Sigal Klipstein

Risk of death in pregnancy achieved through oocyte donation in patients with Turner syndrome: a national survey.

Abstract Objective To determine the risk of death in pregnant women with Turner syndrome who were treated with oocyte donation, and to ascertain the prevalence of preconception cardiac screening in these patients. Design Survey and literature review. Setting Academic infertility center. Participant(s) All 258 donor-egg programs in the 1997 Assisted Reproductive Technology Success Rates publication from the Society for Artificial Reproductive Technology were surveyed by fax or telephone. Main outcome measure(s) Death in pregnancy conceived through oocyte donation and proportion of patients prescreened with echocardiography. Result(s) One hundred thirty-four (52%) programs reported 146 Turner patients treated, resulting in 101 pregnancies. One patient died from aortic rupture while awaiting treatment; 72 (49.3%) patients were pre- screened with echocardiography. No deaths in pregnancy were reported. A literature review identified four case reports of Turner patients who died during pregnancy in the United States during the same time period. Conclusion(s) The maternal risk of death from rupture or dissection of the aorta in pregnancy may be 2% or higher. Patients with Turner syndrome have not been adequately screened with echocardiography before treatment. Specialists who treat patients with Turner syndrome need to be aware of their cardiac risk and its potential exacerbation from the increased cardiac demands of pregnancy.

Bilateral ectopic pregnancy after transfer of two embryos

OBJECTIVE To report a case of bilateral tubal ectopic pregnancy (EP) after the transfer of two embryos. DESIGN Case report. SETTING University hospital. PATIENT(S) A 43-year-old multigravida with bilateral tubal pregnancy. INTERVENTION(S) Operative laparoscopy with right linear salpingostomy and left salpingectomy. MAIN OUTCOME MEASURE(S) Laparoscopy revealed an unruptured left isthmic tubal EP and an unruptured right ampullary tubal EP. RESULT(S) Pathology confirmed immature placental villi in the right tube and placental tissue in the left tube. The patient was discharged home without incident on the day after surgery. CONCLUSION(S) This is a rare case of bilateral tubal pregnancy after the transfer of only two embryos. It is critical to perform a close inspection of the abdomen, pelvis, and contralateral tube after surgery for EP.

Gender bias in the disposition of frozen embryos

OBJECTIVE To examine the gender differences found among couples when choosing the disposition of their frozen embryos. DESIGN Retrospective chart review. SETTING University affiliated in vitro fertilization (IVF) center. PATIENTS Couples undergoing their first cycle of assisted reproductive technology (ART). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Choice of disposition of gametes and embryos. RESULT(S) Gender bias is found when couples choose the disposition of their frozen embryos, but not when they choose the disposition of their gametes. CONCLUSION(S) Gender bias was found in couples who made decisions regarding the disposition of their frozen embryos.

Transferring embryos with genetic anomalies detected in preimplantation testing: an Ethics Committee Opinion

Patient requests for transfer of embryos with genetic anomalies linked to serious health-affecting disorders detected in preimplantation testing are rare but do exist. This Opinion sets out the possible rationales for a providers decision to assist or decline to assist in such transfers. The Committee concludes in most clinical cases it is ethically permissible to assist or decline to assist in transferring such embryos. In circumstances in which a child is highly likely to be born with a life-threatening condition that causes severe and early debility with no possibility of reasonable function, provider transfer of such embryos is ethically problematic and highly discouraged.

Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion

This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. Providers ethically may treat women at elevated risk provided that they are carefully assessed; that specialists in their medical condition are consulted as appropriate; and that patients are fully informed about risks, benefits, and alternatives, including oocyte and embryo donation, use of a gestational surrogate, not undergoing fertility care, and adoption. Providers also may conclude that the risks are too high for them to treat particular patients ethically; such determinations must be made in a medically objective and unbiased manner and patients must be fully informed of the decision. Counseling of women who wish to initiate fertility treatment with underlying medical conditions that confer increased risk during treatment or pregnancy should incorporate the most current knowledge available, being cognizant of the womans personal determinants in relation to her reproductive desires. In such a way, both physician and patient will optimize decision making in an ethically sound, patient-supportive context.

Financial compensation of oocyte donors: an Ethics Committee opinion

Financial compensation of women donating oocytes for infertility therapy or for research is justified on ethical grounds and should acknowledge the time, inconvenience, and discomfort associated with screening, ovarian stimulation, and oocyte retrieval, and not vary according to the planned use of the oocytes, the number or quality of oocytes retrieved, the number or outcome of prior donation cycles, or the donors ethnic or other personal characteristics. This document replaces the document of the same name, last published in 2007 (Fertil Steril 2007;88:305-9).

Cross-border reproductive care: an Ethics Committee opinion

Cross-border reproductive care (CBRC) is a growing worldwide phenomenon, raising questions about why assisted reproductive technology (ART) patients travel abroad, what harms and benefits may result, and what duties health-care providers may have in advising and treating patients who travel for reproductive services. Cross-border care offers benefits and poses harms to ART stakeholders, including patients, offspring, providers, gamete donors, gestational carriers, and local populations in destination countries. This document replaces the previous document of the same name, last published in 2013 (Fertil Steril 2013;100:645-50).

Using family members as gamete donors or gestational carriers

The use of adult intrafamilial gamete donors and gestational surrogates is generally ethically acceptable when all participants are fully informed and counseled, but consanguineous arrangements or ones that simulate incestuous unions should be prohibited. Adult child-to-parent arrangements require caution in order to avoid coercion, and parent-to-adult child arrangements are acceptable in limited situations. Programs that choose to participate in intrafamilial arrangements should be prepared to spend additional time counseling participants and ensuring that they have made free, informed decisions. This document replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:797-803).

Child-rearing ability and the provision of fertility services: an Ethics Committee opinion

Fertility programs may withhold services from prospective patients on the basis of well-grounded reasons that those patients will be unable to provide minimally adequate or safe care for offspring. This document was reviewed and updated; this version replaces the previous version of this document, last published July 2013 (Fertil Steril 2013;100:50-53).

Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion

This document discusses the ethical implications of informing offspring about their conception using gamete or embryo donation. It replaces the 2013 ASRM Ethics Committee document of the same name (Fertil Steril 2013;100:45-9).