.; Leerentveld, R.A.; Willemsen, W.N.P.; Schats, R.; Naaktgeboren, N.; Helmerhorst, F.M.; Bots, R.S.G.M.; Simons, A.H.M.; Hogerzeil, H.V.; Evers, J.L.H.; Dop, P.A. van

    2005-01-01

    Background: We investigated the separate and combined effects of smoking and body mass index (BMI) on the success rate of IVF for couples with different causes of subfertility. Methods: The success rate of IVF was examined in 8457 women. Detailed information on reproduction and lifestyle factors was

  12. Can women have children and a career? IV evidence from IVF treatments

    NARCIS (Netherlands)

    Lundborg, P.; Plug, E.; Rasmussen, A.W.

    This paper introduces a new IV strategy based on IVF (in vitro fertilization) induced fertility variation among childless women to estimate the causal effect of having children on their career. For this purpose, we use administrative data on IVF treated women in Denmark. Because observed chances of

  13. Costs and benefits of individuals conceived after IVF : a net tax evaluation in The Netherlands

    NARCIS (Netherlands)

    Moolenaar, L. M.; Connolly, M.; Huisman, B.; Postma, M. J.; Hompes, P. G. A.; van der Veen, F.; Mol, B. W. J.

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received

  14. Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands

    NARCIS (Netherlands)

    Moolenaar, L. M.; Connolly, M.; Huisman, B.; Postma, M. J.; Hompes, P. G. A.; van der Veen, F.; Mol, B. W. J.

    2014-01-01

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received

  15. An international survey of the health economics of IVF and ICSI.

    Science.gov (United States)

    Collins, JohnA

    2002-01-01

    The health economics of IVF and ICSI involve assessments of utilization, cost, cost-effectiveness and ability to pay. In 48 countries, utilization averaged 289 IVF/ICSI cycles per million of population per annum, ranging from two in Kazachstan, to 1657 in Israel. Higher national utilization of IVF/ICSI was associated with higher quality of health services, as indicated by lower infant mortality rates. IVF and ICSI are scientifically demanding and personnel-intensive, and are therefore expensive procedures. The average cost per IVF/ICSI cycle in 2002 would be US$9547 in the USA, and US$3518 in 25 other countries. Price elasticity estimates suggest that a 10% decrease in IVF/ICSI cost would generate a 30% increase in utilization. The average cost-effectiveness ratios in 2002 would be US$58,394 per live birth in the USA, and US$22,048 in other countries. In three randomized controlled trials, incremental costs per additional live birth with IVF compared with conventional therapy were US$ -26,586, $79,472 and $47,749. The national costs of IVF/ICSI treatment would be US$1.00 per capita in one current model, but the costs to individual couples range from 10% of annual household expenditures in European countries to 25% in Canada and the USA.

  16. New Reproductive Assemblages: Understanding, Managing and ‘Using’ Human In Vitro Fertilization (IVF)

    NARCIS (Netherlands)

    Just, E.M.

    2009-01-01

    This dissertation is a contribution to the ongoing discussion about the body and in vitro fertilization (IVF), also known as assisted reproduction or technologically enhanced reproduction. With help of empirical research on Dutch and Polish IVF-couples, Edyta Just puts into question the meaning of

  17. Cosmopolitan conceptions in global Dubai? The emiratization of IVF and its consequences

    Directory of Open Access Journals (Sweden)

    Marcia C. Inhorn

    2016-06-01

    Full Text Available IVF in the United Arab Emirates (UAE is decidedly cosmopolitan, catering to an international clientele who are attracted to Dubai as a booming global city and an emerging medical tourism hub. Yet this Emirati state-sponsored project of medical cosmopolitanism exists in tension with another state-sponsored project, called emiratization. Emiratization is an attempt by the UAE government to prioritize the needs of Emiratis. In this article, the emiratization of the UAE’s IVF sector is explored. Since the mid-2000s, the Emirati IVF sector has undergone a series of profound transformations, involving the indigenization-qua-emiratization of IVF services in the country. Two main aspects of IVF emiratization are examined. The first involves the Emirati government’s brief experiment with IVF public financing, which started off as a generous IVF subsidization programme for all infertile couples, but ended up solidifying preferential treatment for local Emiratis. The second is the 2010 passage of UAE Federal Law No. 11, which now stands as one of the world’s most restrictive pieces of assisted reproduction legislation. Which now stands as one of the world's most restrictive pieces of assisted reproduction legislation and has fundamentally altered the landscape of IVF in the country.

  18. Assisted reproduction professionals' awareness and attitudes towards their own IVF cycles.

    Science.gov (United States)

    Bonetti, T C S; Melamed, R M M; Braga, D P A F; Madaschi, C; Iaconelli, A; Pasqualotto, F F; Borges, E

    2008-12-01

    Professionals involved in assisted reproductive technologies (ART) have in-depth awareness and knowledge of the risks of multiple pregnancies at the conclusion of in vitro fertilization (IVF) treatment. The aim of the study was to investigate ART professionals' attitudes towards the awareness of the risk of infertility, as well as the decision-making process in IVF issues. Seventy ART professionals answered a questionnaire covering demographic data, infertility awareness and attitudes towards IVF. Approximately half (50.8%) of the participants thought that they were not at risk of infertility. However, if they received a diagnosis of infertility, none would accept childlessness and almost all would undergo IVF. In an IVF cycle, the number of high-quality embryos transferred would be around three, but if treatment was extended to a third cycle, a higher percentage of participants would elect to transfer four or more embryos. All participants would prefer to undergo IVF and accept the risk of multiple pregnancy than remaining childless. It was found that less than a third of ART professionals considered triplets to be an unacceptable complication of IVF. Diagnosis of infertility affects all participants psychosocially, supporting the idea that the emotional aspects of wanting a biological child, and decision making about whether to undertake ART, outweigh the medical position regarding the risks and benefits of IVF.

  19. Effectiveness of indometacin to prevent ovulation in modified natural-cycle IVF : A randomized controlled trial

    NARCIS (Netherlands)

    Rijken-Zijlstra, T. M.; Haadsma, M. L.; Hammer, C.; Burgerhof, J. G. M.; Pelinck, M. J.; Simons, A. H. M.; van Echten-Arends, J.; Arts, J. G. E. M.; Land, J. A.; Groen, H.; Hoek, A.

    Modified natural-cycle IVF has a lower pregnancy rate per started cycle as compared with IVF with ovarian stimulation due to, for example, premature ovulation. Indometacin administered before ovulation prevents follicle rupture. Therefore, addition of indometacin may improve the effectiveness of

  20. Depolarization of sperm membrane potential is a common feature of men with subfertility and is associated with low fertilization rate at IVF.

    Science.gov (United States)

    Brown, Sean G; Publicover, Stephen J; Mansell, Steven A; Lishko, Polina V; Williams, Hannah L; Ramalingam, Mythili; Wilson, Stuart M; Barratt, Christopher L R; Sutton, Keith A; Da Silva, Sarah Martins

    2016-06-01

    Are significant abnormalities in outward (K(+)) conductance and resting membrane potential (Vm) present in the spermatozoa of patients undertaking IVF and ICSI and if so, what is their functional effect on fertilization success? Negligible outward conductance (≈5% of patients) or an enhanced inward conductance (≈4% of patients), both of which caused depolarization of Vm, were associated with a low rate of fertilization following IVF. Sperm-specific potassium channel knockout mice are infertile with defects in sperm function, suggesting that these channels are essential for fertility. These observations suggest that malfunction of K(+) channels in human spermatozoa might contribute significantly to the occurrence of subfertility in men. However, remarkably little is known of the nature of K(+) channels in human spermatozoa or the incidence and functional consequences of K(+) channel defects. Spermatozoa were obtained from healthy volunteer research donors and subfertile IVF and ICSI patients attending a hospital assisted reproductive techniques clinic between May 2013 and December 2015. In total, 40 IVF patients, 41 ICSI patients and 26 normozoospermic donors took part in the study. Samples were examined using electrophysiology (whole-cell patch clamping). Where abnormal electrophysiological characteristics were identified, spermatozoa were further examined for Ca(2+) influx induced by progesterone and penetration into viscous media if sufficient sample was available. Full exome sequencing was performed to specifically evaluate potassium calcium-activated channel subfamily M α 1 (KCNMA1), potassium calcium-activated channel subfamily U member 1 (KCNU1) and leucine-rich repeat containing 52 (LRRC52) genes and others associated with K(+) signalling. In IVF patients, comparison with fertilization rates was done to assess the functional significance of the electrophysiological abnormalities. Patch clamp electrophysiology was used to assess outward (K

  1. [OVARIAN RESERVE AND EFFECTIVENESS OF IVF IN WOMEN OF VARIOUS AGE GROUPS].

    Science.gov (United States)

    Sayadyan, A; Totoyan, E

    2017-01-01

    The purpose of this study is a comparative assessment of ovarian reserve parameters and the effect of these indices on the features of follicle and oogenesis in women of different age groups. A retrospective analysis of IVF results was conducted in 101 patients aged 21 to 49 years. All patients were divided into 4 groups according to age: I group up to 30 y.o. - 45 women, II group - 31-35 y.o - 14 women, III group - 36-40 y.o. - 26 women, IV Group - 41 or more - 16 women. A low ovarian reserve was found in the majority (84,6%) of women in group III and in all women in group IV. It was found that the lowest total dose of rFSH / hMG was used in women aged 21-30 years and 31-35 years, and in women in the age range of 36-40 years, the consumption of drugs was significantly higher and tended to further increase in the age group 41 аnd more years. A large consumption of rFSH/hMG is necessary to overcome the growing FSH level in the process of aging of the reproductive system and the reduced AMH level. However, at the same time, compared age groups had significant differences in the number of oocytes and embryos obtained. With age, a significant reduction in the number of mature oocytes and embryos obtained after follicle puncture and fertilization has been identified. The most promising in terms of pregnancy were the I and II groups. With age, the frequency of pregnancy decreased. The number of pregnancies was statistically lower in the III age group compared to groups I and II. In the IV group, no cases of pregnancy were recorded. Thus, it can be concluded that age is a statistically significant factor affecting the success of infertility treatment by IVF.

  2. Brokering technologies to realize the hydrology scenario in NSF BCube

    Science.gov (United States)

    Boldrini, Enrico; Easton, Zachary; Fuka, Daniel; Pearlman, Jay; Nativi, Stefano

    2015-04-01

    In the National Science Foundation (NSF) BCube project an international team composed of cyber infrastructure experts, geoscientists, social scientists and educators are working together to explore the use of brokering technologies, initially focusing on four domains: hydrology, oceans, polar, and weather. In the hydrology domain, environmental models are fundamental to understand the behaviour of hydrological systems. A specific model usually requires datasets coming from different disciplines for its initialization (e.g. elevation models from Earth observation, weather data from Atmospheric sciences, etc.). Scientific datasets are usually available on heterogeneous publishing services, such as inventory and access services (e.g. OGC Web Coverage Service, THREDDS Data Server, etc.). Indeed, datasets are published according to different protocols, moreover they usually come in different formats, resolutions, Coordinate Reference Systems (CRSs): in short different grid environments depending on the original data and the publishing service processing capabilities. Scientists can thus be impeded by the burden of discovery, access and normalize the desired datasets to the grid environment required by the model. These technological tasks of course divert scientists from their main, scientific goals. The use of GI-axe brokering framework has been experimented in a hydrology scenario where scientists needed to compare a particular hydrological model with two different input datasets (digital elevation models): - the Advanced Spaceborne Thermal Emission and Reflection Radiometer (ASTER) dataset, v.2. - the Shuttle Radar Topography Mission (SRTM) dataset, v.3. These datasets were published by means of Hyrax Server technology, which can provide NetCDF files at their original resolution and CRS. Scientists had their model running on ArcGIS, so the main goal was to import the datasets using the available ArcPy library and have EPSG:4326 with the same resolution grid as the

  3. Influence of embryo culture medium (G5 and HTF) on pregnancy and perinatal outcome after IVF: a multicenter RCT

    NARCIS (Netherlands)

    Kleijkers, Sander H. M.; Mantikou, Eleni; Slappendel, Els; Consten, Dimitri; van Echten-Arends, Jannie; Wetzels, Alex M.; van Wely, Madelon; Smits, Luc J. M.; van Montfoort, Aafke P. A.; Repping, Sjoerd; Dumoulin, John C. M.; Mastenbroek, Sebastiaan

    2016-01-01

    Does embryo culture medium influence pregnancy and perinatal outcome in IVF? Embryo culture media used in IVF affect treatment efficacy and the birthweight of newborns. A wide variety of culture media for human preimplantation embryos in IVF/ICSI treatments currently exists. It is unknown which

  4. Influence of embryo culture medium (G5 and HTF) on pregnancy and perinatal outcome after IVF : a multicenter RCT

    NARCIS (Netherlands)

    Kleijkers, Sander H. M.; Mantikou, Eleni; Slappendel, Els; Consten, Dimitri; van Echten - Arends, Jannie; Wetzels, Alex M.; van Wely, Madelon; Smits, Luc J. M.; van Montfoort, Aafke P. A.; Repping, Sjoerd; Dumoulin, John C. M.; Mastenbroek, Sebastiaan

    2016-01-01

    Does embryo culture medium influence pregnancy and perinatal outcome in IVF? Embryo culture media used in IVF affect treatment efficacy and the birthweight of newborns. A wide variety of culture media for human preimplantation embryos in IVF/ICSI treatments currently exists. It is unknown which

  5. Reducing twin pregnancy rates after IVF--elective single embryo transfer (eSET).

    LENUS (Irish Health Repository)

    Milne, P

    2010-01-01

    Multiple pregnancy is a major complication of IVF and is associated with increased maternal, fetal and neonatal morbidity. Elective single embryo transfer (eSET) during IVF, rather than the more standard transfer of two embryos (double embryo transfer or DET), has been shown to significantly reduce the multiple pregnancy rate associated with IVF, while maintaining acceptable pregnancy rates. Couples undergoing IVF in 2008 who met good prognostic criteria had eSET performed. Pregnancy and twinning rates were compared with those for similar couples in 2007 who had DET. Couples unsuccessful with a fresh cycle of treatment had subsequent frozen embryo transfer cycles with DET. The cumulative pregnancy rate was similar for each group. However there were no multiple pregnancies in the eSET group, compared to 4 twins of 5 pregnancies in the DET group. 96% of eligible couples agreed to eSET. ESET is successful in and acceptable to good prognosis Irish couples undergoing IVF.

