Susan Avery

Risks for transmission of hepatitis C virus during artificial insemination

OBJECTIVE To identify risks of hepatitis C virus transmission by semen from infected donors. DESIGN Case report. SETTING Assisted fertility clinic. PATIENTS Hepatitis C virus-infected semen donor and recipients of his donations. INTERVENTION Testing for hepatitis C virus by serology and polymerase chain reaction. MAIN OUTCOME MEASURES Detection of hepatitis C virus antibodies and viral RNA. RESULTS Hepatitis C virus RNA was detected in the semen donation before but not after purification; none of the recipients of the donors samples were found to have antibodies to hepatitis C virus. CONCLUSIONS Hepatitis C virus RNA can be detected in semen donations from infected donors; purification of donations before insemination significantly reduces the amount of viral RNA in the semen pellet.

Follicular aspiration using a syringe suction system may damage the zona pellucida

The incidence of the formation of cracks in the zona pellucida during aspiration was assessed by comparing two methods of aspirating follicular contents by suction: (a) mamuat aspiration by syringe and (b) mechanical aspiration by pump. Of 36 patients whose follicles were evcuated manually using syringes, 18 had at least one damaged cocyte. Of 38 other patients whose follicles were aspirated by pump, only one had an oocyte with a cracked zona pelluciada. Four patients had their oocytes aspirated by both syringe and pump. In all four the oocytes were intact when aspirated by the pump, but one oocyte was damaged in three of four cases when the follicles were aspirated using syringes.

Making the Best Use of Human Embryos

The best use of human embryos must be that which maximizes a patients chances of conceiving a normal singleton pregnancy and of giving birth to a healthy baby, with minimum risk to herself. Assisted conception treatment is no different from any other medical treatment, in that it should be tailored to the needs of individual patients, should do them no harm, and should maximize their chances of a successful outcome. In attempting to achieve this there are a number of issues that should be considered. It must be remembered that the objective is not to achieve any pregnancy at any cost; therefore the question of the number of embryos that should be replaced should be the first consideration. There are couples for whom a high-order multiple pregnancy would be far more disastrous that no pregnancy at all. There is also the question of supernumerary embryos and maximization of their use by cryopreservation. The number of embryos that can safely be transferred has been the subject of considerable debate. In some cases it is obvious—patients with a history of multiple pregnancy should clearly have the number of embryos replaced limited to one or two at the most. Replacement of two rather than three embryos has been shown to reduce the multiple pregnancy rate and improve perinatal outcome (1 -3). However, in older patients, particularly those over the age of