  6. Semantic Mediation via Access Broker: the OWS-9 experiment

    Science.gov (United States)

    Santoro, Mattia; Papeschi, Fabrizio; Craglia, Massimo; Nativi, Stefano

    2013-04-01

    Even with the use of common data models standards to publish and share geospatial data, users may still face semantic inconsistencies when they use Spatial Data Infrastructures - especially in multidisciplinary contexts. Several semantic mediation solutions exist to address this issue; they span from simple XSLT documents to transform from one data model schema to another, to more complex services based on the use of ontologies. This work presents the activity done in the context of the OGC Web Services Phase 9 (OWS-9) Cross Community Interoperability to develop a semantic mediation solution by enhancing the GEOSS Discovery and Access Broker (DAB). This is a middleware component that provides harmonized access to geospatial datasets according to client applications preferred service interface (Nativi et al. 2012, Vaccari et al. 2012). Given a set of remote feature data encoded in different feature schemas, the objective of the activity was to use the DAB to enable client applications to transparently access the feature data according to one single schema. Due to the flexible architecture of the Access Broker, it was possible to introduce a new transformation type in the configured chain of transformations. In fact, the Access Broker already provided the following transformations: Coordinate Reference System (CRS), spatial resolution, spatial extent (e.g., a subset of a data set), and data encoding format. A new software module was developed to invoke the needed external semantic mediation service and harmonize the accessed features. In OWS-9 the Access Broker invokes a SPARQL WPS to retrieve mapping rules for the OWS-9 schemas: USGS, and NGA schema. The solution implemented to address this problem shows the flexibility and extensibility of the brokering framework underpinning the GEO DAB: new services can be added to augment the number of supported schemas without the need to modify other components and/or software modules. Moreover, all other transformations (CRS

  7. Patients' Preference for Number of Embryos Transferred During IVF ...

    African Journals Online (AJOL)

    Background: The Human Fertilization and Embryology Authority is considering limiting the number of embryos that can be transferred to single embryo per cycle as has been done in several European countries, with the aim of reducing the rate of multiple pregnancies and its attendant complications following in vitro ...

  8. Prospective Randomized Study on the Influence of Myoinositol in PCOS Women Undergoing IVF in the Improvement of Oocyte Quality, Fertilization Rate, and Embryo Quality

    Directory of Open Access Journals (Sweden)

    Bernd Lesoine

    2016-01-01

    Full Text Available Polycystic ovarian syndrome (PCOS is one of the pathological factors involved in the failure of in vitro fertilization (IvF. The aim of the present study was to investigate if the combination of myoinositol + folic acid was able to improve the oocyte quality, the ratio between follicles and retrieved oocytes, the fertilization rate, and the embryo quality in PCOS patients undergoing IvF treatments. 29 patients with PCOS underwent IvF protocols for infertility treatment and were randomized prospectively into two groups. Group A (placebo with 15 patients and group B (4000 mg myoinositol + 400 μg folic acid per day with 14 patients. The patients of group B used for two months myoinositol + folic acid before starting the IvF protocol and data were obtained concerning number of follicles, number of oocytes, quality of oocytes, fertilization rates, and embryo quality in both groups. The ratio follicle/retrieved oocyte was better in the myoinositol group (= group B. Out of the 233 oocytes collected in the myoinositol group 136 were fertilized, whereas only 128 out of 300 oocytes in the placebo group were fertilized. More metaphase II and I oocytes were retrieved in relation to the total amount of oocytes in the myoinositol. More embryos of grade I quality were obtained in the myoinositol. The duration of stimulation was 9,7 days (±3,3 in the myoinositol group and 11,2 (±1,8 days in the placebo group and the number of used FSH units was lower in the myoinositol group: 1750 FSH units (mean versus 1850 units (mean. Our evidence suggests that myoinositol therapy in women with PCOS results in better fertilization rates and a clear trend to a better embryo quality. As the number of retrieved oocytes was smaller in the myoinositol group, the risk of hyper stimulation syndrome can be reduced in these patients.

  9. Successful Pregnancy Outcome in Women with Recurrent IVF Failure and Anti-hCG Autoimmunity: A Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Valeria Muller

    2016-01-01

    Full Text Available We report three cases of effective management of infertility in women with a history of repeated unsuccessful IVF attempts, who have developed antibodies to hCG. A novel approach to conservative treatment of immunologic reproductive failure, suggested for selected patients, included membrane plasmapheresis, combined prednisolone, and intravenous immunoglobulin therapy. No adverse side effects were observed; all cases resulted in pregnancy and subsequent life births. In order to be given an adequate efficient treatment, women with recurrent implantation failure should be suspected for autoimmune factor of infertility and its possible association with anti-hCG autoimmunity.

  10. High gonadotropin dosage does not affect euploidy and pregnancy rates in IVF PGS cycles with single embryo transfer.

    Science.gov (United States)

    Barash, Oleksii O; Hinckley, Mary D; Rosenbluth, Evan M; Ivani, Kristen A; Weckstein, Louis N

    2017-11-01

    Does high gonadotropin dosage affect euploidy and pregnancy rates in PGS cycles with single embryo transfer? High gonadotropin dosage does NOT affect euploidy and pregnancy rates in PGS cycles with single embryo transfer. PGS has been proven to be the most effective and reliable method for embryo selection in IVF cycles. Euploidy and blastulation rates decrease significantly with advancing maternal age. In order to recruit an adequate number of follicles, the average dosage of gonadotropins administered during controlled ovarian stimulation in IVF cycles often increases significantly with advancing maternal age. A retrospective study of SNP (Single Nucleotide Polymorphism) PGS outcome data from blastocysts biopsied on day 5 or day 6 was conducted to identify differences in euploidy and clinical pregnancy rates. Seven hundred and ninety four cycles of IVF treatment with PGS between January 2013 and January 2017 followed by 651 frozen embryo transfers were included in the study (506 patients, maternal age (y.o.) - 37.2 ± 4.31). A total of 4034 embryos were analyzed (5.1 ± 3.76 per case) for euploidy status. All embryos were vitrified after biopsy, and selected embryos were subsequently thawed for a hormone replacement frozen embryo transfer cycle. All cycles were analyzed by total gonadotropin dosage (5000 IU), by number of eggs retrieved (1-5, 5-10, 10-15 and >15 eggs) and patient's age (cycles) euploidy rates ranged from 62.3% (cycle) to 67.5% (>5000 IU were used in the IVF cycle) (OR = 0.862, 95% CI 0.687-1.082, P = 0.2) and from 69.5% (1-5 eggs retrieved) to 60.0% (>15 eggs retrieved) (OR = 0.658, 95% CI 0.405-1.071, P = 0.09). Similar data were obtained in the oldest group of patients (≥41 y.o. - 189 IVF cycles): euploidy rates ranged from 30.7 to 26.4% (OR = 0.811, 95% CI 0.452-1.454, P = 0.481) when analyzed by total dosage of gonadotropins used in the IVF cycle and from 40.0 to 30.7% (OR = 0.531, 95% CI 0.204-1.384, P = 0.19), when assessed by the total

  11. Implementing PGD/PGD-A in IVF clinics: considerations for the best laboratory approach and management.

    Science.gov (United States)

    Capalbo, Antonio; Romanelli, Valeria; Cimadomo, Danilo; Girardi, Laura; Stoppa, Marta; Dovere, Lisa; Dell'Edera, Domenico; Ubaldi, Filippo Maria; Rienzi, Laura

    2016-10-01

    For an IVF clinic that wishes to implement preimplantation genetic diagnosis for monogenic diseases (PGD) and for aneuploidy testing (PGD-A), a global improvement is required through all the steps of an IVF treatment and patient care. At present, CCS (Comprehensive Chromosome Screening)-based trophectoderm (TE) biopsy has been demonstrated as a safe, accurate and reproducible approach to conduct PGD-A and possibly also PGD from the same biopsy. Key challenges in PGD/PGD-A implementation cover genetic and reproductive counselling, selection of the most efficient approach for blastocyst biopsy as well as of the best performing molecular technique to conduct CCS and monogenic disease analysis. Three different approaches for TE biopsy can be compared. However, among them, the application of TE biopsy approaches, entailing the zona opening when the expanded blastocyst stage is reached, represent the only biopsy methods suited with a totally undisturbed embryo culture strategy (time lapse-based incubation in a single media). Moreover, contemporary CCS technologies show a different spectrum of capabilities and limits that potentially impact the clinical outcomes, the management and the applicability of the PGD-A itself. In general, CCS approaches that avoid the use of whole genome amplification (WGA) can provide higher reliability of results with lower costs and turnaround time of analysis. The future perspectives are focused on the scrupulous and rigorous clinical validations of novel CCS methods based on targeted approaches that avoid the use of WGA, such as targeted next-generation sequencing technology, to further improve the throughput of analysis and the overall cost-effectiveness of PGD/PGD-A.

  12. The Effects of ISM1 Medium on Embryo Quality and Outcomes of IVF/ICSI Cycles.

    Science.gov (United States)

    Hassani, Fatemeh; Eftekhari-Yazdi, Poopak; Karimian, Leila; Rezazadeh Valojerdi, Mojtaba; Movaghar, Bahar; Fazel, Mohammad; Fouladi, Hamid Reza; Shabani, Fatemeh; Johansson, Lars

    2013-07-01

    The aim of this study is to investigate the effect of ISM1 culture medium on embryo development, quality and outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This study compares culture medium commonly used in the laboratory setting for oocyte recovery and embryo development with a medium from MediCult. We have assessed the effects of these media on embryo development and newborn characteristics. In this prospective randomized study, fertilized oocytes from patients were randomly assigned to culture in ISM1 (MediCult, cycles: n=293) or routine lab culture medium (G-1TM v5; Vitrolife, cycles: n=290) according to the daily media schedule for oocyte retrieval. IVF or ICSI and embryo transfer were performed with either MediCult media or routine lab media. Embryo quality on days 2/3, cleavage, pregnancy and implantation rates, baby take home rate (BTHR), in addition to the weight and length of newborns were compared between groups. There were similar cleavage rates for ISM1 (86%) vs. G-1TM v5 (88%). We observed a significantly higher percentage of excellent embryos in ISM1 (42.7%) compared to G-1TM v5 (39%, pISM1 had both higher birth weight (3.03 kg) and length (48.8 cm) compared to G-1TM v5 babies that had a birth weight of 2.66 kg and a length of 46.0 cm (pISM1 is a more effective culture medium in generating higher quality embryos, which may be reflected in the characteristics of babies at birth.

  13. The Effects of ISM1 Medium on Embryo Quality and Outcomes of IVF/ICSI Cycles

    Directory of Open Access Journals (Sweden)

    Fatemeh Shabani

    2013-01-01

    Full Text Available Background: The aim of this study is to investigate the effect of ISM1 culture mediumon embryo development, quality and outcomes of in vitro fertilization/intracytoplasmicsperm injection (IVF/ICSI cycles. This study compares culture medium commonly usedin the laboratory setting for oocyte recovery and embryo development with a mediumfrom MediCult. We have assessed the effects of these media on embryo development andnewborn characteristics.Materials and Methods: In this prospective randomized study, fertilized oocytesfrom patients were randomly assigned to culture in ISM1 (MediCult, cycles:n=293 or routine lab culture medium (G-1TM v5; Vitrolife, cycles: n=290 accordingto the daily media schedule for oocyte retrieval. IVF or ICSI and embryotransfer were performed with either MediCult media or routine lab media. Embryoquality on days 2/3, cleavage, pregnancy and implantation rates, baby take homerate (BTHR, in addition to the weight and length of newborns were comparedbetween groups.Results: There were similar cleavage rates for ISM1 (86% vs. G-1TM v5 (88%. Weobserved a significantly higher percentage of excellent embryos in ISM1 (42.7% comparedto G-1TM v5 (39%, p<0.05. Babies born after culture in ISM1 had both higherbirth weight (3.03 kg and length (48.8 cm compared to G-1TM v5 babies that had a birthweight of 2.66 kg and a length of 46.0 cm (p<0.001 for both.Conclusion: This study suggests that ISM1 is a more effective culture medium ingenerating higher quality embryos, which may be reflected in the characteristics ofbabies at birth.

  14. The diversity of regulation and public financing of IVF in Europe and its impact on utilization.

    Science.gov (United States)

    Berg Brigham, K; Cadier, B; Chevreul, K

    2013-03-01

    How do the different forms of regulation and public financing of IVF affect utilization in otherwise similar European welfare state systems? Countries with more liberal social eligibility regulations had higher levels of IVF utilization, which diminished as the countries' policies became more restrictive. Europe is a world leader in the development and utilization of IVF, yet surveillance reveals significant differences in uptake among countries which have adopted different approaches to the regulation and and public financing of IVF. A descriptive and comparative analysis of legal restrictions on access to IVF in 13 of the EU15 countries that affirmatively regulate and publicly finance IVF. Using 2009 data from the European Society of Human Reproduction and Embryology study of regulatory frameworks in Europe and additional legislative research, we examined and described restrictions on access to IVF in terms of general eligibility, public financing and the scope of available services. Multiple correspondence analysis was used to identify patterns of regulation and groups of countries with similar regulatory patterns and to explore the effects on utilization of IVF, using data from the most recent European and international IVF monitoring reports. Regulations based on social characteristics of treatment seekers who are not applicable to other medical treatments, including relationship status and sexual orientation, appear to have the greatest impact on utilization. Countries with the most generous public financing schemes tend to restrict access to covered IVF to a greater degree. However, no link could be established between IVF utilization and the manner in which coverage was regulated or the level of public financing. Owing to the lack of data regarding the actual level of public versus private financing of IVF it is impossible to draw conclusions regarding equity of access. Moreover, the regulatory and utilization data were not completely temporally matched in

  15. Design and implementation of a secure and user-friendly broker platform supporting the end-to-end provisioning of e-homecare services.

    Science.gov (United States)

    Van Hoecke, Sofie; Steurbaut, Kristof; Taveirne, Kristof; De Turck, Filip; Dhoedt, Bart

    2010-01-01

    We designed a broker platform for e-homecare services using web service technology. The broker allows efficient data communication and guarantees quality requirements such as security, availability and cost-efficiency by dynamic selection of services, minimizing user interactions and simplifying authentication through a single user sign-on. A prototype was implemented, with several e-homecare services (alarm, telemonitoring, audio diary and video-chat). It was evaluated by patients with diabetes and multiple sclerosis. The patients found that the start-up time and overhead imposed by the platform was satisfactory. Having all e-homecare services integrated into a single application, which required only one login, resulted in a high quality of experience for the patients.

  16. No common denominator: a review of outcome measures in IVF RCTs.

    Science.gov (United States)

    Wilkinson, Jack; Roberts, Stephen A; Showell, Marian; Brison, Daniel R; Vail, Andy

    2016-12-01

    Which outcome measures are reported in RCTs for IVF? Many combinations of numerator and denominator are in use, and are often employed in a manner that compromises the validity of the study. The choice of numerator and denominator governs the meaning, relevance and statistical integrity of a study's results. RCTs only provide reliable evidence when outcomes are assessed in the cohort of randomised participants, rather than in the subgroup of patients who completed treatment. Review of outcome measures reported in 142 IVF RCTs published in 2013 or 2014. Trials were identified by searching the Cochrane Gynaecology and Fertility Specialised Register. English-language publications of RCTs reporting clinical or preclinical outcomes in peer-reviewed journals in the period 1 January 2013 to 31 December 2014 were eligible. Reported numerators and denominators were extracted. Where they were reported, we checked to see if live birth rates were calculated correctly using the entire randomised cohort or a later denominator. Over 800 combinations of numerator and denominator were identified (613 in no more than one study). No single outcome measure appeared in the majority of trials. Only 22 (43%) studies reporting live birth presented a calculation including all randomised participants or only excluding protocol violators. A variety of definitions were used for key clinical numerators: for example, a consensus regarding what should constitute an ongoing pregnancy does not appear to exist at present. Several of the included articles may have been secondary publications. Our categorisation scheme was essentially arbitrary, so the frequencies we present should be interpreted with this in mind. The analysis of live birth denominators was post hoc. There is massive diversity in numerator and denominator selection in IVF trials due to its multistage nature, and this causes methodological frailty in the evidence base. The twin spectres of outcome reporting bias and analysis of non

  17. Does freeze-all policy affect IVF outcomes in poor responders?

    Science.gov (United States)

    Roque, Matheus; Valle, Marcello; Sampaio, Marcos; Geber, Selmo

    2017-12-27

    To evaluate whether the freeze-all strategy affects in vitro fertilization (IVF) outcomes in poor ovarian responders following the Bologna criteria. We performed a retrospective cohort study conducted between January 2012 and December 2016. A total of 433 poor responders (per the Bologna criteria) fulfilled the inclusion/exclusion criteria and were included in the study, with 277 patients included in the fresh group and 156 in the freeze-all group. All patients were submitted to controlled ovarian stimulation (COS) with a gonadotropin-releasing hormone antagonist protocol and cleavage-stage embryo transfer (ET). The main outcome measure was ongoing pregnancy rate. Secondary outcomes included implantation and clinical pregnancy rates. The freeze-all strategy was implemented when the progesterone serum level was >1.5 ng/mL on the trigger day, when the endometrium was <7 mm on the trigger day, or as a patient preference. Patients with previous failed fresh embryo transfer were also submitted to fresh or freeze-all strategy considering the indications mentioned above. The patients' mean age in the freeze-all group was 39.5±3.6 years, while that of patients in the fresh group was 39.7±3.8 years (P=0.54). The mean number of embryos transferred (nET) was 1.53±0.6 and 1.60±0.6 (P=0.12) in the freeze-all and fresh groups, respectively. Ongoing pregnancy rates did not significantly differ between the freeze-all and fresh groups (9.6% versus 10.1%, respectively; Relative Risk [RR]: 0.95; 95% CI: 0.52-1.73), nor did the clinical pregnancy rates (14.1% versus 13.7%, respectively; RR: 1.03; 95% CI: 0.63-1.76). Implantation rates were 9.6% and 9.8% (P=0.82) in the freeze-all and fresh groups, respectively. The logistic regression analysis (including age, antral follicle count [AFC], the number of retrieved oocytes, the number of mature oocytes, nET, and fresh versus freeze-all strategy) indicated that age (P<0.001) and the nET (P=0.039) were the only independent variables

  18. Language Brokering, Acculturation, and Empowerment: Evidence from South Asian Canadian Young Adults

    Science.gov (United States)

    Cila, Jorida; Lalonde, Richard N.

    2015-01-01

    The present study examined the practice of language brokering (LB) among South Asian Canadian college-age adults and how such practice relates to acculturation to mainstream and heritage cultures, as well as personal empowerment. One hundred and twenty-four young adults reported on three different indices of LB (brokering frequency, diversity of…

  19. Teacher-as-Knowledge-Broker in a Futures-Oriented Health and Physical Education

    Science.gov (United States)

    Macdonald, Doune

    2015-01-01

    The concept of brokering is usually aligned with a business model of an intermediary helping the customer/client with their decisions/choices. As knowledge becomes increasingly accessible, and of varied origins, quality and veracity, the number of professionals engaged in knowledge brokering is simultaneously increasing. This paper considers if…

  20. 75 FR 69791 - Risk Management Controls for Brokers or Dealers With Market Access

    Science.gov (United States)

    2010-11-15

    ... relationship with the ultimate customer, can more effectively implement them. In addition, a broker or dealer... specific risk management controls and supervisory procedures to a customer that is a registered broker... such customer, based on its position in the transaction and relationship with the ultimate customer...

  1. 75 FR 71723 - Policies and Procedures Pertaining to Changes in Listing Brokers Participating in the Federal...

    Science.gov (United States)

    2010-11-24

    ... estate brokers may participate as Listing or Selling brokers under FHA's Management and Marketing III (M... disposition of its REO inventory to private sector contractors under the Management and Marketing (M&M..., program support, management and marketing services throughout the United States, the Caribbean, Guam and...

  2. 78 FR 23116 - Basis Reporting by Securities Brokers and Basis Determination for Debt Instruments and Options...

    Science.gov (United States)

    2013-04-18

    ... in the burden on Form 1099-B, ``Proceeds from Broker and Barter Exchange Transactions,'' when revised... not provide them sufficient time to build and test the systems required to implement the reporting... to allow brokers to test and refine their reporting systems. In response to these comments, as was...

  3. 78 FR 48458 - Notice of Reinstatement of Revoked Customs Broker Licenses

    Science.gov (United States)

    2013-08-08

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Reinstatement of Revoked Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, Department of Homeland Security. ACTION: Reinstatement of customs broker licenses that were erroneously revoked. SUMMARY: CBP...

  4. 77 FR 25729 - Notice of Correction of Revoked Customs Broker Licenses

    Science.gov (United States)

    2012-05-01

    ... DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection Notice of Correction of Revoked Customs Broker Licenses AGENCY: U.S. Customs and Border Protection, U.S. Department of Homeland Security... Customs broker licenses were inadvertently revoked without prejudice on November 18, 2011. See Notice of...

  5. 76 FR 78182 - Basis Reporting by Securities Brokers and Basis Determination for Debt Instruments and Options...

    Science.gov (United States)

    2011-12-16

    ... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [REG-102988-11] RIN 1545-BK05 Basis Reporting by Securities Brokers and Basis Determination for Debt Instruments and Options..., November 25, 2011 (76 FR 72652) relating to reporting by brokers for transactions related to debt...

  6. Health Brokers: How Can They Help Deal with the Wickedness of Public Health Problems?

    Science.gov (United States)

    van Rinsum, Celeste E; Gerards, Sanne M P L; Rutten, Geert M; van de Goor, Ien A M; Kremers, Stef P J

    2017-01-01

    The role of health broker is a relatively new one in public health. Health brokers aim to create support for efforts to optimise health promotion in complex or even "wicked" public health contexts by facilitating intersectoral collaborations and by exchanging knowledge with different stakeholders. The current study aimed to explore the role of health brokers, by examining the motivational, contextual, and behaviour-related factors they have to deal with. Fifteen professionals from various backgrounds and from various policy and practice organisations were recruited for a semistructured interview. To structure the interviews, we developed the "Health Broker Wheel" (HBW), a framework we then specified with more details derived from the interviews. We identified seven primary types of behaviour that health brokers need to engage in: recognizing opportunities, agenda setting, implementing, network formation, intersectoral collaboration, adaptive managing, and leadership. Determinants of health brokers' behaviours were identified and categorised as capability, opportunities, motivation, and local or national contextual factors. The health brokers' role can be seen as an operational approach and is visualised in the HBW. This framework can assist further research to monitor and evaluate this role, and health promotion practitioners can use it as a tool to implement the health brokers' role and to facilitate intersectoral collaboration.

  7. Living in/between Two Worlds: Narratives of Latina Cultural Brokers in Higher Education

    Science.gov (United States)

    Lando, Jennifer Rose

    2015-01-01

    The purpose of this narrative study was to explore how Latina cultural brokers understand their role in translating and interpreting complex, adult situations for their families, called cultural brokering, and how that background shapes their collegiate experiences. While much of the higher education literature in recent years has focused on the…

  8. 26 CFR 1.6045-1T - Returns of information of brokers and barter exchanges (temporary).

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 13 2010-04-01 2010-04-01 false Returns of information of brokers and barter exchanges (temporary). 1.6045-1T Section 1.6045-1T Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF... of information of brokers and barter exchanges (temporary). (a)-(k) [Reserved] For further guidance...

  9. Health brokers : How can they help deal with the wickedness of public health problems?

    NARCIS (Netherlands)

    Van Rinsum, C.E.; Gerards, S.M.P.L.; Rutten, G.J.M.; Van De Goor, L.A.M.; Kremers, S.P.J.

    Background The role of health broker is a relatively new one in public health. Health brokers aim to create support for efforts to optimise health promotion in complex or even “wicked” public health contexts by facilitating intersectoral collaborations and by exchanging knowledge with different

  10. 13 CFR 107.1640 - SBA access to records of the CRA, Brokers, Dealers and Pool or Trust assemblers.

    Science.gov (United States)

    2010-01-01

    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA access to records of the CRA, Brokers, Dealers and Pool or Trust assemblers. 107.1640 Section 107.1640 Business Credit and Assistance... records of the CRA, Brokers, Dealers and Pool or Trust assemblers. The CRA and any broker, dealer and Pool...

  11. 7 CFR 4290.1640 - Secretary's access to records of the CRA, Brokers, Dealers and Pool or Trust assemblers.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Secretary's access to records of the CRA, Brokers, Dealers and Pool or Trust assemblers. 4290.1640 Section 4290.1640 Agriculture Regulations of the... to records of the CRA, Brokers, Dealers and Pool or Trust assemblers. The CRA and any broker, dealer...

  12. 17 CFR 240.10b-3 - Employment of manipulative and deceptive devices by brokers or dealers.

    Science.gov (United States)

    2010-04-01

    ... deceptive devices by brokers or dealers. 240.10b-3 Section 240.10b-3 Commodity and Securities Exchanges... Contrivances § 240.10b-3 Employment of manipulative and deceptive devices by brokers or dealers. (a) It shall be unlawful for any broker or dealer, directly or indirectly, by the use of any means or...

  13. 49 CFR 385.14 - Motor carriers, brokers, and freight forwarders delinquent in paying civil penalties: prohibition...

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Motor carriers, brokers, and freight forwarders....14 Motor carriers, brokers, and freight forwarders delinquent in paying civil penalties: prohibition... commerce under 49 CFR 386.83. (b) A broker, freight forwarder, or for-hire motor carrier that has failed to...

  14. 17 CFR 240.15c1-3 - Misrepresentation by brokers, dealers and municipal securities dealers as to registration.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Misrepresentation by brokers...-The-Counter Markets § 240.15c1-3 Misrepresentation by brokers, dealers and municipal securities..., as used in section 15(c)(1) of the Act, is hereby defined to include any representation by a broker...

  15. 31 CFR 103.17 - Reports by futures commission merchants and introducing brokers in commodities of suspicious...

    Science.gov (United States)

    2010-07-01

    ... merchants and introducing brokers in commodities of suspicious transactions. 103.17 Section 103.17 Money and... merchants and introducing brokers in commodities of suspicious transactions. (a) General—(1) Every futures commission merchant (“FCM”) and introducing broker in commodities (“IB-C”) within the United States shall...

  16. To operate or not to operate on women with deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF)

    Science.gov (United States)

    Carneiro, Márcia Mendonça; Costa, Luciana Maria Pyramo; de Ávila, Ivete

    2017-01-01

    Deep infiltrating endometriosis (DIE) can cause infertility and pelvic pain. There is little evidence of a clear connection between DIE and infertility, and the absolute benefits of surgery for DIE have not been established. This paper aimed to review the current literature on the effect of surgery for DIE on fertility, pregnancy, and IVF outcomes. Clinicians should bear in mind that a comprehensive clinical history is useful to identify patients at risk for endometriosis, although many women remain asymptomatic. Imaging can be useful to plan surgery. The effect of surgery on the fertility of women with DIE remains unanswered due to the heterogeneous nature of the disease and the lack of trials with enough statistical power and adequate follow-up. Surgery is not recommended when the main goal is to treat infertility or to improve IVF results. Decisions should be tailored according to the individual needs of each woman. Patients must be provided information on the potential benefits, harm, and costs of each treatment alternative, while the medical team observes factors such as presence of pelvic pain, patient age, lesion location, and previous treatments. In this scenario, management by a multidisciplinary endometriosis team is a key step to achieving successful outcomes. PMID:28609279

  17. The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET outcome

    Directory of Open Access Journals (Sweden)

    Al-Rejjal Rafat

    2008-09-01

    Full Text Available Abstract Background To evaluate the relationship between endometrial thickness on day of human chorionic gonadotrophin administration (hCG and pregnancy outcome in a large number of consecutive in vitro fertilization and embryo transfer (IVF-ET cycles. Methods A retrospective cohort study including all patients who had IVF-ET from January 2003–December 2005 conducted at a tertiary center. Results A total of 2464 cycles were analysed. Pregnancy rate (PR was 35.8%. PR increased linearly (r = 0.864 from 29.4% among patients with a lining of less than or equal to 6 mm, to 44.4% among patients with a lining of greater than or equal to 17 mm. ROC showed that endometrial thickness is not a good predictor of PR, so a definite cut-off value could not be established (AUC = 0.55. Conclusion There is a positive linear relationship between the endometrial thickness measured on the day of hCG injection and PR, and is independent of other variables. Hence aiming for a thicker endometrium should be considered.

  18. Toward an Intelligent Event Broker: Automated Transient Classificaiton

    Science.gov (United States)

    Wozniak, P.

    In order to succeed, the massive time-domain surveys of the future must automatically identify actionable information from the torrent of imaging data, classify emerging events, and optimize the follow-up strategy. To address this challenge, we are developing a fully autonomous, distributed event broker that will integrate cutting edge machine learning algorithms with high performance computing infrastructure. The talk will give an overview of this work and recent progress on image level variability detection and spectral classification using low resolution spectra.

  19. GEOSS authentication/authorization services: a Broker-based approach

    Science.gov (United States)

    Santoro, M.; Nativi, S.

    2014-12-01

    The vision of the Global Earth Observation System of Systems (GEOSS) is the achievement of societal benefits through voluntary contribution and sharing of resources to better understand the relationships between the society and the environment where we live. The GEOSS Common Infrastructure (GCI) allows users to search, access, and use the resources contributed by the GEOSS members. The GEO DAB (Discovery and Access Broker) is the GCI component in charge of interconnecting the heterogeneous data systems contributing to GEOSS. Client applications (i.e. the portals and apps) can connect to GEO DAB as a unique entry point to discover and access resources available through GCI, with no need to implement the many service protocols and models applied by the GEOSS data providers. The GEO DAB implements the brokering approach (Nativi et al., 2013) to build a flexible and scalable System of Systems. User authentication/authorization functionality is becoming more and more important for GEOSS data providers and users. The Providers ask for information about who accessed their resources and, in some cases, want to limit the data download. The Users ask for a profiled interaction with the system based on their needs and expertise level. Besides, authentication and authorization is necessary for GEOSS to provide moderated social services - e.g. feedback messages, data "fit for use" comments, etc. In keeping with the GEOSS principles of building on existing systems and lowering entry-barriers for users, an objective of the authentication/authorization development was to support existing and well-used users' credentials (e.g. Google, Twitter, etc.). Due to the heterogeneity of technologies used by the different providers and applications, a broker-based approach for the authentication/authorization was introduced as a new functionality of GEO DAB. This new capability will be demonstrated at the next GEO XI Plenary (November 2014). This work will be presented and discussed

  20. Environmental risk assessors as honest brokers or stealth advocates.

    Science.gov (United States)

    Calow, Peter

    2014-11-01

    Risk assessment ought to provide a solid, evidence base to risk management in the development of environmental policy and decisions, where the risk assessors act without advocacy as honest brokers of science advice. But there are concerns that the values of the risk assessors might undermine the objectivity of the process. For similar reasons, there is suspicion that more interaction between risk assessors and risk managers might contaminate the science. On the contrary, here the argument is that making risk assessment more management- and value-relevant, through more effective dialogue, provides a better foundation for objective science advice.

  1. Long-term economic benefits attributed to IVF-conceived children: a lifetime tax calculation.

    Science.gov (United States)

    Connolly, Mark P; Pollard, Michael S; Hoorens, Stijn; Kaplan, Brian R; Oskowitz, Selwyn P; Silber, Sherman J

    2008-09-01

    To evaluate whether lifetime future net tax revenues from an in vitro fertilization (IVF)-conceived child are substantial enough to warrant public subsidy relative to the mean IVF treatment costs required to obtain 1 live birth. Mathematical generational accounting model. The model estimates direct financial interactions between the IVF-conceived child and the government during the child's projected lifetime. In the model, we accrue IVF costs required to conceive the child to the government, and then we estimate future net tax revenue to the federal and state governments from this individual, offset by direct financial transfers from the government (eg, child allowances, education, Medicare, and Social Security). We discount lifetime costs and gross tax payments at Treasury Department rates to establish the present value of investing in IVF. We applied US Congressional Budget Office projected changes in tax rates over the course of the model. An IVF-conceived child, average in every respect (eg, future earnings, healthcare consumption, and life expectancy), represents a net positive return to the government. Based on an average employed individual born in 2005, the projected net lifetime tax contribution is US $606,200. Taking into consideration IVF costs and all direct financial interactions, the net present value is US $155,870. Lifetime net taxes paid from a child relative to the child's initial IVF investment represent a 700% net return to the government in discounted US dollars from fully employed individuals. This suggests that removing barriers to IVF would have positive tax benefits for the government, notwithstanding its beneficial effect on overall economic growth.

  2. RCT to evaluate the influence of adjuvant medical treatment of peritoneal endometriosis on the outcome of IVF.

    Science.gov (United States)

    Decleer, W; Osmanagaoglu, K; Verschueren, K; Comhaire, F; Devroey, P

    2016-09-01

    Does a 3-month adjuvant hormonal treatment of mild peritoneal endometriosis after laparoscopic surgery influence the outcome of IVF stimulation in terms of number of mature oocytes obtained per cycle? Complementary medical treatment of mild peritoneal endometriosis does not influence the number of oocytes per treatment cycle. Endometriosis is a disease known to be related to infertility. However, the influence of superficial endometriosis-and its treatment-is still a matter of debate. A prospective controlled, randomized, open label trial was performed between February 2012 and March 2014 and embryological and clinical outcomes were measured. Patients with laparoscopically diagnosed peritoneal endometriosis (n= 120) were treated by laser surgery after which they were sequentially randomized by computer-generated allocation to one of the two groups. The primary outcome of the trial was the number of Metaphase II (MII) oocytes. Sample size was chosen to detect a difference of two MII oocytes with a power of 80%. The control group (Group B) received the classical long protocol IVF stimulation, whereas the research group (Group A) had an additional pituitary suppression, of 3 months using a long-acting GnRH agonist, prior to IVF. A total of 120 patients were included in the study, 61 of them in the study group and 59 patients in the control group. One patient of the control group was lost to follow up leading to 58 evaluable patients. There was no difference in terms of the number of MII oocytes obtained per cycle: 8.2 in both groups (difference in MII between A and B: 0.07 [-1.89; 2.04] 95% confidence interval (CI)). Pregnancy rate did not differ, being 39.3% for Group A (24 out of 61 patients) versus 39.7% for Group B (23 out of 58 patients) (95% CI around difference in pregnancy rate between A and B: -0.31% [-17.96%; 17.86%]). However, a significantly (P = 0.025) lower dose of FSH (2561 IU for Group A and 2303 IU for Group B, 95% CI around difference in FSH between

  3. The development of IVF practice in Ireland: a personal view.

    LENUS (Irish Health Repository)

    Harrison, Robert F

    2012-03-01

    This paper traces the development of in vitro fertilization (IVF) in the Republic of Ireland from when the first attempts at using this technique were carried out in 1985 up to the present. Clinical changes are chronicled principally using the personal work of the author and his colleagues as representative of the day. The impact of the Catholic Church and the alterations in Medical Council governance guidelines over the years as these reflect societal changes are highlighted. The potential role of other regulators including Irish case law and the EU Tissue directive are discussed as well as the almost invariable private practice nature of the services provided and the various ways in which costs have been alleviated.

  4. IVF and embryo transfer: historical origin and development.

    Science.gov (United States)

    Biggers, John D

    2012-08-01

    IVF and embryo transfer for the treatment of human infertility has now resulted in the birth of over 4 million babies. The technique did not arise as a quantum event but was built on the efforts of many earlier workers in the fields of reproductive endocrinology and development. One should remember the famous saying of Isaac Newton: 'If I have seen further than most, it is because I have stood on the shoulder's of giants'. Ethical and moral issues have always arisen when investigators study early mammalian development, particularly human development. This paper documents these earlier studies and also draws attention to the ethical and moral arguments that inevitably arose. Copyright © 2012 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  5. IVF culture medium affects post-natal weight in humans during the first 2 years of life.

    Science.gov (United States)

    Kleijkers, Sander H M; van Montfoort, Aafke P A; Smits, Luc J M; Viechtbauer, Wolfgang; Roseboom, Tessa J; Nelissen, Ewka C M; Coonen, Edith; Derhaag, Josien G; Bastings, Lobke; Schreurs, Inge E L; Evers, Johannes L H; Dumoulin, John C M

    2014-04-01

    Is post-natal growth during the first 2 years of life in IVF singletons affected by type of medium used for culturing human embryos during an IVF treatment? The in vitro culture of human embryos in medium from Cook resulted in singletons with a lower weight during the first 2 years of life compared with singletons born after embryo culture in medium from Vitrolife. In a previous study, we reported that type of medium used for culturing human IVF embryos during the first few days after fertilization until fresh embryo transfer significantly affects fetal growth and consequently birthweight of the resulting singletons. From July 2003 to December 2006, a total of 1432 IVF treatment cycles with fresh embryo transfer were randomly allocated to have all embryos cultured in medium from Vitrolife AB (n = 715) or from Cook (n = 717). Two years after delivery, questionnaires were sent to the parents of all children requesting data about weight, height and head circumference around 1, 2, 3, 4, 6, 7.5, 9, 11, 14, 18 and 24 months of age. These measurements were collected as part of the children's health programme at municipal infant welfare centres in the Netherlands by health professionals unaware of this study. Patients requiring donor oocytes or applying for PGD were excluded from the study. From the 294 live born singletons that fulfilled our inclusion criteria, 29 were lost to follow-up. The remaining 265 singletons (Cook group: 117, Vitrolife group: 148) were included in the analysis. Data analysis included linear regression, to compare cross-sectionally weight standard deviation score (SDS), height SDS and head circumference, and the first order Berkey-Reed model for a longitudinal analysis of the growth data. Singletons in the Vitrolife group were heavier during the first 2 years of life compared with singletons in the Cook group. Cross-sectional analyses showed that adjusted weight SDS differed between groups at 1 (0.35 ± 0.14, P = 0.010), 2 (0.39 ± 0.14, P = 0

  6. Knowledge brokers, companions, and navigators: a qualitative examination of informal caregivers' roles in medical tourism.

    Science.gov (United States)

    Casey, Victoria; Crooks, Valorie A; Snyder, Jeremy; Turner, Leigh

    2013-12-01

    Many studies examining the phenomena of medical tourism have identified health equity issues associated with this global health services practice. However, there is a notable lack of attention in this existing research to the informal care provided by the friends and family members who typically accompany medical tourists abroad. To date, researchers have not examined the care roles filled by informal caregivers travelling with medical tourists. In this article, we fill this gap by examining these informal caregivers and the roles they take on towards supporting medical tourists' health and wellbeing. We conducted 21 interviews with International Patient Coordinators (IPCs) working at medical tourism hospitals across ten countries. IPCs work closely with informal caregivers as providers of non-medical personal assistance, and can therefore offer broad insight on caregiver roles. The interviews were coded and analyzed thematically. Three roles emerged: knowledge broker, companion, and navigator. As knowledge brokers, caregivers facilitate the transfer of information between the medical tourist and formal health care providers as well as other staff members at medical tourism facilities. The companion role involves providing medical tourists with physical and emotional care. Meanwhile, responsibilities associated with handling documents and coordinating often complex journeys are part of the navigation role. This is the first study to examine informal caregiving roles in medical tourism. Many of the roles identified are similar to those of conventional informal caregivers while others are specific to the transnational context. We conclude that these roles make informal caregivers an integral part of the larger phenomenon of medical tourism. We further contend that examining the roles taken on by a heretofore-unconsidered medical tourism stakeholder group sheds valuable insight into how this industry operates and that such knowledge is necessary in order to respond to

  7. Metformin use in patients undergoing in vitro fertilization treatment: results of a worldwide web-based survey.

    Science.gov (United States)

    Christianson, Mindy S; Wu, Harold; Zhao, Yulian; Yemini, Matan; Leong, Milton; Shoham, Zeev

    2015-03-01

    To identify trends regarding therapeutic approaches to metformin administration in patients undergoing in vitro fertilization (IVF) treatment worldwide. A retrospective evaluation utilizing the results of a web-based survey, IVFWorldwide ( www.IVF-worldwide.com/ ), was performed. Responses from 101 centers performing a total of 50,800 annual IVF cycles was performed. Of these cycles, 10.4% (n = 5,260) reported metformin use during IVF cycles. Indications for metformin use in IVF cycles included polycystic ovary syndrome (PCOS) patients who were habitual abortions (67%), had prior poor egg quality (61%), had high serum insulin levels (56%). Less reported was PCOS with obesity/anvoulation (29%), PCOS with multiple manifestations (23%) and glucose intolerance and insulin resistance (23%). Over half of cycles (54%) treated patients with metformin up to 3 months prior to starting IVF. A majority (82%) of IVF cycles utilized 1500-2000 mg/day of metformin. A nearly equal percentage of centers continued metformin up to a positive β-HCG test (35%) or to 12 weeks gestation (33%). 70% of IVF cycles reported increased pregnancy rates and decreased miscarriage rates due to the use of metformin. 75% reported the data in the literature is not sufficient for reaching a definitive conclusion concerning metformin treatment in patients undergoing IVF. While metformin is used worldwide as an adjunct to standard IVF protocols, there is much variation in its use and the majority of centers report lack of evidence supporting its use.

  8. Low oocyte yield during IVF treatment and the risk of a trisomic pregnancy

    DEFF Research Database (Denmark)

    Honorato, Talita; Hoek, Annemieke; Henningsen, Anna-Karina

    2017-01-01

    A low number of antral follicles may result in the selection of suboptimal oocytes that are prone to meiotic errors. The aim of this case-control study was to evaluate women receiving IVF treatment with low oocyte yield (defined as three or fewer oocytes retrieved after ovarian stimulation) who...... are at an increased risk of a trisomic pregnancy. Data were obtained from Danish and Dutch medical registries between 1983 and 2011. Analyses were carried out in 105 cases and 442 controls matched by age and year of IVF treatment. Cases were women with a trisomic pregnancy (trisomies 13, 18 or 21) resulting from...... fresh IVF treatment and confirmed by karyotyping. Cases were included regardless of pregnancy outcome. Controls were women with a live born child without a trisomy, resulting from fresh IVF treatment. Low oocyte yield was observed in 6.6% (29/440) of the women, of which 8.4% (7/83) were cases and 6...

  9. Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic

    Science.gov (United States)

    Ehrlich, Shelley; Smith, Kristen; Williams, Paige L.; Chavarro, Jorge E.; Batsis, Maria; Toth, Thomas L.; Hauser, Russ

    2015-01-01

    Total hair mercury (Hg) was measured among 205 women undergoing in vitro fertilization (IVF) treatment and the association with prospectively collected IVF outcomes (229 IVF cycles) was evaluated. Hair Hg levels (median=0.62 ppm, range: 0.03-5.66 ppm) correlated with fish intake (r=0.59), and exceeded the recommended EPA reference of 1ppm in 33% of women. Generalized linear mixed models with random intercepts accounting for within-woman correlations across treatment cycles were used to evaluate the association of hair Hg with IVF outcomes adjusted for age, body mass index, race, smoking status, infertility diagnosis, and protocol type. Hair Hg levels were not related to ovarian stimulation outcomes (peak estradiol levels, total and mature oocyte yields) or to fertilization rate, embryo quality, clinical pregnancy rate or live birth rate. PMID:25601638

  10. Knowledge Brokers in the Making: Opportunities to Connect Researchers and Stakeholders

    Science.gov (United States)

    Pennell, K. G.; Pennell, M. C.

    2014-12-01

    Environmental science and engineering graduate students often lack training on how to communicate with policy decision makers who are grappling with questions to which research is responding. They communicate directly with mutual experts, but are many times unable to engage with non-experts about their research, thereby limiting the reach and impact of their findings. This presentation highlights opportunities within environmental science and engineering research to create opportunities for researchers to hone skills as knowledge brokers, so they learn ways to meaningfully engage with a range of stakeholders. A knowledge broker is an individual who connects scientific experts and relevant stakeholders with meaningful and useable information. Recognizing that information must flow in multiple directions, the knowledge broker must quickly and effectively translate needs and questions using established relationships. It is these relationships, as well as the synthesis of scientific knowledge into useable information, on which the success of the knowledge broker lies. Using lessons learned, as well as communication science theory related to knowledge brokering, this presentation highlights training opportunities for knowledge brokers who are primarily educated in science and engineering fields, yet seek to engage with societally relevant stakeholders. We present case study examples of knowledge brokering within two large multi-disciplinary research centers. These centers provide unique experiences for researchers to build relationships with stakeholders, so that the scientific experts not only create novel research within their specific discipline, but also inform policy decision makers, community members and regulatory officials.

  11. The vanishing twin: a major determinant of infant outcome in IVF singleton births

    DEFF Research Database (Denmark)

    Pinborg, Anja; Lidegaard, Ojvind; Andersen, Anders Nyboe

    2006-01-01

    This article attempts to assess the frequency of vanishing twins in assisted reproductive and spontaneously conceived pregnancies, including in-vitro fertilization (IVF), and its impact on the live-born surviving twin.......This article attempts to assess the frequency of vanishing twins in assisted reproductive and spontaneously conceived pregnancies, including in-vitro fertilization (IVF), and its impact on the live-born surviving twin....

  12. Establishing the role of honest broker: bridging the gap between protecting personal health data and clinical research efficiency

    Directory of Open Access Journals (Sweden)

    Hyo Joung Choi

    2015-12-01

    Full Text Available Background. The objective of this study is to propose the four conditions for the roles of honest brokers through a review of literature published by ten institutions that are successfully utilizing honest brokers. Furthermore, the study aims to examine whether the Asan Medical Center’s (AMC honest brokers satisfy the four conditions, and examine the need to enhance their roles.Methods. We analyzed the roles, tasks, and types of honest brokers at 10 organizations by reviewing the literature. We also established a Task Force (TF in our institution for setting the roles and processes of the honest broker system and the honest brokers. The findings of the literature search were compared with the existing systems at AMC—which introduced the honest broker system for the first time in Korea.Results. Only one organization employed an honest broker for validating anonymized clinical data and monitoring the anonymity verifications of the honest broker system. Six organizations complied with HIPAA privacy regulations, while four organizations did not disclose compliance. By comparing functions with those of the AMC, the following four main characteristics of honest brokers were determined: (1 de-identification of clinical data; (2 independence; (3 checking that the data are used only for purposes approved by the IRB; and (4 provision of de-identified data to researchers. These roles were then compared with those of honest brokers at the AMC.Discussion. First, guidelines that regulate the definitions, purposes, roles, and requirements for honest brokers are needed, since there are no currently existing regulations. Second, Korean clinical research institutions and national regulatory departments need to reach a consensus on a Korean version of Limited Data Sets (LDS, since there are no lists that describe the use of personal identification information. Lastly, satisfaction surveys on honest brokers by researchers are necessary to improve the quality of

  13. Brokers and brokerage in the process of trading in commodity futures markets

    Directory of Open Access Journals (Sweden)

    Eremić Milan B.

    2003-01-01

    Full Text Available This paper mainly deals with the analysis of a very complex process of brokerage in commodity futures markets. Unlike a classical commodity market in which brokers are not a necessity, sales and purchases in commodity futures markets cannot be carried out without brokers. Brokers who act as agents of buyers and sellers of futures are a necessary condition for trading in organized markets, such as commodity futures markets. The structure of brokers in futures trading is multilayer and involves participants in futures trading from floor brokers, immediate futures traders and the members of clearing and the clearing house itself, on the one hand, to numerous other necessary actors whose activities out of the stock exchange and the clearing house contribute to the efficient functioning of futures market. The fact that transactions between buyers and sellers in futures markets are not carried out directly but through brokers means that the obligations of buyers and sellers are formally conveyed to brokers, providing at the same time the guarantee by the broker that the actual buyer and the actual seller will fulfill their contractual obligations. At the very beginning of futures trading, the relationship between the seller and the buyer is transformed into a relationship between two brokers. Since that moment on, the original relationship is conveyed to higher levels of brokerage reaching the level of the clearing house. In the process of transformation of the buyer-seller relationship and transmitting obligations and guaranteeing their fulfillment, the clearing house itself becomes the buyer relative to all sellers and the seller relative to all buyers. In this way, it guarantees that obligations regarding all transactions in futures market will be fulfilled. The whole process is carried out in accordance with the prescribed procedures conducted on the floor of commodity exchange, in its administrative departments and in the clearing house itself.

  14. Prognosis and cost-effectiveness of IVF in poor responders according to the Bologna Criteria.

    Science.gov (United States)

    Busnelli, Andrea; Somigliana, Edgardo

    2018-02-01

    Poor ovarian response (POR) to controlled ovarian hyperstimulation for in vitro fertilization (IVF) is one of the most challenging issue in the field of reproductive medicine. However, even if improving IVF outcome in poor responders (PORs) represents a main priority, the lack of a unique definition of POR has hampered research in this area. In order to overcome this impediment, an ESHRE Campus Workshop was organized in Bologna in 2010 and reached a consensus on the criteria for the diagnosis of POR ("Bologna Criteria"). In this review we aimed to estimate the prognostic potential of the ESHRE definition, to elucidate its possible weaknesses and to analyze the economic aspects of IVF in a population of poor responders (PORs). Available evidence confirmed that the Bologna criteria are able to select a population with a poor IVF prognosis thus supporting their validity. Nonetheless, different aspects of the definition have been criticized. The main points of debate concern the homogeneity of the population identified, the cut-off values chosen for the ovarian reserve tests and the risks factors other than age associated with POR. Data concerning the economic profile of IVF in PORs are scanty. The only published study on the argument showed that IVF in these cases is not cost-effective. However, considering the potential substantial impact of cost-effectiveness analyses on public health policies, there is the need for further and independent validations.

  15. The incidence of histological chorioamnionitis in IVF/GIFT preterm births.

    Science.gov (United States)

    Williams, H; Jeffery, H

    1994-08-01

    A retrospective case control study was designed to investigate the role of subclinical infection as a risk factor for the high rate of preterm deliveries in IVF/GIFT pregnancies. The cases and the controls were identified from the records of consecutive livebirths of preclampsia and antepartum haemorrhage. As a marker of subclinical infection, the incidence of histological chorioamnionitis (HCA) in the 2 groups (as defined by the standardized, semiquantitative method of Benirschke) was compared. The matched variables did not differ significantly between the IVF/GIFT group and the control group. No significant difference in the incidence of HCA was detected between IVF/GIFT and control groups for singletons or twins. Overall 24% of IVF/GIFT and 30% of controls showed evidence of HCA, odds ratio (95% confidence intervals), 0.72 (0.40-1.31). This study showed no evidence that the incidence of HCA, is significantly increased in IVF/GIFT preterm births compared with other matched, preterm births. Therefore, we conclude that subclinical infection/inflammation cannot explain the 4-fold increase in preterm births in the IVF/GIFT population.

  16. Hemizona Assay and Sperm Penetration Assay in the Prediction of IVF Outcome: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Paraskevi Vogiatzi

    2013-01-01

    Full Text Available The limited predictive value of semen analysis in achieving natural conception or in IVF outcome confirms the need for sperm function tests to determine optimal management. We reviewed HZA and SPA predictive power in IVF outcome, with statistical significance of diagnostic power of the assays. HZA was readily efficient in predicting IVF outcome, while evident inconsistency among the studies analysed framed the SPA’s role in male fertility evaluation. Considerable variation was noted in the diagnostic accuracy values of SPA with wide sensitivity (52–100%, specificity (0–100%, and PPV (18–100% and NPV (0–100% together with fluctuation and notable differentiation in methodology and cutoff values employed by each group. HZA methodology was overall consistent with minor variation in cutoff values and oocyte source, while data analysis reported strong correlation between HZA results with IVF outcome, high sensitivity (75–100%, good specificity (57–100%, and high PPV (79–100% and NPV (68–100%. HZA correlated well with IVF outcome and demonstrated better sensitivity/specificity and positive/negative predictive power. Males with normal or slightly abnormal semen profiles could benefit by this intervention and could be evaluated prior to referral to assisted reproduction. HZA should be used in a sequential fashion with semen analysis and potentially other bioassays in an IVF setting.

  17. 40 years of bovine IVF in the new genomic selection context.

    Science.gov (United States)

    Sirard, Marc-Andre

    2018-04-10

    The development of a complex technology such as in vitro fertilization (IVF) requires years of experimentation, sometimes comparing several species to learn how to create the right in vitro environment for oocytes, spermatozoa, and early embryos. At the same time, individual species characteristics such as gamete physiology and gamete interaction are recently evolved traits and must be analysed within the context of each species. In the last 40 years since the birth of Louise Brown, IVF techniques progressed and are now used in multiple domestic and non-domestic animal species around the world. This does not mean that the technology is completely matured or satisfactory; a number of problems remain to be solved and several procedures still need to be optimized. The development of IVF in cattle is particularly interesting since agriculture practices permitted the commercial development of the procedure and it is now used at a scale comparable to human IVF (millions of newborns). The genomic selection of young animals or even embryos combined with sexing and freezing technologies is driving a new era of IVF in the Dairy sector. The time has come for a retrospective analysis of the success and pitfalls of the last 40 years of bovine IVF and for the description of the challenges to overcome in the years to come.

  18. Accurate and noninvasive embryos screening during in vitro fertilization (IVF) assisted by Raman analysis of embryos culture medium

    International Nuclear Information System (INIS)

    Shen, A G; Peng, J; Su, L; Wang, X H; Hu, J M; Zhao, Q H; Yang, J

    2012-01-01

    In combination with morphological evaluation tests, we employ Raman spectroscopy to select higher potential reproductive embryos during in vitro fertilization (IVF) based on chemical composition of embryos culture medium. In this study, 57 Raman spectra are acquired from both higher and lower quality embryos culture medium (ECM) from 10 patients which have been preliminarily confirmed by clinical assay. Data are fit by using a linear combination model of least squares method in which 12 basis spectra represent the chemical features of ECM. The final fitting coefficients provide insight into the chemical compositions of culture medium samples and are subsequently used as criterion to evaluate the quality of embryos. The relative fitting coefficients ratios of sodium pyruvate/albumin and phenylalanine/albumin seem act as key roles in the embryo screening, attaining 85.7% accuracy in comparison with clinical pregnancy. The good results demonstrate that Raman spectroscopy therefore is an important candidate for an accurate and noninvasive screening of higher quality embryos, which potentially decrease the time-consuming clinical trials during IVF

  19. Tachycardia-Induced J-Wave Changes in Patients With and Without Idiopathic Ventricular Fibrillation.

    Science.gov (United States)

    Aizawa, Yoshiyasu; Takatsuki, Seiji; Nishiyama, Takahiko; Kimura, Takehiro; Kohsaka, Shun; Kaneko, Yoshiaki; Inden, Yasuya; Takahashi, Naohiko; Nagase, Satoshi; Aizawa, Yoshifusa; Fukuda, Keichi

    2017-07-01

    To know the underlying mechanisms of J waves, the response to atrial pacing was studied in patients with idiopathic ventricular fibrillation (IVF) and patients with non-IVF. In 8 patients with IVF, the J-wave amplitude was measured before, during, and after atrial pacing. All patients had episodes of ventricular fibrillation without structural heart disease. The responses of J waves were compared with those of the 17 non-IVF control subjects who revealed J waves but no history of cardiac arrest and underwent electrophysiological study. The IVF patients were younger than the non-IVF patients (28±10 versus 52±14 years, respectively; P =0.002) and had larger J waves with more extensive distribution. J waves decreased from 0.35±0.26 to 0.22±0.23 mV ( P =0.025) when the RR intervals were shortened from 782±88 to 573±162 ms ( P =0.001). A decrease (≥0.05 mV) in the J-wave amplitude was observed in 6 of the 8 patients. In addition, 1 patient showed a distinct reduction of J waves in the unipolar epicardial leads. In contrast, J waves were augmented in the 17 non-IVF subjects from 0.27±0.09 to 0.38±0.10 mV ( P J waves to rapid pacing suggest different mechanisms: early repolarization in IVF patients and conduction delay in non-IVF patients. The response to atrial pacing was different between the IVF and non-IVF patients, which suggests the presence of different mechanisms for the genesis of J waves. © 2017 American Heart Association, Inc.

  20. Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint.

    Science.gov (United States)

    Polinder, S; Heijnen, E M E W; Macklon, N S; Habbema, J D F; Fauser, B J C M; Eijkemans, M J C

    2008-02-01

    BACKGROUND Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF. METHODS Four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. The main outcome measures are total costs of treatment within a 12 months period after randomization, and the relationship between total costs and proportion of cumulative pregnancies resulting in term live birth within 1 year of randomization. RESULTS Despite a significantly increased average number of IVF cycles (2.3 versus 1.7; P costs over a 12-month period (8333 versus euro10 745; P = 0.006) were observed using the mild strategy. This was mainly due to higher costs of the obstetric and post-natal period for the standard strategy, related to multiple pregnancies. The costs per pregnancy leading to term live birth were euro19 156 in the mild strategy and euro24 038 in the standard. The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was euro185 000 per extra pregnancy leading to term live birth. CONCLUSIONS Despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.

  1. [CHALLENGING THE OPTIMAL NUMBER OF RETRIEVED OOCYTES AND ITS IMPACT ON PREGNANCY AND LIVE BIRTH RATES IN IVF/ICSI CYCLES].

    Science.gov (United States)

    Blais, Idit; Lahav-Baratz, Shirly; Koifman, Mara; Wiener-Megnazi, Zofnat; Auslender, Ron; Dirnfeld, Martha

    2015-06-01

    Large numbers of retrieved oocytes are associated with higher chances of having cryopreservation of embryos. However, the process entailed exposes women to increased risk for ovarian hyperstimulation syndrome. Furthermore, mild ovary stimulation protocols are more patient-friendly and with less adverse effects. Only limited reports exist on the significance of the number of retrieved oocytes achieved in a single stimulation cycle. To investigate the optimal number of retrieved oocytes to achieve pregnancy and live birth. This retrospective analysis included 1590 IVF cycles. Oocytes maturation, fertilization, cleavage, as well as pregnancy and live birth rates were analyzed according to the number of retrieved oocytes. Oocyte maturation, fertilization and cleavage rates were lower in cycles with more than 10 retrieved oocytes compared with other groups. Live birth rates were highest when the number of retrieved oocytes was 11-15. Retrieval of more than 15 oocytes was not associated with a significant increase in chances of conception and birth. The better oocyte quality with 10 or less oocytes retrieved could be the result of a possible interference with the natural selection, or the minimized exposure of growing follicles to the potentially negative effects of ovarian stimulation. Although the average number of available embryos was higher when more than 10 oocytes were retrieved, achievement of more than 15 oocytes did not improve IVF outcome in terms of pregnancy and delivery rates. Analysis of 1590 IVF cycles including the frozen-thawed transfers shows that the best outcomes were achieved with an optimal number of 11-15 oocytes.

  2. Do knowledge brokers facilitate implementation of the stroke guideline in clinical practice?

    Science.gov (United States)

    Willems, Mia; Schröder, Carin; Post, Marcel; van der Weijden, Trudy; Visser-Meily, Anne

    2013-10-23

    The implementation of clinical practice guidelines in rehabilitation practice is often troublesome and incomplete. An intervention to enhance the implementation of guidelines is the knowledge transfer program built around the activities of a knowledge broker (KB).This study investigates the use of KBs to implement guideline recommendations for intensive therapy and physical activity for patients post-stroke in 22 stroke units in hospitals and rehabilitation centers in The Netherlands. This study includes a quantitative evaluation with a non controlled pre-post intervention design and a mixed methods process evaluation. From each stroke unit, enterprising nurses and therapists will be recruited and trained as KB. The KB will work for one year on the implementation of the guideline recommendations in their team. To evaluate the effectiveness of the KB, a questionnaire will be administered to patients, health professionals and KBs at baseline (T0) and after one year (T1). Furthermore, semi structured interviews with 5 KBs will be performed at T1.The primary outcome of this implementation project will be the support health professionals give patients to exercise and be physically active, as reported by patients and health professionals themselves. The support immediately after the intervention is compared with the support at the start of the intervention.Additionally we will explore the influence of socio-demographic characteristics of health professionals and determinants identified in the Theory of Planned Behavior (intention, attitude, subjective norm and perceived behavioral control) on the change of supportive behavior of health professionals. Finally, KBs will complete a questionnaire on their own psychological and social demographic characteristics and on organizational conditions needed for health-care improvement such as time, workforce, sponsoring and support from management. With this study we will gain insight in when and why knowledge brokers seem to be

  3. Costs and benefits of individuals conceived after IVF: a net tax evaluation in The Netherlands.

    Science.gov (United States)

    Moolenaar, L M; Connolly, M; Huisman, B; Postma, M J; Hompes, P G A; van der Veen, F; Mol, B W J

    2014-02-01

    This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative to those naturally conceived. A model based on the method of generational accounting was developed to evaluate investments in IVF. Calculations were based on average investments paid and received from the government by an individual. All costs were discounted to their net present values and adjusted for survival. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective amounts for men and women were -€36,109 and -€112,195. The model was most sensitive to changes in the growth of healthcare costs, economic growth and the discount rate. Therefore, it is concluded that, similarly to naturally conceived individuals in the Netherlands, IVF-conceived individuals have negative discounted net tax revenue at the end of life. The analytic framework described here undervalues the incremental value of an additional birth because it only considers the fiscal consequences of life and does not take into consideration broader macroeconomic benefits. This study evaluated the lifetime future net tax revenues from individuals conceived after IVF relative those naturally conceived. A model based on the method of generational accounting to evaluate investments in IVF was used. Calculations were based on average investments paid and received from the government by an individual. The lifetime net present value of IVF-conceived individuals was -€81,374 (the minus sign reflecting negative net present value). The lifetime net present value of IVF-conceived men and women were -€47,091 and -€123,177, respectively. The lifetime net present value of naturally conceived individuals was -€70,392; respective

  4. The Positions of Virtual Knowledge Brokers in the Core Process of Open Innovation

    NARCIS (Netherlands)

    Hacievliyagil, N.K.; Maisonneuve, Y.E.; Auger, J.F.; Hartmann, L.

    2007-01-01

    Several companies are implementing the strategy of open innovation in their research and development operations. They become more dependent, therefore, on their capabilities to exchange knowledge and technology with external parties. To facilitate these exchanges, virtual knowledge brokers use

  5. 75 FR 72987 - Brokers of Household Goods Transportation by Motor Vehicle

    Science.gov (United States)

    2010-11-29

    ... hyperlink ``Search for Moving Companies and View Complaint History'' which will lead to http://ai.volpe.dot... freight brokers in the future. Finally, FMCSA acknowledges Pro Movers Network's comment about high costs...

  6. 17 CFR 401.9 - Exemption for certain foreign government securities brokers or dealers.

    Science.gov (United States)

    2010-04-01

    ... legally necessary, its customers (with respect to customer information) to permit the foreign broker or..., delivering, and safeguarding funds and securities in connection with the transactions on behalf of the U.S...

  7. Should Nurses Be Knowledge Brokers? Competencies and Organizational Resources to Support the Role.

    Science.gov (United States)

    Catallo, Cristina

    2015-03-01

    Registered nurses with graduate preparation are in a unique position to act as knowledge brokers owing to their extensive clinical experience and ability to be seen as a credible and respected resource by their peers. Nurse knowledge brokers can bridge the gap between research producers and those that need evidence for decision-making and support capacity development for evidence-informed decision-making (EIDM). Knowledge broker competencies include graduate-level education with exposure to research methods; experience with the EIDM process; and established networking skills to bring researchers, decision-makers, stakeholders and policymakers together. For the knowledge broker to be successful, the nurse leader can cultivate an organizational culture supportive of evidence use with advocacy for mandates that require evidence for decisions, structures in place for each stage of the EIDM process, and physical resources such as library services for evidence retrieval. Copyright © 2015 Longwoods Publishing.

  8. 77 FR 33964 - Customs Broker Recordkeeping Requirements Regarding Location and Method of Record Retention

    Science.gov (United States)

    2012-06-08

    ... agency's ability to monitor and enforce recordkeeping compliance. DATES: Effective July 9, 2012. FOR... brokers to manage their recordkeeping responsibilities in a systemic manner which parallels their day-to...

  9. In Vitro Fertilization Outcomes After Placement of Essure Microinserts in Patients With Hydrosalpinges Who Previously Failed In Vitro Fertilization Treatment: A Multicenter Study.

    Science.gov (United States)

    Cohen, Shlomo B; Bouaziz, Jerome; Schiff, Eyal; Simon, Alexander; Nadjary, Michel; Goldenberg, Mordechai; Orvieto, Raoul; Revel, Ariel

    2016-01-01

    To investigate whether hysteroscopic proximal tubal occlusion with Essure microinserts (Conceptus Inc.; Bayer, AG, North Rhine-Westphalia, Germany) can improve pregnancy rates in patients with hydrosalpinges who had failed in vitro fertilization (IVF) treatment. A prospective cohort study. University-affiliated tertiary centers. Twenty-four consecutive women with hydrosalpinges who had failed IVF treatment were included. Hysteroscopic placement of Essure microinserts for hydrosalpinx blockage followed by IVF treatment. Ongoing pregnancy and live birth rates were recorded. Of the 24 patients undergoing a total of 42 IVF cycles after Essure insertion, 18 (75% of patients and 42.8% of IVF cycle attempts) conceived and 16 delivered live births (66.6% of patients and 38.1% of IVF cycle attempts). Hysteroscopic proximal occlusion of hydrosalpinges with Essure microinserts is a valuable alternative to laparoscopic salpingectomy, resulting in reasonable pregnancy rates. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  10. Clinical outcomes after IVF or ICSI using human blastocysts derived from oocytes containing aggregates of smooth endoplasmic reticulum.

    Science.gov (United States)

    Itoi, Fumiaki; Asano, Yukiko; Shimizu, Masashi; Nagai, Rika; Saitou, Kanako; Honnma, Hiroyuki; Murata, Yasutaka

    2017-04-01

    In this study the clinical and neo-natal outcomes after transfer of blastocysts derived from oocytes containing aggregates of smooth endoplasmic reticulum (SER) were compared between IVF and intracytoplasmic sperm injection (ICSI) cycles. Clinical and neo-natal outcomes of blastocysts in cycles with at least one SER metaphase II oocyte (SER + MII; SER + cycles) did not significantly differ between the two insemination methods. When SER + MII were cultured to day 5/6, fertilization, embryo cleavage and blastocyst rates were not significantly different between IVF and ICSI cycles. In vitrified-warmed blastocyst transfer cycles, the clinical pregnancy rates from SER + MII in IVF and ICSI did not significantly differ. In this study, 52 blastocysts (27 IVF and 25 ICSI) derived from SER + MII were transferred, yielding 15 newborns (5 IVF and 10 ICSI) and no malformations. Moreover, 300 blastocysts (175 IVF and 125 ICSI) derived from SER-MII were transferred, yielding 55 newborns (24 IVF and 31 ICSI cycles). Thus, blastocysts derived from SER + cycles exhibited an acceptable ongoing pregnancy rate after IVF (n = 125) or ICSI (n = 117) cycles. In conclusion, blastocysts from SER + MII in both IVF and ICSI cycles yield adequate ongoing pregnancy rates with neo-natal outcomes that do not differ from SER-MII. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach

    NARCIS (Netherlands)

    Broer, S.L.; Disseldorp, J. van; Broeze, K.A.; Dolleman, M.; Opmeer, B.C.; Bossuyt, P.; Eijkemans, M.J.; Mol, B.W.; Broekmans, F.J.; Anderson, R.A.; Ashrafi, M.; Bancsi, L.F.; Caroppo, E.; Copperman, A.; Ebner, T.; Eldar Geva, M.; Erdem, M.; Greenblatt, E.M.; Jayaprakasan, K.; Fenning, R.; Klinkert, E.R.; Kwee, J.; Lambalk, C.B.; La Marca, A.; McIlveen, M.; Merce, L.T.; Muttukrishna, S.; Nelson, S.M.; Ng, H.Y.; Popovic-Todorovic, B.; Smeenk, J.M.J.; Tomas, C.; Linden, P.J. van der; Rooij, I.A. van; et al.,

    2013-01-01

    BACKGROUND Although ovarian reserve tests (ORTs) are frequently used prior to IVF treatment for outcome prediction, their added predictive value is unclear. We assessed the added value of ORTs to patient characteristics in the prediction of IVF outcome. METHODS An individual patient data (IPD)

  12. 17 CFR 405.2 - Reports to be made by registered government securities brokers and dealers.

    Science.gov (United States)

    2010-04-01

    ... government securities broker or dealer shall file Part I of Form BD-Y2K (§ 249.618 of this title) prepared as..., shall file Part II of Form BD-Y2K (§ 249.618 of this title). Part II of Form BD-Y2K shall address each... registered government securities broker or dealer that was not required to file Part II of Form BD-Y2K under...

  13. Hidden Markov Model Application to Transfer The Trader Online Forex Brokers

    Directory of Open Access Journals (Sweden)

    Farida Suharleni

    2012-05-01

    Full Text Available Hidden Markov Model is elaboration of Markov chain, which is applicable to cases that can’t directly observe. In this research, Hidden Markov Model is used to know trader’s transition to broker forex online. In Hidden Markov Model, observed state is observable part and hidden state is hidden part. Hidden Markov Model allows modeling system that contains interrelated observed state and hidden state. As observed state in trader’s transition to broker forex online is category 1, category 2, category 3, category 4, category 5 by condition of every broker forex online, whereas as hidden state is broker forex online Marketiva, Masterforex, Instaforex, FBS and Others. First step on application of Hidden Markov Model in this research is making construction model by making a probability of transition matrix (A from every broker forex online. Next step is making a probability of observation matrix (B by making conditional probability of five categories, that is category 1, category 2, category 3, category 4, category 5 by condition of every broker forex online and also need to determine an initial state probability (π from every broker forex online. The last step is using Viterbi algorithm to find hidden state sequences that is broker forex online sequences which is the most possible based on model and observed state that is the five categories. Application of Hidden Markov Model is done by making program with Viterbi algorithm using Delphi 7.0 software with observed state based on simulation data. Example: By the number of observation T = 5 and observed state sequences O = (2,4,3,5,1 is found hidden state sequences which the most possible with observed state O as following : where X1 = FBS, X2 = Masterforex, X3 = Marketiva, X4 = Others, and X5 = Instaforex.

  14. Can't read my broker face: Learning about trustworthiness with age.

    Science.gov (United States)

    Rasmussen, Eileen C; Gutchess, Angela

    2018-02-05

    We assessed how age impacted learning who to trust, and the extent to which this type of learning relied on explicit memory. In contrast to prior studies, target faces were neutral without prior reputational information. Younger and older adults made investment decisions for 36 brokers, who yielded a good, neutral, or bad outcome. Brokers were encountered three times to measure adaptive learning. After the investment task, participants completed a surprise explicit source memory test for brokers. Although younger and older adults learned to distinguish good and bad brokers from neutral ones, older adults did not learn the brokers' behavior as well as younger adults. In addition, explicit source memory was highly correlated with investment decisions, although less so for good brokers for older than younger adults. Findings extend prior work by establishing that older adults' impairments in learning who to trust extend to neutral faces, and highlighting the role of explicit memory in investment performance. Future work should vary the task demands to explore the contribution of explicit and implicit processes. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Structured P2P overlay of mobile brokers for realizing publish/subscribe communication in VANET.

    Science.gov (United States)

    Pandey, Tulika; Garg, Deepak; Gore, Manoj Madhava

    2014-01-01

    Publish/subscribe communication paradigm provides asynchrony and decoupling, making it an elegant alternative for designing applications in distributed and dynamic environment such as vehicular ad hoc networks (VANETs). In this paradigm, the broker is the most important component that decouples other two components, namely, publisher and subscriber. Previous research efforts have either utilized the deployment of distributed brokers on stationary road side info-stations or have assigned the role of broker to any moving vehicle on ad hoc basis. In one approach, lots of preinstalled infrastructures are needed whereas, in another, the quality of service is not guaranteed due to unpredictable moving and stopping patterns of vehicles. In this paper, we present the architecture of distributed mobile brokers which are dynamically reconfigurable in the form of structured P2P overlay and act as rendezvous points for matching publications and subscriptions. We have taken city buses in urban settings to act as mobile brokers whereas other vehicles are considered to be in role of publishers and subscribers. These mobile brokers also assist in locating a vehicle for successful and timely transfer of notifications. We have performed an extensive simulation study to compare our approach with previously proposed approaches. Simulation results establish the applicability of our approach.

  16. Structured P2P Overlay of Mobile Brokers for Realizing Publish/Subscribe Communication in VANET

    Directory of Open Access Journals (Sweden)

    Tulika Pandey

    2014-01-01

    Full Text Available Publish/subscribe communication paradigm provides asynchrony and decoupling, making it an elegant alternative for designing applications in distributed and dynamic environment such as vehicular ad hoc networks (VANETs. In this paradigm, the broker is the most important component that decouples other two components, namely, publisher and subscriber. Previous research efforts have either utilized the deployment of distributed brokers on stationary road side info-stations or have assigned the role of broker to any moving vehicle on ad hoc basis. In one approach, lots of preinstalled infrastructures are needed whereas, in another, the quality of service is not guaranteed due to unpredictable moving and stopping patterns of vehicles. In this paper, we present the architecture of distributed mobile brokers which are dynamically reconfigurable in the form of structured P2P overlay and act as rendezvous points for matching publications and subscriptions. We have taken city buses in urban settings to act as mobile brokers whereas other vehicles are considered to be in role of publishers and subscribers. These mobile brokers also assist in locating a vehicle for successful and timely transfer of notifications. We have performed an extensive simulation study to compare our approach with previously proposed approaches. Simulation results establish the applicability of our approach.

  17. Biopsy of human morula-stage embryos: outcome of 215 IVF/ICSI cycles with PGS.

    Directory of Open Access Journals (Sweden)

    Elena E Zakharova

    Full Text Available Preimplantation genetic diagnosis (PGD is commonly performed on biopsies from 6-8-cell-stage embryos or blastocyst trophectoderm obtained on day 3 or 5, respectively. Day 4 human embryos at the morula stage were successfully biopsied. Biopsy was performed on 709 morulae from 215 ICSI cycles with preimplantation genetic screening (PGS, and 3-7 cells were obtained from each embryo. The most common vital aneuploidies (chromosomes X/Y, 21 were screened by fluorescence in situ hybridization (FISH. No aneuploidy was observed in 72.7% of embryos, 91% of those developed to blastocysts. Embryos were transferred on days 5-6. Clinical pregnancy was obtained in 32.8% of cases, and 60 babies were born. Patients who underwent ICSI/PGS treatment were compared with those who underwent standard ICSI treatment by examining the percentage of blastocysts, pregnancy rate, gestational length, birth height and weight. No significant differences in these parameters were observed between the groups. Day 4 biopsy procedure does not adversely affect embryo development in vitro or in vivo. The increased number of cells obtained by biopsy of morulae might facilitate diagnostic screening. There is enough time after biopsy to obtain PGD results for embryo transfer on day 5-6 in the current IVF cycle.

  18. Economic evaluations of single- versus double-embryo transfer in IVF.

    Science.gov (United States)

    Fiddelers, A A A; Severens, J L; Dirksen, C D; Dumoulin, J C M; Land, J A; Evers, J L H

    2007-01-01

    Multiple pregnancies lead to complications and induce high costs. The most successful way to decrease multiple pregnancies in IVF is to transfer only one embryo, which might reduce the efficacy of treatment. The objective of this review is to determine which embryo-transfer policy is most cost-effective: elective single-embryo transfer (eSET) or double-embryo transfer (DET). Several databases were searched for (cost* or econ*) and (single embryo* or double embryo* or one embryo* or two embryo* or elect* embryo or multip* embryo*). On the basis of five exclusion criteria, titles and abstracts were screened by two individual reviewers. The remaining papers were read for further selection, and data were extracted from the selected studies. A total of 496 titles were identified through the searches and resulted in the selection of one observational study and three randomized studies. Study characteristics, total costs and probability of live births were extracted. Besides this, cost-effectiveness and incremental cost-effectiveness were derived. It can be concluded that DET is the most expensive strategy. DET is also most effective if performed in one fresh cycle. eSET is only preferred from a cost-effectiveness point of view when performed in good prognosis patients and when frozen/thawed cycles are included. If frozen/thawed cycles are excluded, the choice between eSET and DET depends on how much society is willing to pay for one extra successful pregnancy.

  19. The influence of IVF/ICSI treatment on human embryonic growth trajectories.

    Science.gov (United States)

    Eindhoven, S C; van Uitert, E M; Laven, J S E; Willemsen, S P; Koning, A H J; Eilers, P H C; Exalto, N; Steegers, E A P; Steegers-Theunissen, R P M

    2014-12-01

    Is in vitro fertilization treatment with or without intracytoplasmatic sperm injection (IVF/ICSI) associated with changes in first and second trimester embryonic and fetal growth trajectories and birthweight in singleton pregnancies? Embryonic and fetal growth trajectories and birthweight are not significantly different between pregnancies conceived with IVF/ICSI treatment and spontaneously conceived pregnancies with reliable pregnancy dating. IVF/ICSI treatment has been associated with increased risks of preterm birth, fetal growth restriction and low birthweight. Decreased first-trimester crown-rump length (CRL) in the general population has been inversely associated with the same adverse pregnancy outcomes. In a prospective periconception birth cohort study conducted in a tertiary centre, 146 singleton pregnancies with reliable pregnancy dating and nonmalformed live borns were investigated, comprised of 88 spontaneous and 58 IVF/ICSI pregnancies. Serial 3D ultrasound scans were performed from 6 to 12 weeks of gestation. As estimates of embryonic growth, CRL and embryonic volume (EV) were measured using the I-Space virtual reality system. General characteristics were obtained from self-administered questionnaires at enrolment. Fetal growth parameters at 20 weeks and birthweight were obtained from medical records. To assess associations between IVF/ICSI and embryonic growth trajectories, estimated fetal weight and birthweight, stepwise linear mixed model analyses and linear regression analyses were performed using square root transformed CRL and fourth root transformed EV. In 146 pregnancies, 934 ultrasound scans were performed of which 849 (90.9%) CRLs and 549 (58.8%) EVs could be measured. Embryonic growth trajectories were comparable between IVF/ICSI pregnancies and spontaneously conceived pregnancies (CRL: βIVF/ICSI = 0.10√mm; P = 0.10; EV: βIVF/ICSI = 0.03(4)√cm³; P = 0.13). Estimated fetal weight and birthweight were also comparable between both

  20. Making muslim babies: Ivf and gamete donation in sunni versus shi’a islam

    Science.gov (United States)

    2006-01-01

    Medical anthropological research on science, biotechnology, and religion has focused on the “local moral worlds” of men and women as they make difficult decisions regarding their health and the beginnings and endings of human life. This paper focuses on the local moral worlds of infertile Muslims as they attempt to make, in the religiously correct fashion, Muslim babies at in vitro fertilization (IVF) clinics in Egypt and Lebanon. As early as 1980, authoritative fatwas issued from Egypt’s famed Al-Azhar University suggested that IVF and similar technologies are permissible as long as they do not involve any form of third-party donation (of sperm, eggs, embryos, or uteruses). Since the late 1990s, however, divergences in opinion over third-party gamete donation have occurred between Sunni and Shi’ite Muslims, with Iran’s leading ayatollah permitting gamete donation under certain conditions. This Iranian fatwa has had profound implications for the country of Lebanon, where a Shi’ite majority also seeks IVF services. Based on three periods of ethnographic research in Egyptian and Lebanese IVF clinics, this paper explores official and unofficial religious discourses surrounding the practice of IVF and third-party donation in the Muslim world, as well as the gender implications of gamete donation for Muslim marriages. PMID:17051430

  1. IVF, same-sex couples and the value of biological ties.

    Science.gov (United States)

    Di Nucci, Ezio

    2016-12-01

    Ought parents, in general, to value being biologically tied to their children? Is it important, in particular, that both parents be biologically tied to their children? I will address these fundamental questions by looking at a fairly new practice within IVF treatments, so-called IVF-with-ROPA (Reception of Oocytes from Partner), which allows lesbian couples to 'share motherhood', with one partner providing the eggs while the other becomes pregnant. I believe that IVF-with-ROPA is, just like other IVF treatments, morally permissible, but here I argue that the increased biological ties which IVF-with-ROPA allows for do not have any particular value beside the satisfaction of a legitimate wish, because there is no intrinsic value in a biological tie between parents and children; further, I argue that equality within parental projects cannot be achieved by redistributing biological ties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Failure mode and effects analysis of witnessing protocols for ensuring traceability during IVF.

    Science.gov (United States)

    Rienzi, Laura; Bariani, Fiorenza; Dalla Zorza, Michela; Romano, Stefania; Scarica, Catello; Maggiulli, Roberta; Nanni Costa, Alessandro; Ubaldi, Filippo Maria

    2015-10-01

    Traceability of cells during IVF is a fundamental aspect of treatment, and involves witnessing protocols. Failure mode and effects analysis (FMEA) is a method of identifying real or potential breakdowns in processes, and allows strategies to mitigate risks to be developed. To examine the risks associated with witnessing protocols, an FMEA was carried out in a busy IVF centre, before and after implementation of an electronic witnessing system (EWS). A multidisciplinary team was formed and moderated by human factors specialists. Possible causes of failures, and their potential effects, were identified and risk priority number (RPN) for each failure calculated. A second FMEA analysis was carried out after implementation of an EWS. The IVF team identified seven main process phases, 19 associated process steps and 32 possible failure modes. The highest RPN was 30, confirming the relatively low risk that mismatches may occur in IVF when a manual witnessing system is used. The introduction of the EWS allowed a reduction in the moderate-risk failure mode by two-thirds (highest RPN = 10). In our experience, FMEA is effective in supporting multidisciplinary IVF groups to understand the witnessing process, identifying critical steps and planning changes in practice to enable safety to be enhanced. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Outcomes of first IVF/ICSI in young women with diminished ovarian reserve.

    Science.gov (United States)

    Cohen, Jonathan; Mounsambote, Leonisse; Prier, Perrine; Mathieu d'ARGENT, Emmanuelle; Selleret, Lise; Chabbert-Buffet, Nathalie; Delarouziere, Vanina; Levy, Rachel; Darai, Emile; Antoine, Jean-Marie

    2017-08-01

    There is no consensual definition of diminished ovarian reserve and the best therapeutic strategy has not yet been demonstrated. We performed a retrospective study to evaluate outcomes following a first in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycle in young women with diminished ovarian reserve. Women with tubal factor, endometriosis or previous stimulation cycle were excluded. We defined diminished ovarian reserve as women ≤38 years with an AMH ≤1.1 ng/mL or antral follicular count ≤7. Among 59 IVF/ICSI cycles (40% IVF/60% ICSI), the pregnancy rate was 17% (10/59) and live birth rate 8.5% (5/59). Miscarriage rate was 50%. Baseline characteristics and IVF outcomes of the pregnant and not pregnant women were compared. No differences in age, antral follicular count, AMH, protocol used or number of harvested oocytes were found between the groups. A higher gonadotropin starting dose in the pregnancy group (397.5±87 IU vs. 314.8±103 IU; P=0.02) and a trend to a higher total dose received (4720±1349 IU vs. 3871±1367 IU; P=0.07) were noted. The present study confirms that women with diminished ovarian reserve have low live birth rates after a first IVF-ICSI cycle and that a higher gonadotropin starting dose might be associated with better outcomes.

  4. SULF 1 gene polymorphism, rs6990375 is in significant association with fetus failure in IVF technique

    Directory of Open Access Journals (Sweden)

    Eskandar Taghizadeh

    2015-03-01

    Full Text Available Background: Sulfatase 1 (SULF1 function is to remove the 6-O-sulphate group from heparan sulfate. This action changes the binding sites of extracellular growth factors. SULF1 expression has been reported to be changed in angiogenesis. We hypothesized that single nucleotide polymorphisms (SNPs of SULF1 would impact clinicopathologic characteristics. Objective: Study of SULF1 gene polymorphism with fetus failure in in vitro fertilization (IVF technique. Materials and Methods: We studied one common (minor allele frequency >0.05 regulatory SNP, rs6990375, with polymerase chain reaction and restriction fragment length polymorphism method, in 53 infertile women with fetus failure in IVF technique and 53 women with at least one healthy child as controls. Results: We found that rs6990375 is significantly associated with an early failure in IVF and frequency of G allele is high in women with fetus failure in IVF technique (p<0.001. Conclusion: These findings suggest that SULF1genetic variations may play a role in IVF technique fetus failure. Further studies with large sample sizes on SULF1 SNPs may be useful in support of this claim.

  5. Monitoring of IVF birth outcomes in Finland: a data quality study

    Directory of Open Access Journals (Sweden)

    Hemminki Elina

    2004-03-01

    Full Text Available Abstract Background The collection of information on infertility treatments is important for the surveillance of potential health consequences and to monitor service provision. Study design We compared the coverage and outcomes of IVF children reported in aggregated IVF statistics, the Medical Birth Register (subsequently: MBR and research data based on reimbursements for IVF treatments in Finland in 1996–1998. Results The number of newborns were nearly equal in the three data sources (N = 4331–4384, but the linkage between the MBR and the research data revealed that almost 40% of the reported IVF children were not the same individuals. The perinatal outcomes in the three data sources were similar, excluding the much lower incidence of major congenital anomalies in the IVF statistics (157/10 000 newborns compared to other sources (409–422/10 000 newborns. Conclusion The differences in perinatal outcomes in the three data sets were in general minor, which suggests that the observed non-recording in the MBR is most likely unbiased.

  6. With or against nature? IVF, gender and reproductive agency in Athens, Greece.

    Science.gov (United States)

    Paxson, Heather

    2003-05-01

    Based on ethnographic research in Athens, this paper argues that in vitro fertilization (IVF) in urban Greece does not so much make explicit the social construction of nature, as has been argued of the US and UK, but is accommodated into a prior understanding of "nature" as socially realized. Calling upon an ethic of maternal sacrifice, Athenian women see themselves taking charge of a natural process, often correcting damage done to them by nature. A sense that adults should produce children in order to realize their natures and be completed as women and men also poses particular, and gendered, ethical questions of fertility technologies: is this a proper way of realizing nature? While those who successfully use IVF depict assisted conception as "a natural" and "proper way of reproduction," some fear that others will view their child as abnormal. Contests over "normal" reproduction are articulated to a tradition/modernity dichotomy which Athenians discuss through an idiom of maturity. Believing that Greek society is not always mature enough to understand how natural IVF really is, couples turning to IVF follow one of the two strategies: to educate others or to completely hide it. Both groups want to guard against a view of IVF-in the terms of this volume-as a kind of "reproduction gone awry."

  7. New stimulation regimens: endogenous and exogenous progesterone use to block the LH surge during ovarian stimulation for IVF.

    Science.gov (United States)

    Massin, Nathalie

    2017-03-01

    The advent of embryo and oocyte vitrification today gives reproductive specialists an opportunity to consider new strategies for improving the practice and results of IVF attempts. As the freezing of entire cohorts does not compromise, and may even improve, the results of IVF attempts, it is possible to break away from the standard sequence of stimulation-retrieval-transfer. The constraints associated with ovarian stimulation in relation to the potential harmful effects of the hormonal environment on endometrial receptivity can be avoided. This review will look at the new stimulation protocols where progesterone is used to block the LH surge. Thanks to 'freeze all' strategies, the increase in progesterone could actually be no longer a cause for concern. There are two ways of using progesterone, whether it be endogenous, as in luteal phase stimulation, or exogenous, as in the use of progesterone in the follicular phase i.e. progestin primed ovarian stimulation. A literature search was carried out (until September 2016) on MEDLINE. The following text words were utilized to generate the list of citations: progestin primed ovarian stimulation, luteal phase stimulation, luteal stimulation, duostim, double stimulation, random start. Articles and their references were then examined in order to identify other potential studies. All of the articles are reported in this review. The use of progesterone during ovarian stimulation is effective in blocking the LH surge, whether endogenous or exogenous, and it does not affect the number of oocytes collected or the quality of the embryos obtained. Its main constraint is that it requires total freezing and delayed transfer. A variety of stimulation protocols can be derived from these two methods, and their implications are discussed, from fertility preservation to ovarian response profiles to organization for the patients and clincs. These new regimens enable more flexibility and are of emerging interest in daily practice. However

  8. Fertility preservation: a challenge for IVF-clinics.

    Science.gov (United States)

    Dahhan, Taghride; Mol, Femke; Kenter, Gemma G; Balkenende, Eva M E; de Melker, Annemieke A; van der Veen, Fulco; Dancet, Eline A F; Goddijn, Mariëtte

    2015-11-01

    Acute fertility preservation for women is an interdisciplinary treatment that requires adequate information provision and early referral. This quality management project aimed to improve fertility preservation care by using a practical tool: Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis. Quality management project was executed between May 2011 and July 2013. This project has been executed in a university affiliated IVF-clinic in cooperation with two oncological sites and used a four-step strategy: (1) monitoring baseline referral process, (2) exploring baseline fertility preservation program by Strengths, Weaknesses, Opportunities and Threats' (SWOT)-analysis, (3) setting up a new fertility preservation program and (4) evaluating the new fertility preservation program by means of SWOT-analysis. During the three-months monitoring period, fertility preservation was requested for a total of 126 women. The mean age of the women was 33.8 years old (range 1-42 years old). Most requests came from women who wanted to cryopreserve oocytes because of age-related decline of fertility (n=90; 71%). Most requests for acute fertility preservation concerned women with breast cancer (n=16; 57%). Information leaflets and pre-consultation questionnaires for women improved the quality of first fertility preservation consultation as evaluated by final SWOT-analysis. Collaboration with oncological centres and information about fertility preservation improved the referral process. SWOT-analysis proved useful for setting up a new fertility preservation-program and can be recommended as a tool to improve the management and organisation of new types of reproductive care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  9. Is ovarian hyperstimulation associated with higher blood pressure in 4-year-old IVF offspring? Part I: multivariable regression analysis.

    Science.gov (United States)

    Seggers, Jorien; Haadsma, Maaike L; La Bastide-Van Gemert, Sacha; Heineman, Maas Jan; Middelburg, Karin J; Roseboom, Tessa J; Schendelaar, Pamela; Van den Heuvel, Edwin R; Hadders-Algra, Mijna

    2014-03-01

    Does ovarian hyperstimulation, the in vitro procedure, or a combination of these two negatively influence blood pressure (BP) and anthropometrics of 4-year-old children born following IVF? Higher systolic blood pressure (SBP) percentiles were found in 4-year-old children born following conventional IVF with ovarian hyperstimulation compared with children born following IVF without ovarian hyperstimulation. Increasing evidence suggests that IVF, which has an increased incidence of preterm birth and low birthweight, is associated with higher BP and altered body fat distribution in offspring but the underlying mechanisms are largely unknown. We performed a prospective, assessor-blinded follow-up study in which 194 children were assessed. The attrition rate up until the 4-year-old assessment was 10%. We measured BP and anthropometrics of 4-year-old singletons born following conventional IVF with controlled ovarian hyperstimulation (COH-IVF, n = 63), or born following modified natural cycle IV (MNC-IVF, n = 52), or born to subfertile couples who conceived naturally (Sub-NC, n = 79). Both IVF and ICSI were performed. Primary outcome measures were the SBP percentiles and diastolic BP (DBP) percentiles. Anthropometric measures included triceps and subscapular skinfold thickness. Several multivariable regression analyses were applied in order to correct for subsets of confounders. The value 'B' is the unstandardized regression coefficient. SBP percentiles were significantly lower in the MNC-IVF group (mean 59, SD 24) than in the COH-IVF (mean 68, SD 22) and Sub-NC groups (mean 70, SD 16). The difference in SBP between COH-IVF and MNC-IVF remained significant after correction for current, early life and parental characteristics (B: 14.09; 95% confidence interval (CI): 5.39-22.79), whereas the difference between MNC-IVF and Sub-NC did not. DBP percentiles did not differ between groups. After correction for early life factors, subscapular skinfold thickness was thicker in the

  10. Multivariate analysis identifies the estradiol level at ovulation triggering as an independent predictor of the first trimester pregnancy-associated plasma protein-A level in IVF/ICSI pregnancies.

    Science.gov (United States)

    Giorgetti, C; Vanden Meerschaut, F; De Roo, C; Saunier, O; Quarello, E; Hairion, D; Penaranda, G; Chabert-Orsini, V; De Sutter, P

    2013-10-01

    Can independent predictors of pregnancy-associated plasma protein-A (PAPP-A) levels be identified in a group of women who conceived following IVF/ICSI? The significantly decreased PAPP-A level in IVF and ICSI pregnancies compared with non-IVF/ICSI pregnancies was correlated strongly with the serum estradiol (E2) level at ovulation triggering. The first trimester prenatal combined screening test for fetal aneuploidies in pregnancies conceived following assisted reproduction techniques (ART) is complicated by an alteration of the maternal biomarkers free β-hCG and PAPP-A, causing a higher false-positive rate compared with pregnancies which are conceived naturally. The use of controlled ovarian stimulation prior to IVF/ICSI is suggested to be the principle reason for these alterations of biomarkers in ART pregnancies. Between January 2010 and December 2011, 1474 women who conceived naturally and 374 women who conceived following IVF (n = 89), ICSI (n = 204) or intrauterine insemination (IUI, n = 81) were included in this retrospective study. Only singleton pregnancies were eligible for this study. For all women, serum analysis was performed in the same clinical laboratory. Measurement of nuchal translucency (NT) thickness was performed by four physicians belonging to the same infertility centre. First-trimester combined screening test of aneuploidy parameters (maternal age, PAPP-A and free β-hCG, NT thickness) were compared between non-ART and ART (IVF, ICSI and IUI) singleton pregnancies. Next, a minimal threshold E2 level at ovulation triggering was suggested for IVF/ICSI pregnancies above which the PAPP-A levels were significantly decreased compared with non-ART pregnancies. Finally, a multivariate analysis was performed to reveal independent predictors of PAPP-A level in IVF/ICSI pregnancies. We showed a decrease of the multiple of the median (MoM) PAPP-A level in IVF and ICSI singleton pregnancies compared with non-ART singleton pregnancies (P IVF and ICSI

  11. Minimizing predatory lending: Designing a long-term compensation structure to minimize the actions of opportunistic mortgage brokers

    Directory of Open Access Journals (Sweden)

    Patrick Payne

    2013-07-01

    Full Text Available This paper addresses the inadequacies in the current compensation structure for mortgage brokers, and asserts that the resulting opportunistic behavior by brokers played a major role in the 2008 collapse of the mortgage market. We utilize agency theory as an underpinning to suggest that increased regulation will have only a limited impact on self-serving behavior due to the complex information asymmetries possessed by brokers. We posit that a restructured long-term compensation package would be effective in aligning the interests of borrowers and brokers, ultimately reducing the level of mortgage defaults and foreclosures.

  12. The Oldham Notebooks: an analysis of the development of IVF 1969–1978. V. The role of Jean Purdy reassessed

    Directory of Open Access Journals (Sweden)

    Martin H. Johnson

    2015-06-01

    Full Text Available The role of Jean Purdy in the work leading to the birth of Louise Brown is assessed. We report that Purdy: (i recorded and organized most of the data systematically; (ii probably spent longer working in Oldham than did Edwards; (iii whilst there, was primarily responsible for organizing laboratory supplies, including media preparation and testing; (iv was involved in patient care; and (v was a major source of support to Edwards. We find that Purdy, despite her nursing qualification, was not involved in laparoscopic egg retrieval and clinical aspects, but was focused on basic research activities. The evidence on who was present at embryo transfers is less clear, but suggests that Edwards was present for all, whereas Purdy may have been absent for some. Overall, we conclude that Purdy’s role was a highly significant and under-appreciated element in the achievement of IVF in Oldham.

  13. Professional identity in clinician-scientists: brokers between care and science.

    Science.gov (United States)

    Kluijtmans, Manon; de Haan, Else; Akkerman, Sanne; van Tartwijk, Jan

    2017-06-01

    Despite increasing numbers of publications, science often fails to significantly improve patient care. Clinician-scientists, professionals who combine care and research activities, play an important role in helping to solve this problem. However, despite the ascribed advantages of connecting scientific knowledge and inquiry with health care, clinician-scientists are scarce, especially amongst non-physicians. The education of clinician-scientists can be complex because they must form professional identities at the intersection of care and research. The successful education of clinician-scientists requires insight into how these professionals view their professional identity and how they combine distinct practices. This study sought to investigate how recently trained nurse- and physiotherapist-scientists perceive their professional identities and experience the crossing of boundaries between care and research. Semi-structured interviews were conducted with 14 nurse- and physiotherapist-scientists at 1 year after they had completed MSc research training. Interviews were thematically analysed using insights from the theoretical frameworks of dialogical self theory and boundary crossing. After research training, the initial professional identity, of clinician, remained important for novice clinician-scientists, whereas the scientist identity was experienced as additional and complementary. A meta-identity as broker, referred to as a 'bridge builder', seemed to mediate competing demands or tensions between the two positions. Obtaining and maintaining a dual work position were experienced as logistically demanding; nevertheless, it was considered beneficial for crossing the boundaries between care and research because it led to reflection on the health profession, knowledge integration, inquiry and innovation in care, improved data collection, and research with a focus on clinical applicability. Novice clinician-scientists experience dual professional identities as care

  14. Highly purified HMG versus recombinant FSH for ovarian stimulation in IVF cycles

    DEFF Research Database (Denmark)

    Platteau, P.; Nyboe, Andersen A.; Loft, A.

    2008-01-01

    The objective of this study was to compare the live birth rates resulting from ovarian stimulation with highly purified human menopausal gonadotrophin (HP-HMG), which combines FSH and human chorionic gonadotrophin-driven LH activities, or recombinant FSH (rFSH) alone in women undergoing IVF cycles....... An integrated analysis was performed of the raw data from two randomized controlled trials that were highly comparable in terms of eligibility criteria and post-randomization treatment regimens with either HP-HMG or rFSH for ovarian stimulation in IVF, following a long down-regulation protocol. All randomized...... subjects who received at least one dose of gonadotrophin in an IVF cycle (HP-HMG, n = 491; rFSH, n = 495) were included in the analysis. Subjects who underwent intracytoplasmic sperm injection cycles were excluded. The superiority of one gonadotrophin preparation over the other was tested using...

  15. Predicting IVF Outcome: A Proposed Web-based System Using Artificial Intelligence.

    Science.gov (United States)

    Siristatidis, Charalampos; Vogiatzi, Paraskevi; Pouliakis, Abraham; Trivella, Marialenna; Papantoniou, Nikolaos; Bettocchi, Stefano

    2016-01-01

    To propose a functional in vitro fertilization (IVF) prediction model to assist clinicians in tailoring personalized treatment of subfertile couples and improve assisted reproduction outcome. Construction and evaluation of an enhanced web-based system with a novel Artificial Neural Network (ANN) architecture and conformed input and output parameters according to the clinical and bibliographical standards, driven by a complete data set and "trained" by a network expert in an IVF setting. The system is capable to act as a routine information technology platform for the IVF unit and is capable of recalling and evaluating a vast amount of information in a rapid and automated manner to provide an objective indication on the outcome of an artificial reproductive cycle. ANNs are an exceptional candidate in providing the fertility specialist with numerical estimates to promote personalization of healthcare and adaptation of the course of treatment according to the indications. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  16. Is IVF-served two different ways-more cost-effective than IUI with controlled ovarian hyperstimulation?

    NARCIS (Netherlands)

    Tjon-Kon-Fat, R. I.; Bensdorp, A. J.; Bossuyt, P. M. M.; Koks, C.; Oosterhuis, G. J. E.; Hoek, A.; Hompes, P.; Broekmans, F. J.; Verhoeve, H. R.; de Bruin, J. P.; van Golde, R.; Repping, S.; Cohlen, B. J.; Lambers, M. D. A.; van Bommel, P. F.; Slappendel, E.; Perquin, D.; Smeenk, J.; Pelinck, M. J.; Gianotten, J.; Hoozemans, D. A.; Maas, J. W. M.; Groen, H.; Eijkemans, M. J. C.; van der Veen, F.; Mol, B. W. J.; van Wely, M.

    2015-01-01

    What is the cost-effectiveness of in vitro fertilization (IVF) with conventional ovarian stimulation, single embryo transfer (SET) and subsequent cryocycles or IVF in a modified natural cycle (MNC) compared with intrauterine insemination with controlled ovarian hyperstimulation (IUI-COH) as a

  17. Modified natural cycle versus controlled ovarian hyperstimulation IVF: a cost-effectiveness evaluation of three simulated treatment scenarios

    NARCIS (Netherlands)

    Groen, Henk; Tonch, Nino; Simons, Arnold H. M.; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A.

    2013-01-01

    Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a cost-effective alternative for one

  18. Modified natural cycle versus controlled ovarian hyperstimulation IVF : a cost-effectiveness evaluation of three simulated treatment scenarios

    NARCIS (Netherlands)

    Groen, Henk; Tonch, Nino; Simons, Arnold H. M.; van der Veen, Fulco; Hoek, Annemieke; Land, Jolande A.

    2013-01-01

    STUDY QUESTION: Can modified natural cycle IVF or ICSI (MNC) be a cost-effective alternative for controlled ovarian hyperstimulation IVF or ICSI (COH)? SUMMARY ANSWER: The comparison of simulated scenarios indicates that a strategy of three to six cycles of MNC with minimized medication is a

  19. Presence of bile acids in human follicular fluid and their relation with embryo development in modified natural cycle IVF

    NARCIS (Netherlands)

    Nagy, R. A.; van Montfoort, A. P. A.; Dikkers, A.; van Echten-Arends, J.; Homminga, I.; Land, J. A.; Hoek, A.; Tietge, U. J. F.

    STUDY QUESTION: Are bile acids (BA) and their respective subspecies present in human follicular fluid (FF) and do they relate to embryo quality in modified natural cycle IVF (MNC-IVF)? SUMMARY ANSWER: BAconcentrations are 2-fold higher in follicular fluid than in serum and ursodeoxycholic acid

  20. Health-related quality of life in relation to gender and age in couples planning IVF treatment

    NARCIS (Netherlands)

    Fekkes, M.; Buitendijk, S.E.; Verrips, G.H.W.; Braat, D.D.M.; Brewaeys, A.M.A.; Dolfing, J.G.; Kortman, M.; Leerentveld, R.A.; Macklon, N.S.

    2003-01-01

    Background: Specific subgroups of people planning IVF might be at risk of having more psychological or health-related problems. Identification of subgroups at risk may better enable allocation of appropriate counselling. Methods: A group of 425 men and 447 women planning to undergo IVF treatment